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UNIVERSITATEADEMEDICINIFARMACIEIULIUHAIEGANUCLUJNAPOCA

FACULTATEADEMEDICINDENTAR

TEZDEDOCTORAT
Utilizareainlayurilornafeciunilecoronare
Rezumat

Doctorand,
AndradaPOPOVICI(cs.SOANC)

Conductortiinific,
Prof.Dr.DorinBORZEA

2009

CUPRINS
INTRODUCERE.................................................................................................................................................
PARTEAIA.STADIULACTUALALCUNOATERIIINDOMENIULUTILIZARIIMATERIALELORCOMPOZITE
INSTOMATOLOGIARESTAURATIV..............................................................................................................
CAPITOLUL1.CONCEPTEACTUALEPRIVINDTEHNICILEDERESTAURAREADINILORPOSTERIORICU
RINICOMPOZITE.........................................................................................................................................

1.1RESTAURAREADINILORPOSTERIORIPRINMETODADIRECTCUMATERIALECOMPOZITE..........

1.1.1.Compoziiarinilorcompozitepentrurestauraredirect.....................................................

1.1.2.Tipuriderinicompoziteutilizatentehnicadirect............................................................

1.1.3.Caracteristicilerinilorcompoziteutilizatentehnicadirect..............................................

1.1.4.Indicaiilerestaurrilorcurinicompoziteprintehnicadirect............................................

1.1.5.Avantajele idezavantajeleutilizriirinilorcompozite........................................................

1.2.RESTAURAREADINILORPOSTERIORIPRINMETODAINDIRECTCURINICOMPOZITE..............

1.2.1.Tipuriderestaurriindirecteintracoronare...........................................................................

1.2.2.Tehniciderealizareainlayurilorcompozite..........................................................................

1.2.3.Caracteristicilecompozitelordestinatetehniciiindirecte.....................................................

1.2.4.Sistemeactualedecompozitepentrurestaurriindirecte....................................................

1.2.5Longevitatearestaurrilorcompoziteindirecte.....................................................................

1.3.SUPERIORITATEARESTAURRILORINDIRECTEFADETEHNICADIRECT...................................
CAPITOLUL2.FACTORICAREINFLUENEAZFIABILITATEAINLAYURILORCOMPOZITE.............................

2.1.ROLULACURATEIINETAPELEDEREALIZAREAINLAYURILORCOMPOZITE................................

2.2.ROLULETAPEIDECIMENTARENASIGURAREASUCCESULUIINLAYURILORCOMPOZITE.............

2.2.1.Concepteactualeprivindadeziunealaesuturileduredentare...........................................

2.2.2.Cimenturirinrolulnadaptareamarginalidurabilitateainlayurilor..........................
PARTEAAIIA.CONTRIBUIIPERSONALEPRIVINDUTILIZAREAINLAYURILORCOMPOZITEPENTRU
RESTAURAREAMORFOFUNCIONALADINILORPOSTERIORI..............................................................
Justificareatemeidecercetare...........................................................................................................

CAPITOLUL3.PROTOCOLULCLINICITEHNICDEREALIZAREAINLAYURILORCOMPOZITE.......................
CAPITOLUL4.STUDIULPROPRIETILORMECANICEALEUNORMATERIALECOMPOZITEPENTRU
RESTAURRIINDIRECTE................................................................................................................................

4.1.Notiuniintroductive.........................................................................................................................

4.1.1.PrezentareageneralacompozituluidelaboratorBarodent................................................

4.1.2.Aspecteprivindproprietilemecanicealerinilorcompozite............................................

4.2.Materialimetod..........................................................................................................................

4.3.Rezultate.........................................................................................................................................

4.4.Discuii.............................................................................................................................................

4.5.Concluzii.........................................................................................................................................
CAPITOLUL5.STUDIULINVITROALABSORBIEIDEAPIALSOLUBILITIIUNORMATERIALE
COMPOZITEPENTRURESTAURRIINDIRECTE..............................................................................................

5.1.Notiuniintroductive........................................................................................................................

5.2.Materialimetod..........................................................................................................................

5.3.Rezultate..........................................................................................................................................

5.4.Discuii.............................................................................................................................................
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5.5.Concluzii...........................................................................................................................................
CAPITOLUL6.STUDIULINVITROASUPRASTRUCTURIIIADEZIUNIIUNUIMATERIALCOMPOZITUTILIZAT
PENTRURESTAURRIINDIRECTE...................................................................................................................

6.1.Notiuniintroductive.........................................................................................................................

6.2.Materialimetod...........................................................................................................................

6.3.Rezultate.........................................................................................................................................

6.4.Discuii.............................................................................................................................................

6.5.Concluzii..........................................................................................................................................
CAPITOLUL7.EVALUAREAADAPTRIIMARGINALEAINLAYURILORCOMPOZITEPRINMICROSCOPIE
ELECTRONICDEBALEIAJ..............................................................................................................................

7.1.Notiuniintroductive.........................................................................................................................

7.2.Materialimetod...........................................................................................................................

7.3.Rezultate..........................................................................................................................................

7.4.Discuii.............................................................................................................................................

7.5.Concluzii...........................................................................................................................................
CAPITOLUL8.STUDIULINVITROASUPRAMICROINFILTRAIEIMARGINALEPENTRUINLAYURI
COMPOZITEUTILIZATENRESTAURAREAMORFOFUNCIONALADINILORPOSTERIORI........................

8.1.Notiuniintroductive........................................................................................................................

8.2.Materialeutilizate...........................................................................................................................

8.3.Metodologiedelucru......................................................................................................................

8.3.1.Realizarearestaurarilorindirecte.......................................................................................

8.3.1.1.Pregtireacavitilorpentruinlayuricompozite.................................................

8.3.1.2.Protocoluldelaboratorpentrurealizarearestaurrilorindirecte........................

a)ProtocolulderealizareainlayurilorGradia...............................................................

b)ProtocolulderealizareainlayurilorBarodent...........................................................

8.3.1.3.Protocoluldefixareainlayurilorcompozite........................................................

a)ProtocoluldeutilizareacimentuluirinGCem......................................................

b)ProtocoluldeutilizareasistemuluiadezivExciteDSC cimentrinVariolinkII......

c)ProtocoluldeutilizareasistemuluiadezivOptibondFL cimentrinVariolinkII....

8.3.2.Realizarearestaurarilordirecte...........................................................................................

8.3.2.1.Pregtireacavitilorpentrurestaurrilecompozitedirecte................................

8.3.2.2.Protocolulderealizarearestaurrilordirecte.....................................................

a)ProtocoluldeutilizareasistemuluiadezivGBond.............................................

b)ProtocoluldeutilizareacompozituluiGradiaDirectX.......................................

8.3.3.Investigareaprobelor.........................................................................................................

8.4.Rezultate..........................................................................................................................................

8.5.Discuii.............................................................................................................................................

8.6.Concluzii...........................................................................................................................................
CAPITOLUL9.STUDIULCOMPARATIVALPERFORMANELORCLINICEALEINLAYURILORCOMPOZITE.....

9.1.Notiuniintroductive..........................................................................................................................

9.2.Materialimetod...........................................................................................................................

9.3.Rezultate...........................................................................................................................................

9.4.Discuii..............................................................................................................................................

9.5.Concluzii...........................................................................................................................................
CAPITOLUL10.CONCLUZIIGENERALE...........................................................................................................
REFERINEBIBLIOGRAFICE............................................................................................................................

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Cuvintecheie:Rinicompozitedelaborator;Inlayuricompozite;Proprietimecaniceifizice;Adeziune;
Adaptaremarginal;Microinfiltraiemarginal.

Teza de doctoratUtilizarea inlayurilor n afeciunile coronare este structurat n dou pri


importante, i anume, PARTEA I care sistematizeaz date din literatura de specialitate privind utilizarea
materialelor compozite in stomatologia restaurativ, i respectiv PARTEA A IIA care cuprinde contribuia
personal, constnd n o serie de cercetri experimentale privind utilizarea inlayurilor compozite n
restaurareadinilorposteriori.
2

Principaleleobiectivealetezeidedoctorataufost:
Elaborareaprotocoluluiclinicotehnicderealizareideaplicareainlayurilorcompozitecuscopulobinerii
unorrestaurrifiabileilongevive.
Evaluarea potenialului de utilizare a unui material compozit de provenien autohton pentru restaurari
detipinlay,precumiaunorsistemeadeziveexperimentalepentrucimentareaacestora.
Apreciereacalitiirestaurativeainlayurilorcompoziterealizatecumaterialulautohton,ncomparaiecu
altematerialecomerciale.
Evaluarea calitilor clinice ale inlayurilor compozite, ca alternativ superioar n restaurarea dinilor
posteriori.

Majoritatea cercetrilor experimentale sa desfurat n cadrul Facultii de Medicin Dentar a
Universitii de Medicin i Farmacie Iuliu Haieganu, ClujNapoca, cu sprijinul Departamentului de
CompozitePolimericedinInstitutuldeCercetrinChimieRalucaRipan(ICCRR)ClujNapoca.Opartedintre
cercetrilecucaracterfundamentalsauderulatncadrulunuistagiudeperfecionarencercetaredesfurat
la Facultatea de Odontologie a Universitii Victor Segalen, Bordeaux 2, Frana, beneficiind i de sprijinul
materialalfirmeiGCFrancesas(Frana).

Teza este structurat n 10 capitole la care se adaug introducerea si referinele bibliografice (307
citaiinordineaapariieintext).
Capitolul1Concepteactualeprivindtehnicilederestaurarealedinilorposterioricurinicompozite
Capitolul2Factoricareinflueneazfiabilitateainlayurilorcompozite
Capitolul 3 Protocolul clinic i tehnic de realizare a inlayurilor compozite descrie succint etapele clinice i
tehnice de realizare a inlayurilor compozite prin tehnica indirect, subliniind importana respectrii cu
stricteeapailorcaretrebuieurmaipentrusuccesulacestuitipderestaurare.
Capitolul4Studiulproprietilormecanicealeunormaterialecompozitepentrurestaurriindirecte.
Obiectiv. Scopul studiului a fost prezentarea unor caracteristici fizicochimice ale unui material compozit de
laborator, Barodent, produs de ICCRR destinat realizrii inlayurilor prin tehnica indirect precum i
evaluarea proprietilor mecanice ale materialului Barodent n comparaie cu alte compozite de laborator
cunoscutepepiaastomatologic.
Material i metod. Principalele caracteristici ale materialului Barodent sunt prezentate n tabelul 1. Sa
investigat rezistena la flexiune, compresiune i compresiune diametral a trei materiale compozite utilizate
pentrufabricareadeinlayuriianumeBarodent,Gradia/GCCorporation,BelleGlassNG/KerrCorporation.
Tabelul1.CompoziiamaterialuluicompozitBarodent
Productor
Matriceorganic
Umpluturanorganic
Componente
Sticladebariu
ICCRR, Rinbazatnspecial 50%sticldebariu;20% 45%SiO2;17%B2O3;10%Al2O3;
Romania
peBisGMA
silicecoloidal;30%cuar 20%BaO;8%NaFCaF2
Sau realizat cte 10 specimene din fiecare material pentru fiecare din cele trei teste efectuate
folosind matrie speciale (Fig.1). Pentru realizarea specimenelor i testarea proprietilor materialelor, sau
respectatinstruciunileproductorilorinormelestandarddindomeniu.
Datele au fost apoi prelucrate statistic folosind testul Anova si
PostHocBonferonnipentrurezistenalaflexiune(FS)itestulMann
Whitney pentru rezistena la compresiune(CS) i compresiune
diametral (DTS). Pragul de semnificaie a fost 0,05. Pentru
prelucrareastatisticsauutilizatsofturileSPSS13.0siStatistica7.0.
Rezultate i discuii. Datele testelor mecanice (FS, CS, DTS) au fost

reprezentate grafic (Fig.2) iar valoarea medie (medie), deviaia


Fig.1Specimenepentrutestulla standard(DS)ipraguldesemnificaiepentrufiecarematerialtestat
flexiune
aufostsistematizateintabele.
StudiuldefaaartatcrezistenlaflexiuneafostmaimarepentrucompozitulBelleGlass(84,58MPa),
urmatapoidecompozitulBarodent(63,16MPa)icompozitulGradia(61,68MPa),diferenelentreceletrei
materialefiindsemnificativestatistic(pANOVA=0,0003).Pentrutestulrezisteneilacompresiune,celemai
3

