Five-year clinical evaluation of two adhesive systems in non-carious cervical lesions

Evaluation of surface microhardness and gingival marginal adaptation of three different bulk-fill flowable resin composites: A comparative study

OBJECTIVES

To evaluate surface microhardness and gingival marginal adaptation of three different bulk-fill flowable resin composites (FB-RBCs) in Class V cavities with enamel or dentin margins before and after thermocycling (TMC).

MATERIALS AND METHODS

Three available FB-RBCs were used; Palfique Bulk Flow (PaBF) (Tokuyama Dental), SDR Flow+ Bulk Fill Flowable (Dentsply Sirona), and I-Flow Bulk Fill (I-Dental). Thirty discs were prepared from each type of FB-RBCs. The discs were subjected to Vickers microhardness tester machine. Class V cavities were prepared on 180 molars. Gingival margins of half the specimens were prepared above CEJ and the other half below CEJ. Cavities were restored with FB-RBCs for gingival marginal adaptation test. Two-way ANOVA was used in microhardness, while three-way ANOVA was used for marginal adaptation.

RESULTS

The used materials showed statistically significant differences in microhardness and marginal adaptation.

CONCLUSIONS

Regarding microhardness, PaBF showed the highest value before TMC and SDR was the highest after TMC. Regarding marginal adaptation, SDR revealed the best marginal adaptation than PaBF and I-flow, either subjected to TMC or not.

CLINICAL SIGNIFICANCE

The longevity of cervical restorations depend on both the location of the cavity margin and the material used. The microfractures in resin composite surface due to low surface microhardness as well as marginal gaps seen in laboratory studies could be considered as an indicative parameter for clinical problem associated with marginal differences.

Eight-year clinical evaluation of two types of resin composite in non-carious cervical lesions

OBJECTIVES

In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite.

MATERIALS AND METHODS

Ninety non-carious cervical lesions (NCCLs) in 19 participants were involved in this trial. NCCLs were restored with a flowable composite (Clearfil Flow FX: FX, Kuraray Noritake, Japan) or a conventional resin composite (Clearfil AP-X: AP) in conjunction with a one-step self-etch adhesive (Clearfil S3 Bond). Each participant had both types of resin composite restorations that were randomly allocated. The restorations were evaluated at baseline and annually up to 8 years using modified USPHS criteria. The data were statistically analyzed using the Fisher's exact test, Kaplan-Meier method, and a multivariate Cox-regression with frailty models (p < 0.05).

RESULTS

The 8-year participant recall rate was 95%. One hundred percent retention was recorded for AP, whereas four out of 46 restorations were lost for FX during the 8 years. The incidence of marginal staining increased over time regardless of the type of resin composite, showing 48% for AP and 57% for FX after 8 years. Wear of the resin composite occurred only for the flowable material and there was a significant difference between the types of resin composite (p = 0.024). Overall survival rates at 8 years for AP and FX were 98% and 82% respectively (p = 0.110).

CONCLUSIONS

The flowable resin composite presented lower wear resistance and showed a lower survival rate compared with the conventional composite after eight years of clinical service.

CLINICAL RELEVANCE

Flowable resin composites may show greater wear after long-term clinical service.

TRIAL REGISTRATION NUMBER

UMIN000028745, Date of registration: August 19, 2017.

Clinical Performance of Filled/Nanofilled Versus Nonfilled Adhesive Systems in Noncarious Cervical Lesions: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions.

SUMMARY

Adhesive strategies in cervical lesions: systematic review and a network meta-analysis of randomized controlled trials

OBJECTIVES

A network meta-analysis (NMA) was performed to assess which adhesive strategy is most clinically effective in treating non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

Studies were identified by a systematic search of electronic databases including MEDLINE via PubMed, Brazilian Library in Dentistry (BBO), Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), Scopus, and Web of Science without restrictions on publication year or language. The grey literature was also consulted. Only randomized clinical trials that compared different adhesive strategies in NCCLs in adult patients were included. The risk of bias was evaluated by using the Cochrane Collaboration tool. A random-effects Bayesian mixed treatment comparison model was used to compare adhesive strategies (3ER, 2ER, 2SE, and 1SE) at different follow-up times. The surface under cumulative ranking curve (SUCRA) was estimated for each strategy. Heterogeneity was assessed by using the Cochran Q test and I² statistics. The quality of evidence was evaluated using the GRADE approach.

RESULTS

A total of 5058 studies were identified, 66 of which met the eligibility criteria and of these 5 were judged "low" risk of bias and 57 were meta-analyzed. We did not observe significant differences in the NMA analysis for any two pairs of adhesives, except for the shortest follow-up for 2ER vs 3ER. The material 2SE ranked highest, although it differed only slightly from the other bonding strategies.

CONCLUSIONS

No bonding strategy is better than the others.

CLINICAL RELEVANCE

Adhesive efficacy cannot be characterized by its bonding strategy.

