Consultants’ Comments

• “Overall the restorations have held up very well over time.”
• “Very slight wear was observed with some of the restorations, mostly at the occlusal surface.”
• “Looks very nice at 11 years.”
• “Even very large four-surface restorations have held up very well.”
• “I have noticed some yellowing in a few of the restorations.”
• “At times the surface is grainy, not perfectly glossy.”

Description

Alert is a packable posterior composite first introduced and evaluated by THE DENTAL ADVISOR in March 1999. Alert is highly filled (84% by weight) with glass fibers of various dimensions. It is stiff in consistency, packs well, is non-sticky, and can be cured in 5-mm increments. This product received a 92% clinical rating.

Clinical Evaluation Protocol

• A total of 651 posterior restorations were placed from 1998 to 2002.
• Three hundred and twenty four of these restorations have been in function for 10 years or longer (Figure 1).
• One hundred and thirty one restorations were available for recall and evaluation. They represented 1-, 2-, 3-, and 4-surface composites and were evaluated in the follow areas:
  • Resistance to fracture/chipping
  • Esthetics
  • Resistance to marginal discoloration
  • Wear resistance
• Each category was rated on a scale of 1 to 5: 1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent

Clinical Results

Resistance to Fracture/Chipping
Alert restorations have proven to be very durable at 10 years or more in function. Seventy-seven percent of the recalled restorations showed no fractures or chipping, while 15% exhibited very slight chipping and 5% more moderate chipping necessitating repair (Figure 2). Only 3% needed to be replaced.

Esthetics
Forty-seven percent of restorations were rated excellent for shade and esthetics blending well with the surrounding tooth (Figure 2). Thirty-three percent showed slight discoloration, while 19% showed moderate discoloration with consultants describing them as slightly yellow or opaque. While esthetics ratings have decreased over the 10 years, most restorations were still considered clinically acceptable. Only 1% was considered clinically unacceptable.

Resistance to Marginal Discoloration
Sixty-four percent of Alert restorations did not exhibit any marginal staining at 10 years (Figure 2). Twenty-seven percent showed slight staining while 9% showed more moderate staining at the margins. None of the restorations needed to be replaced because of staining.

Wear Resistance
Occlusal wear was not an issue at the five-year recall and it continues not to be an issue at the 10-year recall. Sixty-six percent of the restorations exhibited no wear at 10 years and 27% exhibited slight wear (Figure 2). Only 7% of the restorations exhibited moderate occlusal wear.

Conclusions
Alert performed very well at the 10-year recall with each category rating very highly:

• 92% of the restorations received very good to excellent ratings in lack of fracture or chipping.
• 80% of the restorations received very good to excellent ratings in the area of esthetics.
• 91% of the restorations received very good to excellent ratings in lack of marginal staining.
• 93% of the restorations received very good to excellent ratings in wear resistance.