marivaloriaufostobinutepentrucompozitulBelleGlass(241,64MPa)icompozitulGradia(226,11MPa),
fr s existe diferene semnificative statistic ntre cele dou materiale (p=0,48). Valorile medii pentru
rezistenalacompresiunediametralaufostsituatentre37,23MPa(BelleGlass)i43,21MPa(Gradia).
Compozitul Barodent a prezentat o valoare intermediar
ntre cele dou compozite cunoscute. Diferene statistic
semnificative au fost ntre Barodent i BelleGlass (p=0,04).
DeiBelleGlassaavutceamaimicvaloarearezisteneila
compresiune diametral, ntre Gradia i BelleGlass nu sau
observat diferene statistic semnificative (p=0,06) datorit
deviaiei standard fa de medie care a fost mai mare
pentru BelleGlass (5,94 pentru BelleGlass, respectiv 5,71
pentru Gradia). Proprietile mecanice ale materialelor
Fig.2Rezultateletestelormecanicepentru compozite depind de coninutul, tipul de umplutur
materialeleaflatenstudiu
anorganicidecompoziiamatriciiorganice.
Concluzii.Cunoatereadectremedicaproprietilormecanicealematerialelorderestaurareiinterpretarea
comportamentuluiacestorancondiiidestressesteimportantpentrunelegereacomportamentullorclinic
ipentrureuitatratamentuluicurestaurriindirecte.MaterialulcompozitBarodentareproprietimecanice
asemntoarecucelealematerialelordecontrol,elputndrezistaforelormasticatoriifuncionale.
Capitolul5.Studiulinvitroalabsorbieideapialsolubilitiiunormaterialecompozitepentrurestaurri
indirecte.
Obiectiv. Scopul studiului a fost determinarea absorbiei i solubilitii n ap a materialului Barodent, n
comparaie cu materialele Gradia/GC Corp i BelleGlass NG/Kerr Corp, precum i evaluarea efectului
postpolimerizriiasupraacestorproprieti.
Material i metod. Pentru fiecare material sau realizat cte 12 specimene sub form de discuri. Jumtate
dintre specimene au fost postpolimerizate conform recomandrilor productorilor (Grup A), iar cealalt
jumtate a rmas fotopolimerizat (Grup B). Specimenele au fost imersate n ap timp de 7 zile, ele fiind
cntritezilniclaintervalestabilitedetimp.Saucalculatabsorbiadeapisolubilitatea,iardateleaufost
prelucrate statistic (SPSS, Statistica 7.0) folosind testele KruskallWallis i MannWhitney. Sau nregistrat
media,DSi praguldesemnificaie (p)pentruabsorbiadeap isolubilitateanap pentrufiecarezi ila
sfritulperioadeidetestare,pentrufiecaregrup.Praguldesemnificaieafost0,05.
Rezultateidiscuii.Pentruabsorbiadeapsaconstatatc,materialulBarodentaavutvalorisemnificativ
maimarifadeGradiairespectivBelleGlass(p=0,002).Barodentaabsorbitaproapede3orimaimultap
fadeGradiaiBelleGlass(Fig.3a)ntrecarenuauexistatdiferenesemnificative(p=0,13).Solubilitateaafost
diferitpentruspecimeneledinambelegrupuri.
Astfel, BelleGlass a avutcea mai mic valoare, urmat apoi de Gradia i Barodent (Fig.3b) existnd diferene
statistice ntre ele (p=0,002). Toate materialele au un anumit grad de solubilizare, ns pierderea de mas a
fostmascatdeabsorbiadeapmultmaimare.

b)

a)
Fig.3Graficalvalorilorabsobieideap(a)isolubilitii(b)pentruspecimenelepostpolimerizate
Comparnd cele dou grupuri aflate n studiu (A i B), nu au fost diferene semnificative n ceea ce
privete absorbia de ap (p>0,05), n schimb solubilitatea a fost diferit (p=0,002). Studiul a artat c
absorbia de ap i solubilitatea n ap a compozitelor pentru restaurri indirecte depinde de compoziia
materialelor,maiexactdenaturaihidrofiliamatriciiorganiceicaracteristicileumpluturiianorganice.
4

Concluzii.Avndnvederecntreceledougrupurinuaufostdiferenesemnificativedeabsorbiedeap,se
poate presupune c aceasta nu a fost influenat de postpolimerizare. Materialul autohton Barodent i cele
controlauprezentatabsorbiedeapisolubilitate,nsvalorilemediicorespundspecificaieiISO4049:2000:
absorbiedeap<40g/mm3isolubilitatenap<7,5g/mm3(dup7ziledeimersienap).
Capitolul 6. Studiul in vitro asupra structurii i adeziunii unui material compozit utilizat pentru restaurri
indirecte.
Obiectiv.StudiulaurmritcapacitateacompozituluiBarodentdeafiutilizatpentrurestaurriindirectedetip
inlay,prinevaluareastructuriimaterialuluiiainterfeeiadezivecreatedeacestanraportcuesuturiledure
dentare.InvestigareasafcutcuajutorulmicroscopieielectronicedebaleiajiamicroanalizeiderazeX.
Materialimetod.Sauutilizat40demolarideminte,integrilanivelulcroraaufostpreparatecavitide
clasaIIpentruinlayuri.Diniiaufostmpriindougrupuridecte20dedinifiecareiaufostrestaurai
cuinlayuricompozite.PrimulgrupafostrestauratfolosindmaterialulcompozitBarodent/ICCRR,iarpentru
comparaie,Grupul2afostrestauratcuunmaterialcompozitdepepiaastomatologic,ianume,BelleGlass
NG/Kerr Corp. Dinii astfel restaurai au fost secionai la microtom obinnduse specimene de 1,5 mm
grosime.Toatespecimeneleaufostanalizateprinmicroscopieelectronicdebaleiaj(SEM)iprinmicroanaliz
elemental(EDX)folosindmicroscopulPhilipsL20.
Rezultate si discuii. Spectrul EDX a relevat compoziia elemental i structura compozitului Barodent cu
distribuiaelementelorcaracteristice,attlanivelulinlayuluictialesuturilordentare(Fig.4).Inacestcaz,
imaginileSEMauartatprezenauneiinterfeecontinuentresubstratuldurdentaricimentulrin,ide
asemeneaoadaptarebunntrecimentulriniinlayulcompozit.

a)

b)
Fig.4ImaginimicroscopicepentruinlayurileBarodent:Microanalizaelemental(a),Microfotografie
SEM(b),undeCIinlaycompozit,RCcimentrin,Ddentin
Concluzii. Analiza prin microscopie electronic de baleiaj i microanaliza elemental au relevat c materialul
compozit autohton n combinaie cu cimentul i sistemul adeziv corespunztor permit o adaptare intern i
marginal corespunztoare a inlayurilor la esuturile dentare, reducnd riscul microinfiltraiei marginale i
sensibilitiipostoperatoriiulterioare.
Capitolul7.Evaluareaadaptriimarginaleainlayurilorcompoziteprinmicroscopieelectronicdebaleiaj.
Obiectiv.StudiulaavutcascopevaluareaadaptriimarginaleiainterfeeiadeziveainlayurilorBarodent
fixate cu diferite sisteme adezive. Calitatea interfeei dinteciment rininlay a fost investigat cu ajutorul
microscopieielectronicedebaleiaj.
Materialsimetod.Sauutilizat60demolarideminteintegri,lanivelulcrorasaupreparatcavitiproximo
ocluzale,careulterioraufostrestauratecuinlayuriBarodentntehnicaindirect.Saufolositdousisteme
adeziveexperimentale,detipselfetch(autogravante)cuumpluturdehidroxiapatit(AD3A,AD3B/ICCRR)
care au fost comparate att ntre ele ct i cu ali adezivi deja cunoscui (OptiBond Solo Plus SelfEtch
Adhesive System, OptiBond AllInOne/Kerr Corp). Pentru fixarea inlayurilor sa utilizat un ciment rin
NX3/Kerr n combinaie cu unul din sistemele adezive. Dinii restaurai au fost nglobai n rin acrilic i
secionaimeziodistal.Sauobinutspecimenede1,5mmgrosime,careaufostanalizateprin
microscopieelectronicdebaleiajladiferitemriri.
Rezultate si discuii. Imaginile SEM au relevat calitatea interfeelor adezive ntre substratul dentinarciment
rininlay,ianumecontinuitateaiuniformitateastratuluiadeziv,prezenagolurilordeaerdealungul
interfeeiprecumiformareastratuluihibrid(Fig.5).
5

a)

b)

Fig.5.ImaginiSEMpentruinterfeelerealizatedeadeziviiautogravaniautohtoniAD3A,ndouetape(a)
iAD3Bntroetap(b),unde:RCcimentrin,HLstrathibrid,Ddentin,sgeataprezenagolurilor
Pentru toate eantioanele, sistemele adezive autogravante n dou etape au reuit formarea unor
straturi hibride mai groase dect cele ntro etap. Adezivii autogravani experimentali cu hidroxiapatit n
compoziie, au manifestat o adeziune bun la substratul dentar, formnd stratul hibrid i o interfa dinte
ciment rin uniform, cu o bun compatibilitate cu cimentul rin utilizat pentru fixarea inlayurilor
compozite.Rezultatelesuntcomparabilecuceleobinutedeadeziviicomerciali,folosiidreptcontrol.
Concluzii. Adezivii autogravani asigur o adeziune imediat, bun la esuturile dentare, dar concentraia
crescutdemonomeriaciziistratulhibridsubireformatarputeaaveaoinfluennegativasuprastabilitii
adeziunii n timp i asupra rezistenei acesteia la condiiile mediului oral. Se impune evaluarea eficienei
adezivilorautogravaniiadurabilitiiprinstudiiinvivo.
Capitolul 8. Studiul in vitro asupra microinfiltraiei marginale pentru inlayuri compozite utilizate n
restaurareamorfofuncionaladinilorposteriori.
Obiectiv. Studiul a urmrit aprecierea cantitativ a microinfiltraiei marginale pentru inlayuri compozite i
restaurridirecte,ncorelaiecusistemeleadezive,cimenturilerin,materialelederestaurareitehnicade
restaurareutilizate.
Materialsimetod.Sauutilizat90demolarideminteextrai,integri,careaufostmpriin9grupuriacte
10 dini. La nivelul fiecrui dinte sau realizat cte dou caviti proximoocluzale pentru inlayuri, respectiv
restaurridirecte.Pentrurestaurareadinilorsauutilizat3materialecompoziteianumeBarodent/ICCRR,
respectiv Gradia/GC Corp pentru inlayuri i Gradia Direct X/GC Corp pentru restaurrile directe. Sau
realizatcte60derestaurricufiecarematerialutilizndusediferitesistemeadeziveicimenturirin.
Sau descris caracteristicile materialelor de restaurare, ale cimenturilor rin i sistemelor adezive
utilizate i sau prezentat succint etapele de preparare a cavitilor, procedura de realizare a restaurrilor
directeiinlayurilor(Fig.6).Sadescrisprotocoluldefixareainlayurilorcompozite,fiindprezentatpelarg
metodologiadeutilizareacimenturilorriniasistemeloradeziveutilizatenstudiu.Astfelaufostdescrise
protocoalele de utilizare ale: a)cimentului rin GCem (GC Corp); b) sistemului adeziv Excite DSC+ciment
rin Variolink II (IvoclarVivadent); c)sistemului adeziv Optibond FL(Kerr)+ciment rin Variolink II; d)
sistemuluiadezivGBond(GCCorp).