Clinical efficacy of universal adhesives for the restoration of noncarious cervical lesions: A randomized clinical trial

Introduction

The efficacy of an adhesive agent is an important aspect in restoring noncarious cervical lesion (NCCL) as studies have proved that compromise in adhesive agent results in reduced bond strength. The purpose of this prospective randomized double-blind clinical trial was to evaluate the efficacy of the newly formulated "universal" dental adhesive in the restoration of NCCLs in permanent dentition using either a self-etch or a selective-etch approach.

Materials and Methods

The study was done following the consolidated standards of reporting trials. 100 NCCLs randomly divided into 2 groups were restored using G-Premio Bond adhesive and Genial flowable composite in selective etch mode and self-etch mode. Restorations were evaluated at 1 week, 6 months, and 12 months using modified US Public Health Service criteria for marginal staining, fracture, and postoperative sensitivity. Statistical analysis was performed using appropriate tests.

Results

Recall rates were 100%, 98%, and 78% at the evaluation time. The result showed that neither the self-etch nor the selective etch mode had significant difference in ALPHA/BRAVO/CHARLIE scores (P > 0.05). Percentage-wise comparison showed less changes reported in the selective etch group compared to self-etch group.

Conclusion

It was concluded that there was no statistical significance between the groups for the parameters evaluated, but selective etch performed better than self-etch group.

Impact of Different Etching Strategies on Margin Integrity of Conservative Composite Restorations in Demineralized Enamel

Good margin integrity with a tight seal of the adhesive interface is considered one of the key factors for the clinical success of composite restorations. This study investigated the effect of enamel etching with phosphoric acid on the margin integrity of self-etch bonded composite restorations in demineralized enamel. Crowns of bovine incisors were assigned into 14 groups (n = 10 per group) of which ten groups (groups 1–5 and 8–12) were demineralized (21 days, acid buffer, pH 4.95) to create artificial carious lesions. Standardized Class V cavities were prepared in all specimens. Demineralized groups were either etched with phosphoric acid for 10, 30, 60, or 120 s (groups 2–5 and 9–12), or no etching was performed (groups 1 and 8). The non-demineralized (sound) groups were etched for 10 s (groups 7 and 14) or remained non-etched (groups 6 and 13). Resin composite restorations were then placed using either a one-step (iBond Self Etch, groups 1–7) or two-step self-etch adhesive (Clearfil SE Bond, groups 8–14). Margin integrity of the restorations was assessed after thermocycling (5000×, 5–55 °C) using scanning electron microscopy, and the percentage of continuous margins (%CM) was statistically analyzed (α = 0.05). Phosphoric acid etching significantly increased %CM in both demineralized and sound enamel. For iBond Self Etch, a significant increase in %CM in demineralized enamel was observed with increased etching times. All etched groups treated with Clearfil SE Bond and those etched for 60 or 120 s and treated with iBond Self Etch showed similar %CM in demineralized enamel as in etched sound enamel, and significantly higher %CM than in non-etched sound enamel. In conclusion, enamel etching with phosphoric acid improves margin integrity of composite restorations in demineralized enamel when bonded with the examined adhesives.

Chemistry of novel and contemporary resin-based dental adhesives

The chemistry of resin-based dental adhesives is critical for its interaction with dental tissues and long-term bonding stability. Changes in dental adhesives composition influences the materials' key physical-chemical properties, such as rate and degree of conversion, water sorption, solubility, flexural strength and modulus, and cohesive strength and improves the biocompatibility to dental tissues. Maintaining a suitable reactivity between photoinitiators and monomers is important for optimal properties of adhesive systems, in order to enable adequate polymerisation and improved chemical, physical and biological properties. The aim of this article is to review the current state-of-the-art of dental adhesives, and their chemical composition and characteristics that influences the polymerisation reaction and subsequent materials properties and performance.

Do Tooth- and Cavity-related Aspects of Noncarious Cervical Lesions Affect the Retention of Resin Composite Restorations in Adults? A Systematic Review and Meta-analysis

PURPOSE

The purpose was to perform a systematic review and meta-analysis based on the following research question: do tooth- and cavity-related aspects of noncarious cervical lesions (NCCLs) affect the retention of composite restorations?

METHODS

Randomized clinical trials (RCTs) that evaluated the retention rate of resin restorations in NCCLs were included for the identification and comparison of their characteristics. The search was conducted in PubMed and adapted for Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions until July 2018. Unpublished and ongoing trial registries were also searched. The Cochrane Collaboration tool was used for assessing risk of bias. The quality of the evidence was graded using the Grading of Recommendations: Assessment, Development and Evaluation. Using the random effects model, a meta-analysis was conducted for each aspect (arch distribution, tooth location, wear facets, dentin sclerosis, shape, size, depth, occluso-gingival distance, and margin location).

RESULTS

We retrieved 6738 articles. After removal of duplicates and nonrelevant articles, 24 RCTs remained. The anterior tooth location favored the retention rates of restoration of NCCLs (relative risk [RR], 1.08; 95% confidence interval [CI], 1.00-1.16). The presence of wear facets is a risk factor for the retention of restorations (RR, 0.91; 95% CI, 0.83-0.99). The evidence was moderate for arch distribution and low or very low for all other factors because of heterogeneity, imprecision, and inconsistency.

