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Paper text:
the demand for tooth color restoration in front teeth as well as in the back teeth has increased in the recent years in pediatric patients . a great number of new materials such as composite resins , ceramic , zircon , or metal - ceramic crowns were introduced for use in cosmetic restorative treatment where substantial crown destruction exists .
it is known that composite resins are widely preferred as they allow for more conservative and direct placement compared to other materials , and as they enable the restoration to be completed in a single session . however , composite resin restorations have certain disadvantages as well as including the difficulty to form bonds while working in the oral cavity , sensitivity to moisture , microleakage , or marginal gap formation due to polymerization shrinkage
. the restoration of large cavities can be accomplished by extraoral polymerization of the resin composite or using the layering technique to avoid polymerization shrinkage and associated problems .
secondary polymerization by heat curing strengthens the physical properties of the material , the process that prevents the formation of monomers and associated problems that could arise .
enabling secondary polymerization by heat curing not only reinforces the physical properties of the material but also prevents residual monomer formation and problems which may arise correspondingly .
inlay / onlay systems using composite resin or ceramic blocks combine the advantages of the secondary polymerization method that employ light or heat curing .
our study evaluated the clinical performance of the indirect composite versus compomer resin placement in the restoration of primary teeth with extensive loss of tooth structure .
seventeen patients ( 7 girls and 10 boys ) were selected among the children between 4 and 8 years of age admitted to our clinic , who did not have any medical problems or bad habits , and who scored 3 or 4 according to the frankl behavior scale .
a total of 48 first and second primary molar teeth ( 33 located in the lower jaw and 15 in the upper jaw ) were included in the study .
clinical and radiographic evaluations were conducted on teeth for which an onlay restoration was planned using the indirect method .
radiographic images and intraoral photos of the relevant tooth / teeth were obtained from the patients selected for radiologic evaluation , and oral hygiene level ( oral hygiene index - simplified [ ohi - s ] ) and the depth of gingival sulcus were measured and recorded before onlay restoration and after treatment at control visits .
after the preparation of the cavity onlay , a cavity impression was created by taking the measurement using condensation - type silicone material .
the cavity was temporarily restored with noneugenol containing cement ( adhesor carbofine , spofa dental , jicin , czech republic ) .
paul , mn , usa ) or dyract extra ( dentsply detrey konstanz , germany ) composite material was placed using the layered technique with a layer thickness of 2 mm , and each layer was light - cured for 20 s ( blue swan , dentanet , ankara , turkey ) .
restorations were placed in lumamat 100 ( ivoclar vivadent , germany ) furnace along with plaster models to heat- and light - cure composite resin restoration and to light - cure compomer restorations .
multilink self - etch resin cement ( ivoclar vivadent , germany ) was used to attach restorations in accordance with the recommendations of the manufacturer .
the excess cement was removed . to evaluate the clinical performance of restorations according to the usphs criteria ,
patients were scheduled for control visits at 3-month intervals after the treatment at baseline ( post polish ) and at 1- , 3- , 6- , 9- , 12- , and 15-month recall visits . the statistical package for the social sciences software version 18.0 ; spss inc inc . , chicago , illinoise software package was used in the statistical analysis of the data .
whitney u - test was employed to compare the materials at each time point since the data regarding ohi - s and the depth of gingival sulcus did not meet the preconditions of parametric tests .
meier survival analysis was used to evaluate the estimated survival of materials and to determine the difference between materials in terms of durability .
a total of 17 children ( 7 girls and 10 boys ) were included in the study with a mean age of 6.86  0.71 years ( range : 48 years ) .
the distribution of restoration according to teeth and jaw is presented in table 1 . the distribution of restoration according to the teeth and jaw the longevity of dental restoration implies complete or partial retention in the mouth .
failed restorations by gender , tooth type and age , and the longevity in the mouth are shown in table 2 .
the failed restorations depending on gender , tooth type and age , and the longevity in the mouth the restorative materials did not differ in terms of anatomic structure , color match , marginal discoloration , secondary caries , and surface structure ( p > 0.005 ) .
clinical performance of restorations ( united states public health service criteria , modified ryge criteria ) the data on oral hygiene were compared using the friedman test .