Fig.6Etapederealizareainlayurilorcompozite:cavitilepreparate,inlayurilepemodel,adaptareala
niveluldinilor
Diniirestauraiaufosttermociclai(2000cicluri)latemperaturidiferite(5Ci55C).Diniiaufost
imersainsoluiedealbastrudemetilen2%timpde24ore,apoisecionainsensmeziodistalobinnduse
oseciunede1mmgrosimeprinmijloculrestaurrilor.
Evaluareamicroinfiltraieimarginaleacolorantuluisafcutcuajutorulunuimicroscopoptic(Olympus
KC301,OlympusInc.isoftulQuickPhotoMicro2.2).Sauurmritvalorilemicroinfiltraieimarginalelanivelul
dentinei i smalului care au fost raportate la lungimea interfeei, reprezentnd proporia microinfiltraiei n
6

dentin, respectiv n smal. Datele obinute au fost prelucrate statistic, utiliznduse testele KruskallWallis,
MannWhitneyirespectiv,Wilcoxon.Dateleaufostreprezentategrafictipboxplot(mediana,percentile
25%75%, minmax) i tip line. Calculele statistice au fost efectuate cu ajutorul aplicaiilor SPSS 13.0,
Statistica7.0iMicrosoftEXCEL.Niveluldesemnificaieafost0,05.
Rezultateidiscuii.Analizaprinmicroscopieopticiprelucrareastatisticarezultatelorapermisaprecierea
cantitativ a microinfiltraiei marginale pentru inlayuri i restaurri directe, n funcie de diferitele sisteme
adezive/cimenturirinsidematerialelederestaurareutilizate.Microinfiltraiamarginalafostprezentla
majoritatea restaurrilor, att la nivelul limitei preparaiei aflat n smal ct i la nivelul limitei situat n
dentin.(Fig.7)

b)

a)
Fig.7.Imaginimicroscopieopticcumsurareamicroinfiltraiei,lungimiiinterfeeiadezivepentruinlayuri
compoziteGradia(a),respectivBarodent(b)

1,2

1,2

1,0

1,0

Microleakage length/interface length

Microleakage length/interface length

Prin compararea grupurilor care au utilizat acelai material compozit, sau observat diferene
semnificative (p<0,05), att la nivelul dentinei (p=0,00001 pentru inlayurile Gradia; p=0,0002 pentru
Barodent;p=0,00001pentrurestaurridirectecuGradiaDirectX),ctilanivelulsmalului(p=0,0004pentru
inlayurileGradia;p=0,000001pentruinlayurileBarodent;p=0,000001pentrurestaurriledirecte)(Fig.8).
Pentruaevaluainfluenamaterialelorutilizatenfixareainlayurilor(cimentrinsistemadeziv),sa
folosituncimentrinautoadeziv(GCem)iuncimentrindualpolimerizabilVariolinkII/IvoclarVivadent
n combinaie cu sistemele adezive clasice Excite DSC / IvoclarVivadent i Optibond FL/Kerr. Inlayurile
compoziteauprezentatoadaptaremarginalbunnprivinamicroinfiltraieilaniveluldentineiismalului,
comparativcutehniciledirecte.Inlayurilecompozitefixatecusistemeadezivetipgravaresplareauavuto
microinfiltraiemarginalmaimiclaniveluldentineidectcelefixatecusistemeautoadezive.

0,8

0,6

0,4

0,2

0,0

0,8

0,6

0,4

0,2

0,0
dentin
enamel

-0,2

dentin
enamel

-0,2

b)

a)
Fig.8.Reprezentareagrafic(mediana,percentile2575%,valorileminimeimaxime)aproporiei
microinfiltraieindentin,respectivsmalpentruinlayurileBarodent(a)iGradia(b)
Group 2

Group 6

Group 7

Group 4

Group 5

Group 1

ntreinlayurilecompozitefixatecusistemeadeziveclasicenuaufostdiferenestatisticesemnificative
privind proporia microinfiltraiei n dentin (p=0,37 pentru inlayurile Gradia, i p=0,76 pentru inlayurile
Barodent). Restaurrile directe realizate cu aceleai sisteme adezive de tip gravaresplare au avut o
microinfiltraie semnificativ mai mic fa de cele realizate cu un adeziv autogravant (p=0,00001), iar ntre
restaurriledirecterealizatecusistemeleadeziveclasicenuaufostdiferenesemnificative(p=0,40).
Concluzii. Studiul a relevat un anumit grad de microinfiltraie marginalpentru toate restaurrile realizate,
inlayuricompozitesauobturaiidirecte.Proporiamicroinfiltraieimarginaleafostsemnificativmaimicla
nivelulsmaluluicomparativcudentina(pentrutoateeantioanele).InlayurileBarodentiGradiaaucondusla
rezultateoptimeprivindmicroinfiltraia,subliniindsuperioritateatehniciifaderestaurrileprinmetoda
direct.Adaptarealormarginaldepindensdecalitateacimentuluiiadezivilorutilizaipentrufixare.
7

Capitolul9.Studiulcomparativalperformanelorclinicealeinlayurilorcompozite
Obiectiv.Studiulaurmritevaluareaperformanelorclinicentimp,pentrudousistemecompoziteindicate
pentru restaurri indirecte (BelleGlass/ Kerr, respectiv Gradia/GC) pentru a evidenia calitile inlayurilor
compozitenrefacereamorfofuncionaladinilorposteriori.
Materialimetod.Sauaplicat72deinlayuricompozitelanivelulmolarilor(60depacieni)pentrunlocuirea
unorrestaurrinecorespunztoaresautratamentulunorleziunicarioase.Alegereapacienilorsabazatpeo
seriedecriteriigeneraleilocale.Sauaplicatcte36inlayuridinceledoumaterialemenionate.nfuncie
desituaiaclinicexistent,sauaplicatunulsaudouinlayuriperpacient.
Inlayurilecompoziteaufostrealizateconforminstruciunilordatedeproductori.Pentrucimentares
a utilizat cimentul rin Variolink II/IvoclarVivadent n combinaie cu sistemul adeziv Excite DSC/Ivoclar
Vivadent, conform instruciunilor date de productori. Inlayurile compozite au fost evaluate dup criteriile
USPHS modificate pentru forma anatomic, adaptare marginal, adaptarea culorii, coloraia marginal, carii
secundare,acordndusescorurilafiecareevaluare.Apreciereaclinicainlayurilorsafcutnziuaaplicrii
restaurrilor(ziua0),iarreevalurilesaufcutla1lun,la6luni,1ani2ani.
DateleaufostprelucratestatisticprintestulFisherexacticurbeleKaplanMeierdesupravieuire.
Niveluldesemnificaieafost0,05,iarpentruprelucraresauutilizatsofturileSPSSiStatistica7.0.
Rezultateidiscuii.Peparcursulcelor2anidezilenusaunregistratpierderidinevidenalepacienilori
nicipierderialerestaurrilorprinfractursaucariisecundaremarginale.Toaterestaurrileauprimitscoruri
Alfa (A) sau Bravo (B), considerate clinic acceptabile. (Fig.9) Analiza statistic nu a relevat diferene
semnificativentreceledougrupuriinvestigate(p>0,05).

a)

b)
Fig.9RestaurarecuinlaycompozitGradia:situaiainiial(a),situaiala2ani(b)

Dup2anidelaaplicare,nusaobservatapariiacariilorsecundaremarginale,inicifracturainlay
urilorcompoziteaplicate,poateidatoritperioadeirelativscurtencaresaefectuatevaluareaclinic.Cele
doumaterialeaudatrezultatecomparabileibune.Comportamentulclinicalinlayurilorafostdeterminat
att de calitatea materialelor compozite utilizate ct i de combinaia ciment rin sistem adeziv folosit
pentrufixarealor.
Concluzii.MaterialeleGradiasiBelleGlassauavutoevoluiesimilarntimp.AttinlayurileGradiactiinlay
urileBelleGlassauprezentatdup2ani,uoaremodificrinceeaceprivetecolorareamarginal,colorarea
suprafeei i adaptarea marginal, ns, restaurrile au rmas n continuare clinic acceptabile. Rezultatele i
analizastatistica datelorindicoratmaredesupravieuirela doianiainlayurilorcompozite,ceea cear
puteasindiceodurabilitatentimpridicataacestora.
Capitolul10.Concluziigenerale
1.Pentrucorectitudinearealizriiinlayurilorcompoziteipentruasigurareareuiteirestaurrilorprinaceast
tehnic este necesar respectarea cu strictee a metodologiei de lucru. Cercetrile efectuate au condus la
elaborarea protocolului clinico tehnic de realizare i aplicare a inlayurilor compozite n restaurarea
morfofuncionalacoroanelordentare.
2.Studiileprivindproprietilefizicochimiceimecanicealematerialuluicompozitdeprovenienautohton
pentrurealizareadeinlayuri,susinutedeprelucrareastatisticarezultatelor,auartatc:
Materialul compozit Barodent (produs experimental) prezint proprieti mecanice asemntoare cu
materialeledejacunoscute(BelleGlassiGradia)ceeacepermiteutilizareaacestuianrealizareadeinlay
urinzonadinilorlaterali.
Proprietile fizicomecanice ale compozitului Barodent sunt influenate de structura materialului, i
anume de tipul de matrice organic (pe baz de bisGMA), precum i de cantitatea i felul umpluturii
8

anorganice(sticldebariu,silicecoloidal,cuar).Imbuntireaformuleimaterialuluiarputeaameliorara
proprietilelui,existndastfelposibilitateadepiriiunoradintrecaracteristicilematerialelorexistente.
MaterialulcompozitautohtonBarodent,lafelcamaterialelecontrolutilizate,aavutabsorbiedeapi
solubilitate,nsvalorilemediinregistratecorespundcerinelorstandarduluiISO4049:absorbiedeap
maimicde40g/mm3isolubilitatenapmaimicde7,5g/mm3(dup7ziledeimersienap).
CompoziiamaterialuluiautohtonBarodentcuocantitatemaimicdeumpluturanorganic(65%wt)i
cuomatriceorganicbazatpemonomerihidrofilici,susceptibillaabsorbiadeap,explicproprietile
observatepentruacestmaterial.
3.Analizaprinmicroscopieelectronicdebaleiajapermisevaluareastructuriiiaadaptriimarginaleainlay
urilorcompoziteBarodentncomparaiecucelerealizatecuunmaterialcomercial,astfel:
MaterialulcompozitBarodentarecaracteristicistructuralesimilarecucelealecompozituluiBelleGlass.
UtilizareainlayurilorfabricatedincompozitulBarodentnasocierecuuncimentcuprizdualcombinat
cu un sistem adeziv de tip gravaresplare favorizeaz o nchidere marginal etan a restaurrilor
indirecte.
4. Analiza prin microscopie electronic de baleiaj efectuat asupra inlayurilor compozite Barodent fixate cu
diferitesistemeadezive(experimentaleicomerciale)apermisevaluareainterfeelordintecimentrininlay
i evidenierea diferenelor privind calitatea adaptrii marginale a restaurrilor investigate. Sau constatat
urmtoarele:
n majoritatea cazurilor, interfeele dinteciment rin inlay compozit sunt continue i exist o bun
adaptaremarginalaacestorrestaurri.
Cei doi adezivi experimentali, adezivul autogravant n dou etape (AD3A) i adezivul autogravant ntro
etap(AD3B)formeazstratulhibrid,realizndoadeziunebunlasubstratuldentinariointerfadinte
ciment rin uniform. Aceste rezultate ar putea fi explicate de utilizarea umpluturii pe baz de
hidroxiapatit;seformeazlegturiadiionalentremonomeri,hidroxiapatiticolagenuldinstructurile
dentare.
Adezivii experimentali autogravani de provenien romneasc au o bun compatibilitate cu cimentul
rin utilizat pentru fixare. Rezultatele sunt comparabile cu cele obinute de adezivii folosii pentru
comparaie.
Adeziviiautogravanindouetapeparsformezeunstrathibridmaigrosimaiomogendectadezivii
autogravanintroetap.
Rezultatele obinute in vitro arat beneficiile adezivilor autogravani din punct de vedere al simplitiii
protocolului clinic. Se impune evaluarea prin studii in vivo a eficienei adezivilor autogravani i a
durabilitiintimpaadeziunii.
5. Analiza prin microscopie optic i prelucrarea statistic a rezultatelor a permis aprecierea cantitativ a
microinfiltraieimarginalepentruinlayuri(Barodent,Gradia)irestaurridirecte(GradiaDirectX)ncorelaie
cudiferitesistemeadezive,cimenturirinimaterialelederestaurare.Saconcluzionatc:
CompoziteledelaboratorBarodentirespectivGradiaauuncomportamentasemntornceea
ceprivetemicroinfiltraiamarginallanivelulsmaluluiidentinei,aceastafiindinfluenatdecimentul
rinutilizatlafixareainlayurilorcompozite.
Sistemeleadezivedetipgravaresplare,precumicombinaiaacestoracuuncimentrinclasic
utilizate pentru fixarea inlayurilor compozite au reuit o nchidere marginal bun la nivelul dentinei i
optimlanivelulsmalului.
Inlayurile reprezint o alternativ superioar n restaurarea dinilor posteriori atunci cnd limitele
restaurrilordirectesuntdepite.
Adaptarealormarginaldepindedecalitateacimentuluiiadezivilorutilizaipentrufixare.
6.Studiulcliniccomparativefectuatcumaterialecomerciale(Gradia,BelleGlass)arelevatfaptulcinlayurile
compozitepotfiutilizatecusuccesnrefacereamorfofuncionaliesteticadinilorposteriori.Saconstatat
c:
Celedoumaterialeauavutoevoluiesimilarntimp.AttinlayurileGradiactiinlayurileBelleGlass
auprezentatuoaremodificrinceeaceprivetecolorareamarginal,colorareasuprafeeiiadaptarea
marginal,nsrestaurrileaurmasncontinuareclinicacceptabile.
Rezultatele i analiza statistic a datelor indic o rat mare de supravieuire la doi ani a inlayurilor
compozite,ceeacearputeasindiceodurabilitateridicataacestorantimp.
9

Se recomand o evaluareclinic pe o perioad de timp mai lung (dect cea utilizat n studiul de fa)
pentru a valida protocolul clinico tehnic de realizare i aplicare a inlayurilor i pentru a confirma
avantajeleoferitedeaceasttehnicnrefacereamorfofuncionaladinilorposteriori.
Inlayurile compozite reprezint restaurri fiabile i durabile pentru refacerea morfofuncional a
dinilor posteriori. Compozitul Barodent, material de provenien autohton, ntrunete calitile necesare
realizrii de restaurri indirecte. Cimenturile rin i sistemele adezive investigate au favorizat obinerea
unor restaurri indirecte cu adaptare marginal adecvat. Calitatea adaptrii marginale a inlayurilor
compozite nu depinde numai de materialul compozit sau de protocolul de realizare al restaurrii, ci este
influenat i de sistemul de fixare al acesteia, i anume cimentul rin cu sau fr sistem adeziv.
Durabilitatea inlayurilor compozite este asigurat de calitile materialului de restaurare, de respectarea cu
stricteeaprotocoluluidectremedicidemotivaiaicontiinciozitateapacientului.