CONCLUSION

The tooth location and the presence of wear facets can affect the retention of composite resins in NCCLs.

Evaluation of Three Esthetic Restorative Materials Used for Carious or Noncarious Cervical Lesion Restoration

Background: Cervical lesions appear on the cervical surface of the lingual or buccal side of the tooth and are classified into carious and non-carious lesions.

Aim: The present study evaluates the performance of three different types of aesthetic restorative materials, used for the restoration of carious or non-carious cervical lesions.

Materials and methods: The study comprised 195 cervical lesions in 45 patients. The restorations were carried out for non-carious cervical lesions in 34.62% of the cases, for primary carious lesions in 40.00% of the cases, and to replace a previous restoration in 25.38% of the cases. The restorations were evaluated at 2 weeks (the reference line), and then at 1 and 2 years after placement. The following have been assessed: restoration retention, color harmonization, surface texture, margin discoloration, anatomical contour, margin integrity, and the presence of secondary caries. The characteristics were registered in conformity with the modified USPHS criteria.

Results: At the one-year evaluation, we noticed the loss of 12 restorations, and after 2 years, the loss of 19 restorations. The results showed significant differences between restorative materials regarding color, margin adaptation, margin coloration, surface texture, as well as criteria regarding the anatomical contour (p <0.05).

Conclusions: The evaluation of the success of restorative material retention must consider the location of the cervical lesion. A successful treatment depends particularly on a full understanding of the factors that caused the lesions and on the method of their treatment.

Compliance of Randomized Clinical Trials in Noncarious Cervical Lesions With the CONSORT Statement: A Systematic Review of Methodology

The literature was reviewed to evaluate the compliance of randomized clinical trials (RCTs) with the CONsolidated Standards of Reporting Trials (CONSORT ) and the risk of bias of these studies through the Cochrane Collaboration risk of bias tool (CCRT). RCTs were searched at Cochrane Library, PubMed, and other electronic databases to find studies about adhesive systems for cervical lesions. The compliance of the articles with CONSORT was evaluated using the following scale: 0 = no description, 1 = poor description, and 2 = adequate description. Descriptive analyses about the number of studies by journal, follow-up period, country, and quality assessments were performed with CCRT for assessing risk of bias in RCTs. One hundred thirty-eight RCTs were left for assessment. More than 30% of the studies received scores of 0 or 1. Flow chart, effect size, allocation concealment, and sample size were more critical items, with 80% receiving a score of 0. The overall CONSORT score for the included studies was 15.0 ± 4.8 points, which represents 46.9% of the maximum CONSORT score. A significant difference among countries was observed (p&lt;0.001), as well as range of year (p&lt;0.001). Only 4.3% of the studies were judged as at low risk; 36.2% were classified as having unclear risk and 59.4% as having high risk of bias. The adherence of RCTs evaluating adhesive systems to the CONSORT is low with unclear/high risk of bias.

Influence of Surface Treatment on Composite Adhesion in Noncarious Cervical Lesions: Systematic Review and Meta-analysis

The purpose of this study was to analyze the influence of dentin surface treatments on the retention rate of resin composite restorations in non-carious cervical lesions (NCCLs). Seven randomized clinical trials were included in this review. Data regarding retention rate, type of surface treatment, and the main characteristics of studies were analyzed. Two reviewers performed a literature search up to December 2016 in eight databases: PubMed (Medline), Lilacs, Ibecs, Web of Science, BBO, Scopus, Scielo and The Cochrane Library. Only clinical trials evaluating dentin surface treatments in resin composite restoration in NCCLs were included. Noncontrolled clinical trials, reviews, editorial letters, case reports, case series and studies published in a language other than English, Portuguese, or Spanish were not included. The included studies evaluated different surface treatments, such as using an adhesive system with a frictional technique, drying the dentin, and removing sclerotic dentin by using a bur and applying EDTA before primer use. The analysis considering the mechanical removal of dentin surface with a bur and the application of an adhesive system in a frictional mode showed these treatments improved retention rates of the resin composite restorations in NCCLs ( p<0.05). There is evidence in the literature suggesting that the mechanical removal of dentin surface with a bur and the application of an adhesive system in a frictional mode could improve the retention rates of resin composite restorations in NCCLs. However, the studies showed high heterogeneity, and additional clinical trials are needed to determine the best dentin treatment option in NCCLs.

Influence of adhesive strategy on clinical parameters in cervical restorations: A systematic review and meta-analysis

OBJECTIVES

We aimed to answer the following PICO question: "Is the risk of postoperative sensitivity (POS), retention rates and marginal discoloration of composite restorations [CR] bonded with self-etch (SE) in non-carious cervical lesions (NCCLs) of adults equals to etch-and-rinse (ER) adhesives?".

