Polymer-Infiltrated Ceramic Network Versus Smart Bioactive Self-Curing Composite for Cervical Restorations in...

Background and Objectives: Professional ballet dancers endure high occlusal loads, increasing cervical defect prevalence. Conventional composites fail frequently under such conditions. This randomized clinical trial (RCT) compared 24-month performance of a polymer-infiltrated ceramic network (PICN, VITA Enamic) versus a self-curing bioactive composite (Stela) for cervical restorations. Materials and Methods: Twenty professional ballet dancers (40 cervical defects: 21 carious, 19 abfraction) were enrolled in a paired split-mouth RCT. Each received one PICN inlay and one self-curing composite restoration on two non-adjacent defects. Restorations were assessed at 6, 12, and 24 months using United States Public Health Service (USPHS) criteria (primary: marginal integrity) and a dye penetration test. Secondary outcomes included secondary caries, hypersensitivity, and Oral Health Impact Profile-14 (OHIP-14). Statistical tests: McNemar, Fisher's exact, Kaplan-Meier, log-rank (α = 0.05). Results: At 24 months, marginal integrity (USPHS Alpha) was maintained in 91% of PICN restorations for carious defects and 89% for abfraction defects, compared to 70% and 50% for self-curing composite, respectively. No PICN restoration failed (0%). Self-curing composite failures were 20% (carious) and 30% (abfraction) (exploratory uncorrected p = 0.031; non-significant after correction). Dye penetration was lower for PICN in abfraction defects (11% vs. 60%, adjusted p = 0.048) but not in carious defects (9% vs. 30%, adjusted p = 0.317). Kaplan-Meier survival favoured PICN (log-rank p = 0.001); 24-month survival probability: PICN 100% (95% CI: 83-100%), self-curing composite 75% (95% CI: 55-95%). No secondary caries or serious adverse events occurred. Conclusions: PICN hybrid ceramic provided superior marginal integrity and zero failures over 24 months in cervical restorations of professional ballet dancers, outperforming the self curing composite. Within this high-risk population, PICN inlays are recommended for abfraction defects. However, because the study was conducted exclusively in professional ballet dancers, direct extrapolation to the general population should be made with caution. The self-curing composite may be considered for carious defects when light curing is problematic, but patients should be informed of higher failure risk. Longer studies are needed.