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10


CURRICULUMVITAE
DATEPERSONALE
Nume,prenume:POPOVICIANDRADA
Starecivil:cstorit(numedupcstorieSOANC)
Datanaterii:16septembrie1976
Nationalitate:romn
Adresapersonal:str.INTRELACURINR.55,ClujNapoca,Romnia
Adresaelectronic:andrapopovici@yahoo.com
Adresa profesional: Facultatea de Medicin Dentar, Universitatea de Medicin i FarmacieIuliu
Haieganu,Str.VictorBabenr.15,400023,ClujNapoca,Romnia
STUDII
19831991
19911995

19952001

StudiigimnazialelaLiceuldetiinealeNaturii,ClujNapoca
StudiilicealelaLiceulTeroeticnr.4,ClujNapoca
Media anilor din liceu 9,66; Bacalaureat (specific chimiefizic) cu media 9,32/10;
Participrilaolimpiadecolaredelimbistrine
FacultateadeStomatologieaU.M.F. IuliuHatieganu, ClujNapoca
Mediaaniloruniversitari9,24/10;Mediaexamendelicen9,73/10

STUDIIPOSTUNIVERSITARE
20012003
Rezideniat,specialitateaStomatologieGeneralmedicspecialiststomatolog(ian.2004)
20032009 Doctorand(tiineMedicale/MedicinDentar;prof.Dr.D.BORZEA)
2005
DiplomdeCompetennRadiodiagnosticulMaxiloDentar
20032008
Medicspecialist,specialitateaStomatologieGeneralmedicprimar(ian.2009)
ACTIVITATEPROFESIONAL
19962002
Activitatevoluntariatcaasistentmedicalntruncabinetstomatologic
2003prezent MedicstomatolognCabinetulstomatologicC.M.I.dr.PascuLaurentiu,ClujNapoca
20022003
MedicrezidentlaSpitalulClinicJudeeanCluj
2004prezent Asistent universitar, Facultatea de Medicin Dentar a UMF Iuliu Hatieganu ClujNapoca
(CatedradeParodontologie)Stagiiclinicecustudenii(secianlimbaromn,linianlimba
francez),elaborare/participarecursuri
SPECIALIZRIICALIFICRI
nstrintate:
IunSept Bursa de studii Socrates/Erasmus Stagiu profesional la Facultatea de Medicin Joseph
2000
Fourier,Grenoble,FrantaAtestatdestudiiinternationale
FebApr Bursa de studii guvernamental Stagiu de perfecionare la Facultatea de Odontologie,
2002
UniversitateaAixMarseilleII,Marsilia,FranaAtestatdeparticipare
Feb2007 Curs La protection duparodonte dansles reconstitutions coronaire, Program de mobiliti
de nvmnt Socrates la Facultatea de Odontologie, Marsilia, Frana Attestation de
mobilit
FebMar BursdeperfecionarencercetareA.U.F.laFacultatea deOdontologieaUniversitii Victor
2008
SegalenBordeaux2,FranaAtestatdeparticipare
nRomnia:
Ian2001 Curs postuniversitar Riscul alergic i anafilactic n practica stomatologic (Prof. Dr. A.
Rotaru)
20032005 Cursurideperfecionarepostuniversitar (Prof.F.Louise/FacultedOdontologie,Marsilia),Cluj
Napoca: Incidente estetice ale afectiunilor parodontale si tratamentul lor; Reconstructia
pierderilor de substan la nivelul crestei edentate; Chirurgia plastic parodontal, grefele
epitelioconjunctivesiconjunctive
MarApr Cursdeperfecionarepostuniversitar Restaurrileintegralceramice(Prof.Dr.Dorin
2004
Borzea/CatedradePropedeuticStomatologic)
Apr2004 CursdeperfecionarepostuniversitarRestaurareaesteticaarcadelordentareprininlayuri
estetice(Conf.Dr.DianaDudea/CatedradePropedeuticStomatologic)
Nov2004 CursdeparodontologieRegenerareaparodontal:orientricliniceibiologice(Conf.Dr.
AlexandraRoman/CatedradeParodontologie),ClujNapoca
11

Mar2005

Curs de perfecionare (Prof.Dr. JeanLouis Brouillet/Faculte dOdontologie, Marsilia, Franta),


ClujNapoca: Restaurri estetice n regiunea frontal. Tehnica indirect (faete, coroane);
Restaurri estetice n regiunea frontal. Tehnica direct tradiional i tehnica stratificrii
(materialulcompozitHFOMicerium)
Apr2005, Curs de chirurgie muco gingivala, Live OP Chirurgia plastica parodontala: noi tendinte
Apr.2006 transmisiune interactiva n direct (Societatea German de Parodontologie Regensburg
FacultateadeMedicinaDentara,U.M.F.VictorBabes),Timisoara
Ian2006 Curs de perfectionare Tratamentul mecanic i obturaia canalar prin condensare lateral
(Prof.JeanFrancoisPeliiProf.DominiqueOriez/FacultdOdontologie,UniversitateaVictor
SegalenBordeaux2,Frana),ClujNapoca
Mai2006 Cursuri de perfecionare postuniversitar: Faete ceramice: evoluie spre stomatologia
restaurativ (Prof. Jean Franois Lasserre/ Facult dOdontologie, Universitatea Victor
Segalen Bordeaux 2);Incidene estetice i corectarea n boala parodontal (Prof. F.
Louise/FacultedOdontologie,Marsilia),Bucureti
PREMII/DIPLOME
Sep2000 Premiul Asociaiei medicilor stomatologi cu practic privat n Romnia pentru activitate
profesionalfoartebun
Dec2000 Diplom de merit pentru rezultatele profesionale remarcabile, acordat de Facultatea de
MedicinDentar,cuocaziaZilelorU.M.F.IuliuHatieganu
MEMBRUALASOCIAIILORPROFESIONALE

SSER(SocietateadeStomatologieEsteticadinRomania);SRB(SocietateaRomnde
Biomateriale);CMDR(ColegiulMedicilorDentistidinRomania)
LIMBISTRAINECUNOSCUTE

francezafoartebine;englezafoartebine;italianbine

ACTIVITATESTIINIFIC
A.CRIPUBLICATE
1.RomanA,PopoviciA,PastravO,CondorD,Odontologierestaurativ:ghidteoreticiclinic,EdituraMedical,
ClujNapoca,2006
2. Roman A, Popovici A, Cara R, Vitiuc I. Ghid teoretic si practic de parodontologie, Editura Medical
UniversitaraIuliuHatieganu,ClujNapoca,2008.

B.LUCRRIPUBLICATE
1.PopoviciA,BorzeaD,PopA,RomanA,PastravO,MoldovanM,PrejmereanC.StudyofthePhysicaland
MechanicalPropertiesofBiomaterialCompositesUsedinMixedCrowns.EngeneeringofBiomaterials,2005,
VIII(4753):1516
2. Roman A, Popovici A. Interactiuni bacteriene n biofilmul dentar i consecinte terapeutice. Clujul Medical
2006;LXXIX(4):639645
3.RomanA,PopoviciA.Augmentareagingieikeratinizatepringrefgingivalliber.Prezentaredecaz.Revista
RomndeChirurgieRinoSinusal2007;1(34):4145
4.FodorO,TigI,MoldovanM,PopoviciA,PopA.Adeziviidentinaricamijlocdeprotectieaplagiidentinare:
unstudiuelectronomicroscopic.TransilvaniaStomatologic2007,2:2333
5.FodorO,TigI,MoldovanM,PopoviciA,PopA.Proprietilemecaniceapatrurinicompozite.Transilvania
Stomatologic2007,2:3441
6.RomanA,PopoviciA.Locullambouluipoziionatcoronarntratamentulretraciilorgingivale;RevMedChir
SocMedNatIai2007;III(1):254258(suppl1)
7.PopoviciA,SeceleanuR,RomanA.Rehabilitationusingendodonticandadhesivetechniquesinperiodontal
disease.CasePresentation,JOralHealthDentalManagementBlackSeaCountries2008,VII(2):2022(suppl)
8. Popovici A, Roman A, Tassery H, Seceleanu R. Direct versus Indirect Resin Composite Restoration on the
PosteriorTeeth.RevistaRomndeMedicinDentar,2008,XI(4):5768

12

9.Popovici A, Fodor O, Moldovan M, Roman A, Borzea D. In vitro study ofa new composite biomaterialfor
indirectrestorations.Optoelectron.AdvMaterRapidComm2008;2(12):891894
10.PopoviciA,TrifM,NicolaC,MoldovanM,FodorO,RomanA,SavaS,BarbuTL.Comparativestudyregarding
someexperimentalhydroxyapatiteadhesivesystems.JOptoelectronAdvMSymposia2009;1(1):203
11.Roman A, Popovici A. Regenerarea parodontal asociat xenogrefelor osoase. Discuii pe baza unui caz
clinic.RevistaRomndeChirurgierinosinusal2009;1(12):5154
12. Popovici A, Nicola C, Moldovan M, Bondor CI, Badet C, Roman A, Baciut G, Baciut M, Bran S. A
microleakagecomparativestudyforindirectcompositerestorationsonposteriorteeth.JOptoelectronAdvM
2009;11(4):490493
13.PopoviciA,TrifM,MoldovanM,FodorO,NicolaC,BorzeaD.Scanningelectronmicroscopyevaluationof
compositeinlayslutedwithdifferentadhesivesystems.OptoelectronAdvMaterRapidComm2009;6(3):616
620.

C.COMUNICRITIINIFICE
1. Fildan F, Covalcic IM, PopoviciA. Dificultati de diagnostic radiologic n fracturile mandibulare; Volumul de
rezumatealZilelorUniversitiideMediciniFarmacieIuliuHaieganu,Dec2000,ClujNapoca,p.154
2.RomanA,PastravO,PopoviciA.Restaurricomplexecuamalgamlapacientiicudeficientementale,Cahiers
deResumeesde25mesJournesduCollgeNationaldesEnseignantsenOdontologieConservatrice,1315Jun
2005Bordeaux,Franta
3.Popovici A, Borzea D, Pop A, Roman A, Pastrav O, Moldovan M, Prejmerean C. Study of the Physical and
MechanicalPropertiesofBiomaterialCompositesUsedinMixedCrowns.BookofAbstractsoftheConference
onBiomaterialsinMedicineandVeterinaryMedicine,912Oct2005,Rytro,Polonia
4.PopoviciA,BorzeaD,PastravO,MoldovanM,PrejmereanC.StudyoftheStructureandAdhesiontoDental
Tissues of a Composite Biomaterial used in Prothetic Restorations. Caiet de Rezumate al International
CongressofDentalMaterials,NapocaBiodent,912Nov2005,ClujNapoca,p.133
5.Popovici A,Borzea D, Moldovan M. In vitro study of a composite biomaterial for indirect restorations.
Proceedingsofthe20thEuropeanConferenceonBiomaterials,Nantes,France,27Sep1Oct2006,p.284.
6.Popovici A. Restaurarea coronar morfofuncional prin inlayuri compozite Masa rotund Estetic i
funcionalitate,ZileleU.M.F.IuliuHatieganu,Dec2006,ClujNapoca
7.PopoviciA,BorzeaD,MoldovanM,TrifM,RomanI,AlexandrescuE.EvaluationoftheMarginalIntegrityof
Composite Inlays Luted with Different Adhesive/Resin Cement Systems, Proceedings of the 21st European
ConferenceonBiomaterials,913Sept,2007,Brighton,UK,p.247
8.PopovicioancA,RomanA,CmpianR,CiobanC.Interdisciplinaryapproachinaggressiveperiodontitis:
from diagnosis to treatment in some clinical cases, Programme of 6th Congress of the European
FederationofPeriodontology,46Jun2009,Stockholm,Sweden,p.50
9.RomanA,PopovicioancA,CmpianR.Freegingivalgraft:doesitstillfindaplaceinperiodontalplastic
surgery? Programme of 6th Congress of the European Federation of Periodontology, 4 6 Jun 2009,
Stockholm,Sweden,p.50
10.Roman A, oanc A. Importana chirurgiei plastice parodontale n ameliorarea esteticii i funciei n
parodontiteleagresive.DentaFest,810Oct2009,Sibiu.