METHODS

A comprehensive search was performed in May 2016 in the MEDLINE, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE, abstracts of IADR, unpublished and ongoing trials registries, dissertations and theses without restrictions. Only randomized clinical trials that compared composite resin restorations placed with self-etch and etch-and-rinse in NCCLs were included. After removal of duplicates and non-eligible articles, 50 articles from 42 studies (follow-ups of the same study were merged) remained for synthesis of the risk of bias (Cochrane Risk of bias tool).

RESULTS

Thirteen studies were at "high" risk of bias, yielding 29 studies for meta-analysis. No difference on the POS after restoration placement (risk ratio [RR] 1.04; 95% CI 0.81 to 1.34) as well as in the retention rates for all follow-up periods was observed. The etch-and-rinse approach produced less marginal discoloration at 18 months to 2 years (RR 1.51; 95% CI 1.21 to 1.90) and at 4 to 5 years (RR 1.81; 95% CI 1.28 to 2.55) (p<0.0007).

CONCLUSIONS

The adhesive strategy did not influence the POS and the retention rates of composite resin in NCCLs in any of the follow-up periods; but less marginal discoloration was found in etch-and-rinse adhesives.

CLINICAL SIGNIFICANCE

Composite resin restorations placed with self-etch and etch-and-rinse adhesives produce restoration with the similar clinical service and POS, however using etch-and-rinse adhesives one can reduce marginal discoloration. PROSPERO registration number: CRD42015019533.

The Survival of Class V Composite Restorations and Analysis of Marginal Discoloration

The aims of this retrospective clinical study were to analyze the longevity of class V composite restorations and compare the results obtained from clinical and laboratory evaluation of marginal discoloration. A total of 186 restorations were evaluated with modified US Public Health Service criteria. Longevity and associated variables were analyzed with the Kaplan-Meier method and a Cox proportional hazard model. Restorations with marginal discoloration were additionally evaluated using digital photographs and epoxy resin replicas under a stereomicroscope. The mean survival time was 15.0 years, with five- and 10-year survival rates of 95.5% and 83.1%, respectively. Z250 had a higher risk of failure (hazard ratio=7.01, 95% confidence interval=2.07-23.72) than Z100. In addition, the presence of occlusal wear facets and bleeding on probing were associated with an increased risk of failure of the restorations. However, the use of an adhesive system (Scotchbond Multi-Purpose or Clearfil SE Bond) did not affect the longevity of the restorations. The results of laboratory evaluation were significantly different from clinical evaluation (p&lt;0.001, McNemar test). Among 55 restorations rated as Bravo in the clinical evaluation, 24 restorations (43.6%) were determined to have penetrating discoloration on laboratory evaluation. When evaluating aged composite restorations, surface refurbishment and the use of a microscope are recommended, which will be helpful in determining the need for timely repair or replacement.

Selective enamel etching in cervical lesions for self-etch adhesives: A systematic review and meta-analysis

OBJECTIVES

To identify if selective etching of enamel (SEE) margins improves the retention rates and marginal discoloration of cervical composite restorations in non-carious cervical lesions (NCCLs) of adult patients.

SOURCE

MEDLINE, Scopus, Web of Science, LILACS, BBO Library, Cochrane Library and SIGLE were searched without restrictions, as well as IADR abstracts and gray literature via trial registries. Dissertations and theses were searched using the ProQuest Dissertations and Periódicos Capes Theses databases.

STUDY SELECTION

We included randomized clinical trials that compared the clinical effectiveness of SEE using the self-etch adhesive for direct composite resin restorations in NCCLs in the permanent dentition.

DATA

After removal of duplicates, 2689 articles were identified. Following screening of abstracts, 10 studies remained in the qualitative synthesis. Seven were considered to be at "low" risk of bias. The report of the studies varied from 1 to 5 years. Except for one-year follow-up, there was a significantly lower marginal discoloration and marginal adaptation during all follow-up periods. Significantly less loss of retention of restorations at the 3-year follow-up was observed with the selective enamel etching technique.

CONCLUSIONS

Selective enamel prior to application of self-etch adhesive systems in NCCLs might improve clinical performance of resin-composite cervical restorations, although further long-term research is required to confirm this.

CLINICAL SIGNIFICANCE

Selective enamel etching prior to application of self-etch adhesive systems in NCCLs can produce composite restorations with higher longevity.

Six-year clinical performance of etch-and-rinse and self-etch adhesives

OBJECTIVE

To evaluate the 6-year clinical performance of Xeno IV, Xeno III, and XP Bond adhesives in the restoration of non-carious cervical lesions (NCCLs).

METHODS

This was a randomized controlled clinical trial where 39 participants met the inclusion/exclusion criteria and were enrolled. Lesions restored were notch-shaped NCCLs. Prior to adhesive procedures, NCCLs were roughened. No enamel bevel was placed and no mechanical retention was created. Adhesive systems were applied following manufacturer's instructions and the NCCLs were restored with composite resin (TPH(3)). Restorations were finished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, and secondary caries using modified USPHS criteria. Descriptive statistics were performed. Logistic regression models were performed for each outcome separately with compound symmetry correlation structure where teeth were clustered by participants. All analyses were conducted using SAS 9.2.