the treatment options for deep tooth decay extending to the pulp and with a substantial loss in tooth structure are limited compared to traditional restorative treatments .
various studies indicate that children between the age of 4 and 12 years , and their parents prefer restorations with better cosmetic appearance .
it is suggested that the success of tooth - colored filling materials in pedodontics is based on the degree of the polymerization of resin composites . in direct placements ,
light energy is absorbed by the upper layer , creating layers of unpolymerized monomers as the restoration deepens , which affects the quality of restoration negatively , and the monomers also cause undesired reactions in the pulp .
therefore , to overcome these problems , extraoral polymerization using secondary polymerization methods were proposed .
the effects of secondary polymerization by light - curing on composite resins have been studied by various researchers . in the present study ,
secondary polymerization was carried out using a  lumamat 100  furnace which is above the glass recycling level . in the restoration of primary teeth ,
abrasion characteristics of restorative material are desired to be close to the abrasion characteristics of the primary teeth .
the use of hybrid resin composites was recommended in a study evaluating the placement of block crowns prepared to restore primary molar teeth .
the clinical success of onlay resin composite with respect to resin compomer restorations was evaluated according to usphs criteria .
the clinical success of onlay restorations was determined at the baseline and at 3-month periods . at the end of 15 months
, the success rates in all criteria except longevity and marginal discoloration were 100% for both materials , and there was no difference between the materials .
the longevity of restoration was 78% and 96% , and marginal discoloration was 100% and 95% for the compomer and the resin composite , respectively .
although marginal discoloration was observed only in a single resin composite restoration , the failure rate appears to be high due to the small number of patients .
compomer restorations achieved a higher success rate compared to resin composite restorations in terms of marginal discoloration .
the findings of the study suggest that the indirect method proves successful in terms of marginal adaptation and color match .
material , dentist 's technique , and experience were reported to cause a decline in clinical performance by adhesion . during the 15-month follow - up , in terms of the development of secondary decays ,
the use of the indirect method eliminated the requirement to use matrix band , provided convenience by reducing the total procedure time , and ensured almost perfect marginal adaptation .
it is reported that secondary caries is the first cause of the renewal of restoration , which is followed by fractures or total loss of restoration .
studies evaluating the clinical success of direct restoration of the posterior primary teeth indicated a success rate of 85.8%100% for resin composites and 75%100% for resin compomers in terms of the integrity of restoration . of 48 restorations performed in this study ,
6 ( 5 compomer , 1 composite ) were considered unsuccessful in terms of retention .
the fracture of restoration or secondary caries was not observed in any of the lost restorations .
the finding that restorations were often lost from the first molar teeth could be attributed to low restoration and enamel thickness .
it should also be noted that oral hygiene training repeated at each quarterly visit , along with the positive motivation caused by better cosmetic appearance may have contributed to the improvement in oral hygiene . while an increase was observed in the depth of gingival sulcus , the values were within normal ranges and close to the values observed in the control group included in the previous study .
the evaluation of indirect onlay restorations performed in the current study did not reveal any significant difference between restorative materials . using the indirect method ,
dyract extra yielded a success rate of 78%100% , whereas z250 yielded 96%100% , respectively .
in this in vivo study , the rate of overall success and survival of restorations were high .
the high survival rate of restorations in the current study is the result of almost perfect extraoral preparation of the forms , beveling and occlusal loading locations of restorations using the indirect placement technique , as well as the secondary polymerization applied to improve physical and cosmetic characteristics .
objective : the aim of this study was to evaluate indirect compomer and composite resin onlay restorations of severely damaged primary molars in vivo.materials and methods : at the study , 48 restorations , in seven girls and ten boys totally 17 patients aged 48 , was evaluated clinically with using usphs criteria for 15 months.results:the study results revealed that the clinical success rate of compomer and composite onlay restorations was 79% and 96% , respectively . 
 no significant differences were found statistically between the materials.conclusions:in the children severely damaged primary molars , onlays are usually worked with an indirect technique in clinics . 
 one of the advantages of indirect technique is being most similar to its original form morphologically .