D.PROIECTEDECERCETARE
1. Proiect PNIIParteneriate, Rolul psihoterapiei cognitivcomportamentale n tratamentul chirurgical
parodontal:unstudiucliniccontrolatPSIDENT,Contract42141/2008(Cercettor).
2.ProiectPNIIParteneriateBiomaterialecomplexecugradavansatdespecificitateutilizateintratamentele
endodonticeENDODENT,Contract72190/2008(Cercettor).
3.ProiectPNIIIDEIEvaluareainterdisciplinararezultatelortratamentuluirecesiunilortisularemarginaleprin
grefegingivale,ID1341,Contract1213/2009(Cercettor).
Data,
octombrie2009

Semntura,
Dr.AndradaPopovici

13

UNIVERSITYOFMEDICINEANDPHARMACYIULIUHAIEGANUCLUJNAPOCA
FACULTYOFDENTALMEDICINE

PhDTHESIS
Applicationofinlaysfordentalcrownrestoration
Abstract

PhDStudent,
AndradaPOPOVICI(cs.SOANC)

ScientificCoordinator,
Prof.Dr.DorinBORZEA

2009

CONTENTS

INTRODUCTION.............................................................................................................................................
PARTI.CURRENTSTAGEOFKNOWLEDGEINTHEFIELDOF COMPOSITEMATERIALSFORRESTORATIVE
DENTISTRY.......................................................................................................................................
CHAPTER1.CURRENTCONCEPTSREGARDINGTHEPOSTERIORTEETHRESTORATIVETECHNIQUESUSING
COMPOSITERESINS.......................................................................................................................................

1.1.DIRECTTECHNIQUEFORPOSTERIORTEETHRESTORATIONUSINGCOMPOSITEMATERIALS.........

1.1.1.Compositionofdirectcompositeresins.................................................................................

1.1.2.Typesofdirectcompositeresins................................................................................

1.1.3.Propertiesofdirectcompositeresins......................................................................................

1.1.4.Indicationsofrestorationswithdirectcompositeresins.........................................................

1.1.5.Advantagesanddisadvantagesofdirectcompositeresins......................................................

1.2.INDIRECTTECHNIQUEFORPOSTERIORTEETHRESTORATIONUSINGCOMPOSITERESINS.............

1.2.1.Typesofindirectintracoronalrestorations.............................................................................

1.2.2.Fabricationtechniqueforcompositeinlays............................................................................

1.2.3.Properties ofindirectcompositeresins .................................................................................

1.2.4.Currentcompositesystems forindirectrestorations.............................................................

1.2.5Durability ofindirectcompositerestorations.........................................................................

1.3.SUPERIORITYOFINDIRECTRESTORATIONSOVERTHEDIRECTRESTORATIONS...............................
CHAPTER2.FACTORSINFLUENCINGTHECLINICALOUTCOMEOFCOMPOSITEINALYS..............................

2.1.IMPORTANCEOFACCURACYTHROUGHOUTTHE REALISATIONOFCOMPOSITEINLAYS....

2.2.IMPORTANCEOFTHELUTINGSTEP INASSURINGTHESUCCESSOFCOMPOSITEINLAYS...............

2.2.1.Currentconceptsregardingtheadhesiontoteethstructures.................................................

2.2.2.Resincementstheirroleinmarginal adaptationanddurabilityofcompositeinlays.........
PARTII.PERSONALCONTRIBUTIONSREGARDINGTHEUSEOFCOMPOSITEINLAYSFORMORPHO
FUNCTIONALRESTORATIONOFPOSTERIORTEETH....................................................................................
Motivationoftheresearchtheme........................................................................................................
CHAPTER3.CLINICALANDTECHNICALPROTOCOL FORCOMPOSITEINLAYSFABRICATION.......................
CHAPTER4.STUDYOFTHEMECHANICALPROPERTIESOFSOME COMPOSITEMATERIALSFORINDIRECT
RESTORATIONS.............................................................................................................................................

4.1.Introductoryconcepts.......................................................................................................................

4.1.1.GeneralpresentationoftheindirectcompositeBarodent.....................................................

4.1.2.Aspectsregardingthemechanicalpropertiesofcompositeresins.......................................

4.2.Materialandmethod........................................................................................................................

4.3.Results..............................................................................................................................................

4.4.Discussions........................................................................................................................................

4.5.Conclusions.......................................................................................................................................
CHAPTER5.INVITROSTUDYOFWATERSORPTIONANDSOLUBILITYOFSOMECOMPOSITEMATERIALS
FORINDIRECTRESTORATIONS........................................................................................................................

5.1.Introductoryconcepts.......................................................................................................................

5.2.Materialandmethod........................................................................................................................

5.3.Results...............................................................................................................................................

5.4.Discussions........................................................................................................................................

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5.5.Conclusions.......................................................................................................................................
CHAPTER6.INVITROSTUDYOFSTRUCTUREANDADHESIONOFACOMPOSITEMATERIALFORINDIRECT
RESTORATIONS...............................................................................................................................................

6.1.Introductoryconcepts.......................................................................................................................

6.2.Materialandmethod........................................................................................................................

6.3.Results...............................................................................................................................

6.4.Discussions........................................................................................................................................

6.5.Conclusions.......................................................................................................................................
CHAPTER7.SCANNINGELECTRONMICROSCOPY EVALUATIONOFMARGINALADAPTATIONOF
COMPOSITEINLAYS........................................................................................................................................

7.1.Introductoryconcepts.......................................................................................................................

7.2.Materialandmethod.........................................................................................................................

7.3.Results................................................................................................................................................

7.4.Discussions.........................................................................................................................................

7.5.Conclusions........................................................................................................................................
CHAPTER8.INVITROSTUDYONMARGINALMICROLEAKAGEOF COMPOSITEINLAYSUSEDFORMORPHO
FUNCTIONALRESTORATIONOFPOSTERIORTEETH...................................................................................

8.1.Introductoryconcepts........................................................................................................................

8.2.Materials..........................................................................................................................................

8.3.Methodology....................................................................................................................................

8.3.1.Realisationofindirectrestorations.........................................................................

8.3.1.1.Cavitypreparationforcompositeinlays.................................................................

8.3.1.2.Technicalprotocolfortherealisationofindirectrestorations..............................

a)Technicalprotocolfor Gradiainlays..........................................................................

b)Technicalprotocolfor Barodentinlays.......................................................................

8.3.1.3.Thelutingprocedureofcompositeinlays...............................................................

a)Protocolforapplication ofGCemresincement.........................................................

b)ProtocolforapplicationofExciteDSCadhesivesystemVariolinkIIresincement...

c)ProtocolforapplicationofOptibond FL adhesivesystemVariolinkIIresincement..

8.3.2.Realisationofdirectrestorations............................................................................

8.3.2.1.Cavitypreparationfordirectcompositerestorations..................................

8.3.2.2.Clinicalprotocolforrealisationofdirectrestorations................................

a)Protocolforapplicationof GBond adhesivesystem............................................

b)Protocolforapplicationof GradiaDirectXcompositeresin......................

8.3.3.Specimensinvestigation.........................................................................................

8.4.Results..............................................................................................................................................

8.5.Discussions.......................................................................................................................................

8.6.Conclusions.......................................................................................................................................
CHAPTER9.COMPARATIVESTUDYOFTHECLINICALPERFORMANCES OFCOMPOSITEINLAYS...................

9.1.Introductoryconcepts........................................................................................................

9.2.Materialandmethod..........................................................................................................

9.3.Results................................................................................................................................

9.4.Discussions.........................................................................................................................

9.5.Conclusions........................................................................................................................
CHAPTER10.GENERALCONCLUSIONS.........................................................................................................
BIBLIOGRAPHY................................................................................................................................

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Keywords: Laboratory processed composite resins; Composite inlays; Mechanical and physical properties;
Adhesion;Marginaladaptation;Microleakage.

ThePhDthesisApplicationofinlaysfordentalcrownrestorationisstructuredintwo mainparts,
thatis,PARTIwhichsystematisesdatafromtheliteraturereferringattheuseofcompositematerialsinthe
restorativedentistry,andrespectivelyPARTIIthatincludesthepersonalcontributions,consistingofaseriesof
experimentalresearchregardingtheuseofcompositeinlaysforposteriorteethrestoration.

15

Themainobjectivesofthethesiswere:
Elaborationoftheclinicalandtechnicalprotocolforcompositeinlaysrealisationandapplication,withthe
purposeofachievingqualitativeanddurablerestorations.
EvaluationoftheabilityofaRomanianexperimentalcompositematerialtobeusedforinlayrestorations,
aswellasofsomeRomanianexperimentaladhesivesystemsforinlayslutingprocedure.
AnalysisoftherestoringqualityoftheinlaysfabricatedwiththeRomaniancomposite,incomparisonwith
otherwellknowncompositematerials.
Evaluation of the clinical performances of composite inlays as a superior alternative for posterior teeth
restoration.

Most of the experimental research took place at the Faculty of Dental Medicine of the Iuliu
Hatieganu University of Medicine and Pharmacy, ClujNapoca with the permanent help from the Dental
CompositesDepartmentfromtheRalucaRipanInstituteforResearchinChemistry(ICCRR),ClujNapoca.A
part of the fundamental research on the indirect composite materials was performed during an internship
traininginresearchattheFacultyofOdontologyoftheVictorSegalenUniversity,Bordeaux2,France,with
thehelpoftheFrenchbranchofGCCorporationGCFrancesas.

Thethesisisstructuredin10chapterstowhich,theintroductionandthebibliography(307citationsin
theirappearanceorder)areadded.

Chapter1.Currentconceptsregardingtheposteriorteethrestorativetechniquesusingcompositeresins
Chapter2.Factorsinfluencingtheclinicaloutcomeofcompositeinlays
Chapter3.Clinicalandtechnicalprotocolforcompositeinlaysfabricationdescribesthoroughlytheclinical
andtechnicalstepsfortherealisationofcompositeinlaysbyindirecttechnique,underliningtheimportancein
respectingtheexactstepsforsuccessfulrestorations.
Chapter4.Studyofthemechanicalpropertiesofsomeindirectcompositematerials.
Objective. The purpose of this study was the characterisation of the physical and chemical properties of a
Romanian laboratory processed material, Barodent, manufactured by ICCRR, indicated for indirect
restorations,aswellastheevaluationofthemechanicalpropertiesofBarodentmaterialincomparisonwith
otherwellknownindirectcompositeresins.
Material and method. The main characteristics of the Barodent material are shown in Table 1. Flexural
resistance, compressive strength and diametral tensile strength were tested for three composite materials
usedforinlayrestorations,thatisBarodent,Gradia/GCCorporation,BelleGlassNG/KerrCorporation.
Table1.CompositionofBarodentmaterial
Producer
Organicmatrix
Inorganicfiller
Components
Bariumglass
ICCRR,
50%bariumglass;20% 45%SiO2;17%B2O3;10%Al2O3;
BisGMAbasedresin
Romania
colloidalsilica;30%quartz 20%BaO;8%NaFCaF2
Ten specimens of each material were manufactured for the above mentioned tests using special
moulds(Fig.1).
Specimenmanufactureandtestingweredoneaccordingtothe
manufacturersinstructionsandtotheinternationalstandards.
All data were statistically analysed using Anova and PostHoc
Bonferonni tests for flexural strength (FS) and MannWhitney
test for compressive strength (CS) and diametral tensile
strength (DTS). The significance level was 0,05. For the

statisticalanalysisSPSS13.0andStatistica7.0softwareswere
Fig.1Specimensforflexuralstrength
used.
Resultsanddiscussions.Dataofthemechanicaltests(FS,CS,DTS)aregraphicallyrepresented(Fig.2),andthe
meanvalues(mean),standarddeviations(DS)andthesignificancelevelforeachmaterialweresystematisedin
tables.
This study showed that the flexural strength was bigger for BelleGlass composite (84,58 MPa),
followed by Barodent (63.16 MPa) and Gradia (61.68MPa) composites, the differences between the three
16

materials being statistically significant (p ANOVA=0,0003). For the compressive strength, BelleGlass(241.64
MPa)andGradia(226.11MPa)materialsshowedthebiggervalueswithnostatisticaldifferencesbetweenthe
two composites (p=0.48). The mean values for the diametral tensile strength were situated between 37. 23
MPa(BelleGlass)i43.21MPa(Gradia).
The Barodent composite had an intermediate value between
the well known resins. Statistical differences were found
betweenBarodentandBelleGlass(p=0.04).AlthoughBelleGlass
had the smaller value for DTS, no statistical differences were
observed between Gradia and BelleGlass (p=0.06) because of
the standard deviation from the mean, which was bigger for
BelleGlass (5.94 for BelleGlass, respectively 5.71 for Gradia).
The mechanical properties of the materials are influenced by