RESULTS

The 6-year recall rate was 77.5% of the restorations (76.9% of the participants). No statistical differences were found between adhesives for retention, marginal discoloration, and marginal adaptation. Restorations failed by loss of retention (16.7%, 27.6%, and 11.8% of Xeno IV, Xeno III, and XP Bond restorations, respectively) and marginal discoloration (7.4% of Xeno IV restorations). For every unit increase in restoration volume it was 1.31 (95%C.I. 1.05, 1.63, P=0.01) times more likely that the restoration retention would be maintained.

SIGNIFICANCE

The tested adhesive systems presented similar clinical performance after six years of service, with annual failure rates of 2.8%, 4.6%, and 2.0% for Xeno IV, Xeno III, and XP Bond, respectively.

One-year clinical evaluation of the bonding effectiveness of a one-step, self-etch adhesive in noncarious cervical lesion therapy

This study evaluated the one-year clinical performance of a one-step, self-etch adhesive (Optibond All-in-One, Kerr, CA, USA) combined with a composite (Herculite XRV Ultra, Kerr Hawe, CA, USA) to restore NCCLs with or without prior acid etching. Restorations performed by the same practitioner were evaluated at baseline and after 3, 6, and 12 months using modified USPHS criteria. At 6 months, the recall rate was 100%. The retention rate was 84.2% for restorations with prior acid etching, but statistically significant differences were observed between baseline and 6 months. Without acid etching, the retention rate was 77%, and no statistically significant difference was noted between 3 and 6 months. Marginal integrity (93.7% with and 87.7% without acid etching) and discoloration (95.3% with and 92.9% without acid etching) were scored as Alpha or Bravo, with better results after acid etching. After one year, the recall rate was 58.06%. Loss of pulp vitality, postoperative sensitivity, or secondary caries were not observed. After one year retention rate was of 90.6% and 76.9% with and without acid conditioning. Optibond All-in-One performs at a satisfactory clinical performance level for restoration of NCCLs after 12 months especially after acid etching.

Shear bond strength of self-adhering flowable composite on dentin with and without application of an adhesive system

PURPOSE

The aim of this study was to evaluate the shear bond strength (SBS) of conventional and self-adhering flowable resin composites on the dentin surfaces of primary and permanent teeth and to evaluate the effect of the application of an adhesive system under self-adhering flowable resin composite on SBS.

METHODS

Prepared permanent and primary tooth dentin surfaces were randomly distributed into 3 groups according to application protocols as follows: group 1: Vertise Flow; group 2: OptiBond + Filtek Ultimate; and group 3: OptiBond + Vertise Flow. A universal testing machine was used to measure SBS of prepared specimens, and data were analyzed using 1-way ANOVA and Tukey test.

RESULTS

Statistically significant differences were observed among all groups for primary and permanent teeth (P<0.05). The highest values were observed in group 2, followed by group 3, in both permanent and primary teeth. SBSs of all groups were significantly higher for permanent teeth than for primary teeth (P<0.05).

CONCLUSION

Although SBS values of Vertise Flow groups were lower than those for conventional flowable resin composite groups, with further developments in material technology, self-adhering materials could be promising materials especially for pediatric dentistry.

Retention of tooth-colored restorations in non-carious cervical lesions--a systematic review

OBJECTIVES

The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs).

METHODS

Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013.

RESULTS

Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed.

CONCLUSION

The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.

A New Universal Simplified Adhesive: 18-Month Clinical Evaluation

Purpose

To evaluate the 18-month clinical performance of a multimode adhesive (Scotchbond Universal Adhesive, SU, 3M ESPE, St Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria.

Materials and Methods

Thirty-nine patients participated in this study. Two-hundred restorations were assigned to four groups: ERm, etch-and-rinse + moist dentin; ERd, etch-and-rinse + dry dentin; Set, selective enamel etching; and SE, self-etch. The composite resin, Filtek Supreme Ultra (3M ESPE), was placed incrementally. The restorations were evaluated at baseline, and at 18 months, using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed using Friedman repeated-measures analysis of variance by rank and McNemar test for significance in each pair (α=0.05).

Results

Five restorations (SE: 3; Set: 1; and ERm: 1) were lost after 18 months (p&gt;0.05 for either criteria). Marginal staining occurred in four and 10% of the restorations evaluated (p&gt;0.05), respectively, for USPHS and FDI criteria. Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38%, 40%, 36%, and 44% for groups ERm, ERd, Set, and SE, respectively, when the FDI criteria were applied (p&gt;0.05). However, when semiquantitative scores (or SQUACE) for marginal adaptation were used, SE resulted in a significantly greater number of restorations, with more than 30% of the total length of the interface showing marginal discrepancy (28%) in comparison with the other groups (8%, 6%, and 8%, respectively, for ERm, ERd, and Set).

Conclusions

The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy. The only differences between strategies were found for the parameter marginal adaptation, for which the FDI criteria were more sensitive than the USPHS criteria.

One-Year Evaluation of a Simplified Ethanol-Wet Bonding Technique: A Randomized Clinical Trial

The objective of this randomized clinical trial was to evaluate the clinical performance of adhesive restorations using a three-step etch-and-rinse adhesive (TSER), a one-step self-etching adhesive (OSSE), and a simplified ethanol-wet bonding technique (EWBT) prior to the application of a composite resin in non-carious cervical lesions. Ninety-three restorations (31 for each group) were placed in 17 patients by a single operator. No cavity preparation was performed. After 6 and 12 months, the restorations were assessed by two previously trained examiners using modified Ryge criteria for retention (kappa=1.00) and marginal adaptation/staining (kappa=0.81), and the results were analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups at the 6- and 12-month time points for any of the assessed criteria (p≥0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the baseline/12-month time intervals in marginal adaptation in OSSE (p=0.0180) and in marginal staining in TSER (p=0.0117). The survival analysis for retention criteria performed using a log-rank test did not show significant differences (p>0.05). The restorations placed using the simplified EWBT performed equally well as the other adhesive strategies employed.

Marginal adaptation of direct class II composite restorations with different cavity liners

The aim of this study was to evaluate how cavity linings with different elastic modulus can influence the marginal adaptation (MA) of Class II composite restorations before and after thermo-mechanical loading.

MATERIALS AND METHODS

Forty Class II cavities with margins extending 1 mm below the cement-enamel junction were prepared in extracted human third molars. In each group except the control group, a lining material of 1-mm thickness was applied to the bottom of the cavity and polymerized before placing the resin composite Herculite XRV Ultra (group A: control; group B: Premise Flowable lining; group C: Herculite XRV Ultra lining; and group D: Optibond FL lining). MA was evaluated (with a scanning electron microscope) before and after loading (200,000 loading cycles). Statistical analysis was done using the Shapiro-Wilks test, the analysis of variance test, and Duncan post hoc test at p<0.05.

RESULTS

Before loading, the percentages of continuous margins in dentin were superior (p<0.05) for groups C and D (71.1% and 87.2%, respectively) compared to groups A and B (55.7% and 48.3%, respectively). After loading, group D (79.8%) was statistically superior in dentin compared to all of the other groups (43.6%, 35.9%, and 54.4%, respectively). In occlusal enamel, no significant difference was found between groups. The percentage of enamel fractures and the percentage of noncontinuous margins in proximal enamel were high, with no significant difference between liners. It can be concluded that for the materials used in this study, a 1-mm-thick lining with an extremely low elastic modulus (2-3 GPa) could redistribute shrinkage stress. The use of a flowable composite did not significantly improve MA.

The Clinical Effectiveness of Various Adhesive Systems: An 18-Month Evaluation

The aim of this clinical trial was to compare the clinical performance of three different adhesive systems over 18 months in noncarious cervical lesions (NCCLs). Thirty patients, with at least three noncarious cervical lesions, were enrolled in the study. One operator randomly restored a total of 90 lesions with resin composite (Herculite XRV). The restorations were bonded with either Optibond FL (OF), three-step total-etch; Optibond Solo Plus (OS), two-step total-etch; or Optibond All-In-One (OA), one step self-etch. The restorations were clinically evaluated at baseline and after six, 12, and 18 months using the eight United States Public Health Services criteria. Data were analyzed using Friedman and Wilcoxon signed ranks tests (p&lt;0.05). After 18 months, the retention rate was (OF) 96.5%, (OS) 93.1%, and (OA) 89.7%. Differences among the three adhesive systems for evaluated criteria were not observed in comparison of the mean Alfa score percentages. There was a significant increase in marginal discoloration for (OA) adhesive after 18 months compared with baseline (p=0.011). Other restoration criteria had no statistically significant differences among the three adhesives (p&gt;0.05). With the exception of marginal discoloration, the clinical effectiveness of three types of adhesive systems in NCCLs was acceptable after 18 months. However, using the one-step self-etch adhesive may lead to some marginal discolorations.

Clinical evaluation of different adhesives used in the restoration of non-carious cervical lesions: 24-month results

BACKGROUND

The aim of this study was to compare after 24 months the clinical performance of cervical restorations placed with the use of an etch-and-rinse and an all-in-one adhesive.

METHODS

Twenty-four patients with at least one pair of non-carious cervical lesions participated in this study. One hundred and twenty-three cervical lesions were restored (62 etch-and-rinse adhesive, Solobond M; 61 all-in-one adhesive, Futurabond NR). A nanohybrid resin composite, Grandio, was used as the restorative material. Restorations were evaluated according to modified USPHS criteria by two independent examiners. The survival rates of the restorations were calculated by the Kaplan-Meier estimator and log-rank test. The restorations in each category were compared using the Pearson chi-square test, while the performance of restorations at the baseline and at each recall time was evaluated by McNemar's test (p < 0.05).