Fig.2Plotofthemechanicaltestsresults thecontentandthetypeoftheinorganicfilleraswellasbythe
forthetestedmaterials
organicmatrixcomposition.
Conclusions.Itisimportantforthecliniciantocometoknowledgeofthemechanicalpropertiesofmaterials
andtounderstandtheirbehaviourinstressconditionsforthesuccessfultreatmentwithindirectrestorations.
TheBarodentcomposite materialhas similarmechanicalpropertieswith the materialsusedascontrol,thus
beingabletoresisttofunctionalmasticatoryforces.
Chapter 5.In vitro study of water sorption and solubility of some composite materials for indirect
restorations.
Objective. The purpose of this study was to determine the water sorption and solubility of the Barodent
compositematerial,incomparisonwithGradiaandBelleGlassmaterials,usedforinlayfabricationaswellasto
evaluatethepostcuringeffectonthesematerials.
Materialandmethod.Twelvediscshapedspecimenswerepreparedforeachofthethreematerials.Halfof
themwaspostcuredaccordingtothemanufacturersinstructions(GroupA),andtheotherhalfwasonlylight
cured(GroupB).Allspecimenswereimmersedindistilledwaterfor7days,andtheywereweighedeachday
atfixedperiodoftime.Watersorptionandsolubilitywerecalculatedandalldatawerestatisticallyanalysed
(SPSS,Statistica7.0)usingKruskallWallisiMannWhitneytests.Meanvalues,DSandsignificancelevel(p)for
water sorption and solubility were recorded for both groups, every day and at the end of the immersion
period.Thesignificancelevelwas0.05.
Results and discussions. The water sorption analysis showed that Barodent material had significant bigger
values than Gradia and BelleGlass (p=0.002). The Romanian composite absorbed 3 times much water than
GradiaandBelleGlass(Fig.3a)whichdidntdiffersignificantly(p=0,13).Thesolubilityinwaterwasdifferent
for all specimens. Thus, BelleGlass had the smallest value, followed by Gradia and Barodent (Fig.3b), the
differences between the materials being significant (p=0,002). All tested materials had a certain degree of
solubilisation,butthemasslosswasshieldedbythebiggerwatersorption.

a)

b)

Fig.3Watersorption(a)andsolubility(b)valuesforthepostcuredspecimens

By comparing the two study groups (A and B), no statistical significant differences were found
regarding the water sorption (p>0.05), but there were between the solubility values (p=0.002). The study
showed that the water sorption and solubility of the indirect composite resins were influenced by the
materials composition, more precisely by the nature and hydrophilicity of the organic matrix and the
characteristicsoftheinorganicfiller.
17

Conclusions. Since there were no statistical differences between both groups of specimens regarding water
sorption,itcouldbeconcludedthattheresultswerenotinfluencedbythepostcuringprocess.TheRomanian
Barodentcompositeaswellasthematerialsusedascontrol,hadwatersorptionandsolubility,butthemean
valuescorrespondto4049ISOstandardspecification:watersorptionvaluelessthan40g/mm3andsolubility
lessthan7,5g/mm3(after7daysofwaterstorage).
Chapter6.Invitrostudyofstructureandadhesionofacompositematerialforindirectrestorations.
Objective. This study tested the ability of the Barodent composite to be used for inlaytype indirect
restorations, by evaluating the materials structure and the adhesive interface created between inlays and
dental structures. The investigations were performed by scanning electron microscopy and Xray dispersive
energyanalysis(EDX).
Materialandmethod.Inthisstudy,40extracted,cariesfreethirdmolarswereusedonwhichclassIIcavities
forinlayswereprepared.Teethweredividedinto2groupsof20teetheachandthentheywererestoredwith
compositeinlays.InGroupI,teethwererestoredusingBarodent/ICCRRcomposite,whileinGroupIIawell
knowncompositewasused,thatisBelleGlassNG/KerrCorp.Therestoredteethweresectionedusingalow
speed diamond saw resulting 1.5 mm specimens and then they were analyzed. The specimen analysis was
done by scanning electron microscopy (SEM) and Xray dispersive energy analysis (EDX) using a Philips L20
electronmicroscope.
Results and discussions. The EDX analysis revealed the elemental composition and the structure of the
Barodent composite with the element distribution map both in the inlay restoration and the dental tissues
(Fig.4).Inthiscase,SEMimagesshowedthepresenceofacontinuousinterfacebetweenthedentalsubstrate
andresincement,andalsoagoodadaptationbetweentheresincementandcompositeinlays.

a)
b)

Fig.4SEMimagesforBarodentinlays:Elementalanalysis(a),SEMimage(b),whereCIcomposite
inlay,RCresincement,Ddentin
Conclusions. The scanning electron microscopy and the Xray dispersive energy analysis (EDX) revealed that
the Romanian composite material in combination with the right resin cement and adhesive system allow a
proper internal and marginal adaptation of inlays to tooth structure, minimizing future microleakage and
postoperativesensitivityrelatedtotheindirectrestoration.
Chapter7.Scanningelectronmicroscopyevaluationofmarginaladaptationofcompositeinlays.
Objective. The purpose of this study was to evaluate the marginal adaptation and adhesive interface of
Barodentcompositeinlayslutedwithdifferentadhesivesystems.Thequalityofthetoothresincementinlay
interfaceswasinvestigatedusingscanningelectronmicroscopyanalysis.
Material and method. Standard proximoocclusal cavities were prepared for inlays, on 60 extracted, sound
permanentmolarsandthenrestoredwithBarodentcompositeinlays,manufacturedbytheindirecttechnique.
Two experimental hydroxyapatite filled selfetch adhesive systems (AD3A, AD3B/ICCRR) were used in
comparison with other wellknown adhesives (OptiBond Solo Plus SelfEtch Adhesive System, OptiBond
AllInOne/Kerr Corp). The composite inlays were luted using the dualcured resin cement NX3/Kerr in
combination with one of the adhesive systems. Teeth were embedded in acrylic resin and then sectioned
mesiodistally. Specimens of 1.5 mm width were analysed by scanning electron microscopy at different
magnitudes.
Results and discussions. SEM images revealed the quality of the adhesive interface between the dental
substrateresin cementinlay, more precisely the continuity and the uniformity of the adhesive layer, the
presenceofvoidsalongtheinterfaceandtheformationofthehybridlayer(Fig.5).
18

a)

b)

Fig.5.SEMimagesfortheinterfacesrealisedbytheRomanianadhesives:AD3A,twostepselfetch(a)and
AD3Bonestepselfetch(b),where:RCresincement,HLhybridlayer,Ddentin,arrowvoids
Forallspecimens,thetwostepselfetchadhesivesystemsformedhybridlayersthickerthantheone
step selfetch adhesives. The Romanian experimental hydroxyapatite selfetch adhesives achieved a good
adhesiontothedentalsubstrate,formingthehybridlayerandauniformtoothresincementinterfacewitha
goodcompatibilitywiththeresincementusedforlutingtherestorations.Theresultsarecomparablewiththe
wellknownadhesivesusedascontrol.
Conclusions. Selfetch adhesives assure an immediate, good bond to the dental tissues, but the big
concentration of the acidic monomers and the thin hybrid layer formed, may have a negative effect on the
adhesion stability and on its resistance in oral environment. Therefore, it is recommended to evaluate the
efficiencyandtheadhesiondurabilityoftheselfetchadhesivesbyinvivostudies.
Chapter8.Invitrostudyofmarginalmicroleakageofcompositeinlaysusedforposteriorteethrestorations.
Objective. The purpose of this study was the quantitative evaluation of marginal microleakage of composite
inlaysanddirectrestorations,asinfluencedbytheadhesivesystems,resincements,restorativematerialsand
techniques.
Materialandmethod.Forthisstudy,90extracted,soundmolarsweredividedin9groupsof10teeth.Oneach
tooth, two proximoocclusal cavities were prepared for inlays and direct restorations. Three composite
materials were used, that is Barodent/ICCRR, respectively Gradia/GC Corp for inlays and Gradia Direct
X/GC Corp for direct restorations. Sixty restorations were prepared with each material using different
adhesivesystemsandresincements.
Thecharacteristicsoftherestorativematerials,resincementsandadhesivesystemsweredescribed,
and the steps for cavity preparation as well as the protocol for restorations manufacture were thoroughly
presented(Fig.6).Thelutingprocedureforcompositeinlayswaspresented,describingthemethodologyfor
the application of resin cements and adhesive systems. Therefore, there were presented the protocols of
application of: a) the GCem/GC Corp resin cement; b) the Excite DSC adhesive system+ Variolink II/Ivoclar
Vivadentresincement;c)theOptibondFL/Kerradhesivesystem+VariolinkIIresincement;d)GBond/GCCorp
adhesivesystem.

Fig.6.Stepsforcompositeinlaymanufacture:cavitypreparation,inlayfabricationonmodels,inlay
adaptationonthepreparedcavities
Therestoredteethwerethermocycled(2000cycles)atdifferenttemperatures(5Cand55C).Teeth
wereimmersedfor24hoursin2%methylenebluesolutionandthensectionedmesiodistally,obtaining1
mmthickspecimensthroughthemiddleoftherestorations.
The evaluation of the microleakage was achieved using an optical microscope (Olympus KC301,
Olympus Inc. and QuickPhoto Micro 2.2 software). The microleakage values in dentin and enamel were
measured,andthenreportedtotheinterfacelength,representingtheproportionofmicroleakageindentin,
respectivelyinenamel.TheresultswerestatisticallyanalysedusingKruskallWallis,MannWhitneyand
19

respectively,Wilcoxontests.Datawerepresentedingraphicsboxplot(median,25%75%percentiles,min
max) and line types. The statistics were done with SPSS 13.0, Statistica 7.0 and Microsoft EXCEL
applications.Thelevelofsignificancewas0.05.
Resultsanddiscussions.Theopticalmicroscopyandthestatisticalanalysisallowedthequantitativeevaluation
of the microleakage of composite inlays and direct restorations, as influenced by the different adhesive
systems/resincementsandtherestorativematerials.Themicroleakagewaspresentforthemajorityofthe
restorations,bothindentinandinenamellimits(Fig.7).

b)

a)
Fig.7.MicroscopyimagesmeasuringthemicroleakageforGradia(a),respectivelyBarodentinlays(b)

1,2

1,2

1,0

1,0

Microleakage length/interface length

Microleakage length/interface length

Bycomparingthegroupsofspecimensthatusedthesame composite material,significantstatistical


differences were observed (p<0.05), in dentin (p=0.00001 for Gradia inlays; p=0.0002 for Barodent inlays;
p=0.00001forGradiaDirectXrestorations),aswellasinenamel(p=0.0004forGradiainlays;p=0.000001for
Barodentinlays;p=0.000001fordirectrestorations)(Fig.8).
Inordertoevaluatetheinfluenceofthematerialsforlutinginlays(resincementadhesivesystem),
there were used an autoadhesive resin cement (GCem) as well as a dualcured resin cement, Variolink II/
IvoclarVivadent in combination with a classic adhesive system Excite DSC / IvoclarVivadent or Optibond
FL/Kerr.
Composite inlays had a good marginal adaptation regarding microleakage in dentin and enamel, in
comparison with the direct restorations. Composite inlays luted with the classic etch and rinse adhesive
systems had a lower marginal microleakage in dentin than the ones luted with the autoadhesive resin
cement.