RESULTS

The recall rate of patients was 100%. The retention rates were 82% and 75% at 6 months and 77% and 62% at 12 months for Solobond M and Futurabond NR, respectively. At the 24-month recall, the retention rate was 69% for Solobond M and 49% for Futurabond NR, and this difference was statistically significant (p < 0.05). No statistically significant difference was found for colour match, marginal staining, or marginal adaptation between the adhesives (p > 0.05). None of the restorations had secondary caries, loss of anatomical form, or surface texture changes.

CONCLUSIONS

Cervical restorations placed with an etch-and-rinse adhesive showed higher retention than an all-in-one adhesive.

Effect of substrate age and adhesive composition on dentin bonding

PURPOSE

To study the effect of dentin age and adhesive composition on the microtensile dentin bond strengths (μTBS) of five dentin adhesives.

MATERIALS AND METHODS

Sixty extracted caries-free human teeth were assigned to the appropriate age group: less than 21 years of age (<21), 21-40 years of age (21-40), and greater than 40 years of age (>40). For each age group, specimens were randomly divided into five dentin adhesives: (1) Adper Easy Bond (EB, 3M ESPE), a one-step self-etch adhesive; (2) Experimental Adper Easy Bond without the Vitrebond Co-polymer (CP) (EBnoCP, 3M ESPE); (3) Adper Single Bond Plus (SB, 3M ESPE), a two-step etch&rinse adhesive; (4) Experimental Adper Single Bond Plus without CP (SBnoCP, 3M ESPE); and (5) Adper Scotchbond Multi-Purpose (MP, 3M ESPE), a three-step etch&rinse adhesive, as the control group. Specimens were sectioned in X and Y directions and the resulting beams were tested to failure in tension mode at a crosshead speed of 1 mm/min. Statistical analysis was computed using t-test and two-way analysis of variance followed by Fisher least significant difference multiple comparison post hoc test at p < 0.05.

RESULTS

The highest mean μTBS values were obtained in the control group (MP) for all age groups. EB resulted in statistically similar mean μTBS compared to EBnoCP for all age groups: p = 0.538 for (<21); p = 0.974 for (21-40); and p = 0.909 for (>40). SB resulted in statistically higher mean μTBS than SBnoCP for all age groups [p<0.009 for (<21); p<0.028 for (21-40); and p<0.041 for (>40)]. MP, the control group, resulted in statistically lower mean μTBS when applied to the oldest age group (>40) compared to the youngest age group (<21), at p < 0.04. When means were pooled for the variable 'age group,' SB resulted in significantly higher mean μTBS than SBnoCP at p < 0.009, while EB resulted in statistically similar mean μTBS compared to EBnoCP (p=0.9). MP resulted in statistically higher mean μTBS than all other adhesives-SB (p<0.0001), SBnoCP (p<0.0001), EBnoCP (p<0.022), and EB (p<0.046).

CONCLUSIONS

The substrate age influenced the bonding ability of the three-step etch&rinse adhesive. The presence of a carboxylic-based polymer (CP) enhanced the bonding ability of the two-step etch&rinse adhesive.

Two-year clinical evaluation of three adhesive systems in non-carious cervical lesions

Objectives

Adhesive systems are continuously being introduced to Dentistry, unfortunately often without sufficient clinical validation. The aim of this study was to evaluate the clinical performance of cervical restorations done with three different adhesive systems.

Material and methods

158 non-carious cervical lesions of 23 patients were restored with a nanofilled composite resin (Filtek Supreme, 3M/ESPE) combined with Single Bond (3M/ESPE, group SI), Clearfil SE (Kuraray Medical Inc., group CL) and Xeno III (De Trey Dentsply, group XE). In groups SI-B, CL-B and XE-B, the outer surface of the sclerotic dentin was removed by roughening with a diamond bur before application of the respective adhesive systems. In groups CL-BP and XE-BP, after removal of the outer surface of the sclerotic dentin with the bur, the remaining dentin was etched with 37% phosphoric acid and the self-etch adhesive systems Clearfil SE and Xeno III were applied, respectively. Lesions were evaluated at baseline, and restorations after 3 months, 1 year and 2 years using modified USPHS criteria.

Results

After 2 years, no significant difference was found between the retention rates of the groups (p >0.05). Although groups CL and SI showed significantly better marginal adaptation than group XE (p<0.05) at 2 years, no significant difference was found between the marginal adaptation of the groups SI-B, CL-B and XE-B (p>0.05). After 2 years no significant difference was observed among the marginal staining results of all groups (p>0.05).

Conclusion

Although all adhesive systems showed similar retention rates, Clearfil SE and Single Bond showed better marginal adaptation than Xeno III after 2 years of follow-up.

Two-year clinical evaluation of composite resins in non-carious cervical lesions

OBJECTIVE

The purpose of this double-blind, randomised trial was to compare the clinical performance of a hybrid composite (Clearfil AP-X, Kuraray, Tokyo) and a nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN) over a period of 2 years in non-carious class V lesions using a modified US Public Health Service (USPHS) system.