0,8

0,6

0,4

0,2

0,0

0,8

0,6

0,4

0,2

0,0
dentin
enamel

-0,2

dentin
enamel

-0,2

b)

a)
Fig.8.Boxplot(median,2575%percentiles,minmax)oftheproportionofmicroleakageindentin
andenamelforBarodent(a),respectivelyGradia(b)inlays
Group 2

Group 6

Group 7

Group 4

Group 5

Group 1

Nostatisticaldifferenceswereobservedbetweenthecompositeinlayslutedwiththedualcuredresin
cementincombinationwiththeetchandrinseadhesives(p=0.37forGradiainlaysandp=0.76forBarodent
inlays).Also,thedirectrestorationsusingthesameetchandrinseadhesiveshadlessmicroleakagethanthe
selfetchadhesive(p=0.00001).Therewerenostatisticalsignificantdifferences(p=0.40)betweenthegroups
thatusedtheetchandrinseadhesives.
Conclusions.Thestudyrevealedacertaindegreeofmicroleakageforalltherestorations,compositeinlays
ordirectrestorations.Forallspecimens,theproportionofmicroleakageindentinwasmorereducedthanin
enamel.
BarodentandGradiainlaysobtainedgoodresultsregardingmarginalmicroleakageunderliningtheadvantages
ofthetechniqueoverthedirectrestorations.Themarginaladaptationofinlaysdependsonthequalityofthe
resincementandtheadhesiveusedforthelutingprocedure.
20

Chapter9.Comparativestudyoftheclinicalperformancesofcompositeinlays.
Objective. The purpose of this study was the evaluation of the clinical performances for two composite
materialsusedforindirectrestorations(BelleGlass/Kerr,respectivelyGradia/GC)inordertoputinevidence
thequalityofcompositeinlaysinmorphofunctionalrestorationofposteriorteeth.
Material and method. Seventytwo composite inlays were applied on molars (in 60 patients) in order to
replacedamagedrestorationsorforthetreatmentofcariouslesions.Thepatientswerechosenaccordingto
general and local inclusion criteria. Thirtysix inlays were applied from each of the two abovementioned
materials.Accordingtotheclinicalsituation,oneortwoinlayswereappliedperpatient.
Composite inlays were manufactured according to the producers instructions. For the luting
procedure,thedualcuredresincementVariolinkII/IvoclarVivadentincombinationwiththeadhesivesystem
ExciteDSC/IvoclarVivadentwereused,accordingtothemanufacturersinstructions.
Composite inlays were evaluated using the USPHS modified criteria for anatomic form, marginal
adaptation, colour match, marginal discoloration, secondary caries, using appreciation scores at each
evaluation.Theclinicalevaluationwasdoneatthebaseline(day0)andthereevaluationswereperformedat
1month,6month,1yearand2years.
The results were statistically analysed using Fisherexact test and KaplanMeier survival curves. The
significancelevelwas0.05,andtheanalysiswasperformedusingSPSSandStatistica7.0softwares.
Resultsanddiscussions.Duringthe2yearsofinvestigationtherewerenoreportedwithdrawalsofthepatients
or losses of the restorations by fracture or recurrent caries. All restorations received Alfa (A) or Bravo (B)
scores,beingconsideredclinicalacceptable(Fig.9).Thestatisticalanalysisrevealednosignificantdifferences
betweentheinvestigatedgroups(p>0.05).

b)

a)
Fig.9Gradiacompositeinlayrestoration:situationatbaseline(a),situationat2years(b)
After 2 years from application, no secondary caries and no composite inlays fracture were noticed,
maybe because of the short period of clinical investigation. Comparable and good results were obtained at
evaluation for the two materials. Their clinical performance was determined both by the quality of the
composite materials as well as by the combination of resin cement adhesive system used for the luting
procedure.
Conclusions. The two materials behaved similarly in time. After 2 years, both Gradia and BelleGlass inlays
presented some changes, regarding the marginal discoloration, surface coloration and marginal adaptation,
but,allrestorationsremainedclinicalacceptable.Theresultsandthestatisticalanalysisshowagreatsurvival
rateofthecompositeinlays,attwoyears,whichcouldindicateahighdurabilityoftheserestorationsintime.
Chapter10.Generalconclusions
1.Forthecorrectapplicationofcompositeinlaysandforassuringtheirclinicalsuccessitisveryimportantto
strictlyrespecteverystepofthemethodologyusedfortheirrealisation.Theaccomplishedresearchhelpedto
elaborate the clinical and technical protocol for composite inlay fabrication and application in the morpho
functionalteethrestoration.
2. The studies regarding the physicalchemical and mechanical properties of the Romanian experimental
compositematerialforindirectinlayrestorations,supportedbythestatisticalanalysis,showedthat:
BarodentcompositematerialhasmechanicalpropertiessimilartoBelleGlassandGradiamaterials,which
indicatestheabilitytobeusedforposteriorteethrestorationwithinlays.
ThephysicalandmechanicalpropertiesofBarodentcompositematerialhadbeeninfluencedbythetype
oforganicmatrix(BisGMAbasedresin)aswellasbythequantityandtypeofinorganicfiller(bariumglass,
21

colloidalsilica,quartz).Theimprovementinthematerialsformulationcouldameliorateitsproperties,and
perhapstoexceedsomeofthecharacteristicsofthealreadyknownmaterials.
The Romanian composite Barodent, as well as the materials used for control had water sorption and
solubility, but the mean values are in agreement with the international standard ISO 4049/2000: water
sorptionlessthan40g/mm3andsolubilitylessthan7.5g/mm3(after7daysofimmersion).
ThewatersorptionandsolubilityresultsofBarodentmaterialweredeterminedbyitscompositioni.e.the
smaller quantity of inorganic filler (65% wt) and the organic matrix based on hydrophilic monomers
(sensitivetowatersorption).
3. The scanning electron microscopy allowed the evaluation of the structure and marginal adaptation of
compositeinlays.Itcouldbeconcludedthat:
TheBarodentcompositematerialhadsimilarstructuralcharacteristicstotheBelleGlassmaterial.
TheuseofBarodentcompositeinlaysincombinationwiththeadequateresincementandadhesivesystem
isinthefavourofagoodmarginalsealofindirectrestorations.
4. The scanning electron microscopy performed on Barodent inlays luted with different adhesive systems
(experimental and wellknown) allowed the evaluation of the toothresin cementinlay interfaces and the
observationofthequalityofmarginaladaptation.Thefollowingconclusionscouldbeascertained:
In most of the cases, the toothresin cementcomposite inlay interfaces were continuous, with a good
marginaladaptationoftherestorations.
TheRomanianexperimentaladhesivesystems,thetwostepselfetch(AD3A)andonestepselfetch(AD
3B)adhesives,arecapableofproducingagoodadhesiontothedentalsubstrateandauniforminterface
betweenthetoothandtheresincement.Theseresultscouldbeexplainedbythehydroxyapatitefillerof
the adhesive systems; additional bonds between monomers, hydroxyapatite and the collagen from the
dentalstructuresareformed.
The selfetch experimental adhesives have a good compatibility with the resin cement used for
cementation.Theresultsarecomparabletothosefortheadhesivesusedascontrol.
Twostepselfetchadhesivesystemsseemtoformathickerandamorehomogenoushybridlayerthanthe
onestepselfetchadhesives.
These in vitro results show the benefit of the selfetch adhesives regarding their simplified clinical
protocol.Therefore,itisrecommendedtoevaluatetheefficiencyandtheadhesiondurabilityoftheself
etchadhesivesbyinvivostudies.
5.Theopticalmicroscopyandstatisticalanalysisallowedthequantitativeevaluationofthemicroleakagefor
composite inlays (Gradia, Barodent) and direct restorations (Gradia Direct X), as influenced by different
adhesivesystems,resincementsandrestorativematerials.Thefollowingconclusionscouldbedrawn:
Barodent and Gradia indirect composite resins had a similar behaviour regarding the marginal
microleakage in enamel and dentin, this being influenced by the resin cement used for inlay luting
procedure.
The etch and rinse adhesive systems, as well as their combination with a conventional dualcured resin
cement for inlay luting procedure, succeeded a good marginal seal in dentin and an optimal seal in
enamel.
Composite inlays represent a superior alternative for posterior teeth restoration, whenever the direct
restorativelimitsareovertaken.
Their marginal adaptation depends on the qualities of the resin cements and adhesive systems used for
cementation.
6.TheclinicalcomparativestudyoftheGradiaandBelleglassindirectcompositeresinsrevealedthesuccessful
useofinlaysforthemorphofunctionalandaestheticrestorationofposteriorteeth.
Thetwoinvestigatedmaterialshadsimilarbehaviorintime.Therewereobservedsmallchangesregarding
themarginalcoloration,surfacecolorationandmarginaladaptationforbothGradiaandBelleGlassinlays,
butallrestorationsremainedclinicalacceptable.
Thesurvivalrateat2yearsforcompositeinlayswasgreat,thatcouldindicatealongdurabilityofthese
restorationsoveragreatperiodoftime.
A longterm clinical evaluation is recommended in order to validate the clinical protocol for composite
inlay application and to confirm the advantages of this technique in posterior teeth morphofunctional
restoration.
22

Composite inlays represent good and durable restorations for the posterior teeth. The Barodent
composite is a Romanian experimental material that fulfils the requirements for indirect restorations. The
qualityofthemarginaladaptationforcompositeinlaysdoesnotdependonlyonthecompositematerialoron
theprotocolforrestorationsrealisation,butitisalsoinfluencedbythelutingmateriali.e.theresincement
with or without the adhesive system. The durability of the composite inlays is assured by the quality of the
restorativematerial,thecliniciansaccuracyduringeverystepoftheprotocolandthepatientsmotivationand
conscientiousness.
Selectivebibliography
Albers HF. Materials Science in ToothColored Restoratives: Principles and Techniques, 9th ed. London (UK):Bc
DeckerInc;2002.p.117,81110,111119
CanSayE,NakajimaM,SenawongseP,SoymanM,OzerF,OgataM,TagamiJ.Microtensilebondstrengthofafilled
vsunfilledadhesivetodentinusingselfetchcandtotaletchtechnique.JDent2006;34:283291
DeMunckJ,VanLanduytK,PeumansM,PoitevinA,LambrechtsP,BraemM,VanMeerbeekB.ACriticalReviewof
theDurabilityofAdhesiontoToothTissue:MethodsandResults.JDentRes2005;84(2):118132
FodorO,TigI,MoldovanM,PopoviciA,PopA.Adeziviidentinaricamijlocdeprotectieaplagiidentinare:unstudiu
electronomicroscopic.TransilvaniaStomatologic2007,2:2333
Hikita K, Van Meerbeek B, De Munck J, Ikeda T, Van Landuyt K, Maida T, Lambrechts P, Peumans M. Bonding
effectivenessofadhesivelutingagentstoenamelanddentin.DentMater2007;23:7180
KoubiS,FaucherA,BrouilletJL,WeissrockG,PertotW,VictorJL.Lesinlaysonlaysenrsinecomposite.Nouvelle
approche.InformationDentaire2006,5:194205
ManhartJ,ChenH,HammG,HickelR.BuonocoreMemorialLecture.ReviewOftheclinicalsurvivalofdirectand
indirectrestorationsinposteriorteethofthepermanentdentition.OperDent2004;29(5):481508
ManhartJ,ScheibenbogenFuchsbrunnerA,ChenHY,HickelR.A2yearclinicalstudyofcompositeandceramic
inlays.ClinOralInvest2000d;4:192198

Nicola C, Sava S, Moldovan M, Prejmerean C, Bondor C, Dudea D. Effect of adhesive system on microleakage in
classIIdirectcompositerestorations.JOptoelectronAdvM2008;10(4):954957
Nicola C. Materiale dentare: consideraii clinice i tehnologice.ClujNapoca: Casa Crii de tiin;2009. p.59
93,214236
PopoviciA,FodorO,MoldovanM,RomanA,BorzeaD.Invitrostudyofanewcompositebiomaterialforindirect
restorations.Optoelectron.AdvMaterRapidComm2008;2(12):891894
PopoviciA,TrifM,NicolaC,MoldovanM,FodorO,RomanA,SavaS,BarbuTL.Comparativestudyregardingsome
experimentalhydroxyapatiteadhesivesystems.JOptoelectronAdvMSymposia2009;1(1):203
Popovici A, Nicola C, Moldovan M, Bondor CI, Badet C, Roman A, Baciut G, Baciut M, Bran S. A microleakage
comparativestudyforindirectcompositerestorationsonposteriorteeth.JOptoelectronAdvM2009c;11(4):490493
Popovici A, Trif M, Moldovan M, Fodor O, Nicola C, Borzea D. Scanning electron microscopy evaluation of
compositeinlayslutedwithdifferentadhesivesystems.OptoelectronAdvMaterRapidComm2009;6(3):616620
Roman A, Popovici A, Pastrav O, Condor D. Odontologie restaurativ: ghid teoretic i clinic, Ed. Medical, Cluj
Napoca;2006.p.90112
Sideridou ID, Karabela MM, Vouvoudi EC. Dynamic thermomechanical properties and sorption characteristics of
twocommerciallightcureddentalresincomposites.DentMater2008;24:737743
SwiftEJ,SturdevantJR,RitterAV.ClassesIandIIIndirectToothColoredRestorations,inRobersonTM,Heymann
HO,SwiftEJEditors.SturdevantsArt&ScienceofOperativeDentistry,4thed.NewYork:MosbyInc;2002.P.569590
TerryDA,LeinfelderKF,MaragosC.DevelopingForm,Function,andNaturalAestheticswithLaboratoryProcessed
CompositeResinPartI,PractProcedAesthetDent2005a,17(5):AF

23


CURRICULUMVITAE
PERSONALDATA
Name,surname:POPOVICIANDRADA
Maritalstatus:married(nameaftermarriage:SOANC)
Dateofbirth:September16,1976
Nationality:Romanian
Personaladdress:INTRELACURIStreet,no.55,ClujNapoca,Romania
Electronicaddress:andrapopovici@yahoo.com
Professionaladdress:FacultyofDentalMedicine,IuliuHaieganuUniversityofMedicineandPharmacy,Victor
Babestreet,no.15,400023,ClujNapoca,Romania
EDUCATION
19831991
19911995

19952001

Secondarystudies:NatureScience College,ClujNapoca
HighSchoolstudies:Theoretical Collegeno.4,ClujNapoca
Overall average of 9,66; Major in chemistryphysics with an average of 9,32/10;
AttendancetoforeignlanguageOlympics
Facultyofdentistryatthe IuliuHatieganuU.M.F., ClujNapoca
Overallaverageof9,24/10;Licencedegreewithanaverageof9,73/10

POSTGRADUATESTUDIES
20012003
Internship,GeneralDentistryspecialtySpecialistdentist(jan.2004)
20032009
PhDStudent(MedicalScience/DentalMedicine;Prof.Dr.D.BORZEA)
2005
CertificateinMaxillofacialRadiologicalDiagnostic
20032008
Specialistdentist,GeneralDentistryspecialtySeniordentist(jan.2009)
PROFESSIONALACTIVITY
19962002
Voluntary activityasamedicalnursein ageneraldentistoffice
2003present DentistintheDentalPrivatePractice C.M.I.dr.PascuLaurentiu,ClujNapoca
20022003
InternattheDistrictClinicalHospitalof Cluj
2004present Assistant Professor, Faculty of Dental Medicine of the Iuliu Hatieganu UMF ClujNapoca
(Periodontology Department) Practical labs with students (Romanian and French lines),
elaboration/participationincourses
SPECIALISATIONSANDQUALIFICATIONS
Inforeigncountries:
JunSept2000 Socrates/Erasmus Scholarship Professional training at the Joseph Fourier Faculty of
Medicine,Grenoble,FranceCertificateofInternationalStudies
FebApr2002 RomanianGovernmentScholarship TrainingattheFacultyofOdontologyoftheAixMarseille
IIUniversity,Marsilia,FranceCertificateofAttendance
Feb2007
Course La protection du parodonte dans les reconstitutions coronaire, Socrates Teaching
MobilitysProgrammeSocratesattheFacultyofOdontologyoftheAixMarseilleIIUniversity,
Marsilia,FranceCertificateofAttendance
FebMar2008 AUF Research Specialisation Scholarship at the Faculty of Odontology of Victor Segalen
University,Bordeaux2,FranceCertificateofAttendance
InRomania:
Jan2001
PostGraduate Lecture Riscul alergic i anafilactic n practica stomatologic (Prof. Dr. A.
Rotaru)
20032005
PostGraduate lecture (Prof. F. Louise/Faculty of Odontology, Marsilia), Cluj Napoca:
Incidenteesteticealeafectiunilorparodontalesitratamentullor;Reconstructiapierderilorde
substan la nivelul crestei edentate; Chirurgia plastic parodontal, grefele epitelio
conjunctivesiconjunctive
MarApr2004 PostGraduatelectureRestaurrileintegralceramice (Prof.Dr.DorinBorzea/Dental
MorphologyDepartmentandProsthodonticsSemiology)
Apr2004
PostGraduatelectureRestaurareaesteticaarcadelordentareprininlayuriestetice (Conf.
Dr.DianaDudea/DentalMorphologyDepartmentandProsthodonticsSemiology)
Nov2004
PeriodontologyLectureRegenerareaparodontal:orientricliniceibiologice(Conf.Dr.
AlexandraRoman/PeriodontologyDepartment),ClujNapoca
24

Mar2005

Specialisation lecture (Prof.Dr. JeanLouis Brouillet/Faculty of Odontology, Marsilia, France),


ClujNapoca: Restaurri estetice n regiunea frontal. Tehnica indirect (faete, coroane);
Restaurri estetice n regiunea frontal. Tehnica direct tradiional i tehnica stratificrii
(materialulcompozitHFOMicerium)
Apr2005,
Mucogingival surgery lecture , Live OP Chirurgia plastica parodontala: noi tendinte
Apr.2006
transmisiune interactiva n direct (The German Society of Periodontology, Regensburg
FacultyofDentalMedicine,U.M.F.VictorBabes),Timisoara
Ian2006
Specialisation lecture Tratamentul mecanic i obturaia canalar prin condensare lateral
(Prof.JeanFrancois Peli i Prof. Dominique Oriez/ Faculty of Odontology, Victor Segalen
UniversityBordeaux2,France),ClujNapoca
Mai2006
PostGraduate specialisation lecture: Faete ceramice: evoluie spre stomatologia
restaurativ (Prof. Jean Franois Lasserre/ Faculty ofOdontology, Victor Segalen University
Bordeaux2);Incideneesteticeicorectareanboalaparodontal(Prof.F.Louise/Facultyof
Odontology,Marsilia),Bucharest
PRIZES/DIPLOMAS
Sep2000
Prize of the Romanian Association of Private Practice Dentists for the very good professional
activity
Dec2000
Diploma of talent for the remarkable professional results, offered by the Faculty of Dental
MedicineonoccasionoftheIuliuHatieganuUniversityDays.
MEMBEROFPROFESSIONALASSOCIATIONS

SSER(TheRomanianSocietyofAestheticDentistry);SRB(TheRomanianSocietyof
Biomaterials);CMDR(TheRomanianDentistAssociation)
FOREIGNLANGUAGESKNOWLEDGE

Frenchverygood;Englishverygood;Italiangood

SCIENTIFICACTIVITY

A.BOOKS
1.RomanA,PopoviciA,PastravO,CondorD,Odontologierestaurativ:ghidteoreticiclinic,EdituraMedical,
ClujNapoca,2006
2.RomanA,PopoviciA,CaraR,VitiucI.Ghidteoreticsipracticdeparodontologie,EdituraMedicalUniversitara
IuliuHatieganu,ClujNapoca,2008.

B.PUBLISHEDPAPERS
1. Popovici A, Borzea D, Pop A, Roman A, Pastrav O, Moldovan M, Prejmerean C. Study of the Physical and
MechanicalPropertiesofBiomaterialCompositesUsedinMixedCrowns.EngeneeringofBiomaterials,2005,
VIII(4753):1516
2.RomanA,PopoviciA.Interactiunibacterienenbiofilmuldentariconsecinteterapeutice.ClujulMedical2006;
LXXIX(4):639645
3.Roman A, Popovici A. Augmentarea gingiei keratinizate prin gref gingival liber. Prezentare de caz. Revista
RomndeChirurgieRinoSinusal2007;1(34):4145
4.FodorO,TigI,MoldovanM,PopoviciA,PopA.Adeziviidentinaricamijlocdeprotectieaplagiidentinare:
unstudiuelectronomicroscopic.TransilvaniaStomatologic2007,2:2333
5. Fodor O, Tig I, Moldovan M,Popovici A, Pop A. Proprietile mecanice a patrurini compozite. Transilvania
Stomatologic2007,2:3441
6.RomanA,PopoviciA.Locullambouluipoziionatcoronarntratamentulretraciilorgingivale;RevMedChirSoc
MedNatIai2007;III(1):254258(suppl1)
7.Popovici A, Seceleanu R, Roman A. Rehabilitation using endodontic and adhesive techniques in periodontal
disease.CasePresentation,JOralHealthDentalManagementBlackSeaCountries2008,VII(2):2022(suppl)
8. Popovici A, Roman A, Tassery H, Seceleanu R. Direct versus Indirect Resin Composite Restoration on the
PosteriorTeeth.RevistaRomndeMedicinDentar,2008,XI(4):5768

25

9. Popovici A, Fodor O, Moldovan M, Roman A, Borzea D. In vitro study of a new composite biomaterial for
indirectrestorations.Optoelectron.AdvMaterRapidComm2008;2(12):891894
10. Popovici A,Trif M, Nicola C, Moldovan M,Fodor O,Roman A, Sava S, Barbu TL. Comparative study regarding
someexperimentalhydroxyapatiteadhesivesystems.JOptoelectronAdvMSymposia2009;1(1):203
11.RomanA,PopoviciA.Regenerareaparodontalasociatxenogrefelorosoase.Discuiipebazaunuicazclinic.
RevistaRomndeChirurgierinosinusal2009;1(12):5154
12.PopoviciA,NicolaC,MoldovanM,BondorCI,BadetC,RomanA,BaciutG,BaciutM,BranS.Amicroleakage
comparativestudyforindirectcompositerestorationsonposteriorteeth.JOptoelectronAdvM2009;11(4):490
493
13. Popovici A, Trif M, Moldovan M, Fodor O, Nicola C, Borzea D. Scanning electron microscopy evaluation of
composite inlays luted with different adhesive systems. Optoelectron Adv MaterRapid Comm 2009; 6(3):616
620

C.WORKSATSCIENTIFICCOMMUNICATIONS
1. Fildan F, Covalcic IM, PopoviciA. Dificultati de diagnostic radiologic n fracturile mandibulare; Volumul de
rezumatealZilelorUniversitiideMediciniFarmacieIuliuHaieganu,Dec2000,ClujNapoca,p.154
2.RomanA,PastravO,PopoviciA.Restaurricomplexecuamalgamlapacientiicudeficientementale,Cahiersde
Resumeesde25mesJournesduCollgeNationaldesEnseignantsenOdontologieConservatrice,1315Jun2005
Bordeaux,Franta
3.Popovici A, Borzea D, Pop A, Roman A, Pastrav O, Moldovan M, Prejmerean C. Study of the Physical and
MechanicalPropertiesofBiomaterialCompositesUsedinMixedCrowns.BookofAbstractsoftheConferenceon
BiomaterialsinMedicineandVeterinaryMedicine,912Oct2005,Rytro,Polonia
4.Popovici A, Borzea D, Pastrav O, Moldovan M, Prejmerean C.Study of the Structure and Adhesion to Dental
TissuesofaCompositeBiomaterialusedinProtheticRestorations.CaietdeRezumatealInternationalCongressof
DentalMaterials,NapocaBiodent,912Nov2005,ClujNapoca,p.133
5. Popovici A,Borzea D, Moldovan M. In vitro study of a composite biomaterial for indirect restorations.
Proceedingsofthe20thEuropeanConferenceonBiomaterials,Nantes,France,27Sep1Oct2006,p.284.
6. Popovici A. Restaurarea coronar morfofuncional prin inlayuri compozite Masa rotund Estetic i
funcionalitate,ZileleU.M.F.IuliuHatieganu,Dec2006,ClujNapoca
7. Popovici A, Borzea D, Moldovan M,Trif M, Roman I, Alexandrescu E. Evaluation of the Marginal Integrity of
Composite Inlays Luted with Different Adhesive/Resin Cement Systems, Proceedings of the 21st European
ConferenceonBiomaterials,913Sept,2007,Brighton,UK,p.247
8.PopovicioancA,RomanA,CmpianR,CiobanC.Interdisciplinaryapproachinaggressiveperiodontitis:from
diagnosis to treatment in some clinical cases, Programme of 6th Congress of the European Federation of
Periodontology,46Jun2009,Stockholm,Sweden,p.50
9. Roman A, Popovici oanc A, Cmpian R. Free gingival graft: does it still find a place in periodontal plastic
surgery?Programmeof6thCongressoftheEuropeanFederationofPeriodontology,46Jun2009,Stockholm,
Sweden,p.50
10.Roman A, oanc A. Importana chirurgiei plastice parodontale n ameliorarea esteticii i funciei n
parodontiteleagresive.DentaFest,810Oct2009,Sibiu.

D.RESEARCHPROJECTS
1.ProjectPNIIPartnershipRolulpsihoterapieicognitivcomportamentalentratamentulchirurgicalparodontal:
unstudiucliniccontrolatPSIDENT,Grant42141/2008(Researcher).
2. Project PNIIPartnership Biomateriale complexe cu grad avansat de specificitate utilizate in tratamentele
endodonticeENDODENT,Grant72190/2008(Researcher).
3.ProjectPNIIIdeasEvaluareainterdisciplinararezultatelortratamentuluirecesiunilortisularemarginaleprin
grefegingivale,ID1341,Grant1213/2009(Researcher).

Date,
October2009

Signature,
Dr.AndradaPopovici

26