METHODS

Forty-six patients with at least one pair of equivalent non-carious cervical lesions under occlusion and a mean age of 44.1 years (range 27-66 years; median 45 years) were enrolled in this study. A total of 116 restorations (58 with each material) were placed according to manufacturer's instructions by two calibrated operators. The restorations were evaluated at baseline and at 6, 12 and 24 months after placement using the USPHS criteria for retention, colour match, marginal discolouration, marginal adaptation, anatomic form, surface texture and secondary caries. Statistical analysis was conducted using the Cochran and the McNemar tests at a significance level of 5% (P < 0.05).

RESULTS

No surface texture changes or secondary caries were detected in association with any restorations. The retention rates for Clearfil AP-X (100%) and for Filtek Z350 (91.38%) did not differ significantly (P > 0.05). Two Z350 restorations were completely lost after 2 years. No significant differences were observed in the colour match, marginal discolouration, marginal adaptation or anatomic form.

CONCLUSIONS

There were no significant differences in the clinical performances between the materials.

CLINICAL RELEVANCE

Both restorative materials exhibited acceptable clinical performance in class V non-carious lesions 2 years post-restoration.

Randomized Clinical Trial of Four Adhesion Strategies: 18-Month Results

Clinical Relevance

SUMMARY

Statement of the Problem

With Institutional Review Board approval, 39 patients who needed restoration of noncarious cervical lesions (NCCLs) were enrolled in this study. A total of 125 NCCLs were selected and randomly assigned to four groups: 1) a three-step etch-and-rinse adhesive, Adper Scotchbond Multi-Purpose (MP, 3M ESPE, St Paul, MN, USA); 2) a two-step etch-and-rinse adhesive, Adper Single Bond Plus (SB, 3M ESPE); 3) a two-step self-etch adhesive, Adper Scotchbond SE (SE, 3M ESPE); and 4) a one-step self-etch adhesive, Adper Easy Bond (EB, 3M ESPE). A nanofilled composite resin was used for all restorations. Restorations were evaluated at six months and 18 months using modified U.S. Public Health Service (USPHS) parameters.

Results

At six months after initial placement, 107 restorations (85.6% recall rate) were evaluated. At 18 months, 94 restorations (75.2% recall rate) were available for evaluation. The 6 mo/18 mo overall retention rates (%) were 100/90.9 for MP; 100/91.7 for SB; 100/90.9 for SE; and 96.4/92.3 for EB with no statistical difference between any pair of groups at each recall. Sensitivity to air decreased significantly for all adhesives from the preoperative to the postoperative stage and was stable thereafter. Interfacial staining did not change statistically from baseline to six months; however, interfacial staining at the enamel margins was statistically worse at 18 months than at baseline for the two self-etch adhesives EB and SE. Marginal adaptation was statistically worse at 18 months compared with baseline only for EB. This tendency was already significant at the six-month recall.

Conclusion

Although 18-month retention was similar for the different adhesion strategies, enamel marginal deficiencies were more prevalent for the self-etch adhesives.

Restoration of noncarious cervical lesions: when, why, and how

At this time, restoration of noncarious cervical lesions (NCCLs) is a common occurrence in clinics nowadays. Some reasons for this are the growth of the elderly population, a smaller rate of tooth loss, and possibly the increase of some etiologic factors. These factors include inadequate brushing techniques in gingival recession cases, corrosive food and drink consumption, and occlusal stress concentrating factors (occlusal interferences, premature contacts, habits of bruxism, and clenching). Unfortunately, Class V restorations also represent one of the less durable types of restorations and have a high index of loss of retention, marginal excess, and secondary caries. Some causes for these problems include difficulties in isolation, insertion, contouring, and finishing and polishing procedures. This work aims to help dentists in choosing the best treatment strategy, which necessarily involves steps of problem identification, diagnosis, etiological factor removal or treatment, and, if necessary, restoration. Finally, appropriate restorative techniques are suggested for each situation.

Clinical effectiveness of contemporary dentin bonding agents

Aim:

The purpose of this paper is to review the literature on the clinical effectiveness of contemporary resin-based dentin bonding agents primarily focussing on the longevity of restoration.

Materials and Methods:

The literature published from June 2004 up to September 2010 was reviewed for clinical trials that tested the effectiveness of dentin bonding agents in the longevity of noncarious class V restoration. Results of each study reported using the USPHS criteria for clinical assessment of restoration were included and tabulated. The American Dental Association guidelines for dentin and enamel adhesives were used as a reference to compare the performance of individual bonding agents. Kruskal–Wallis followed by Mann–Whitney U was done to compare the mean Alfa score percentage for the three categories of bonding systems [etch-and-rinse (ER), self-etch primer (SEP), and self-etch-adhesive (SEA)].

Results:

A comparison of the mean Alfa score percentages revealed no difference between the ER, SEP, and SEA categories of bonding systems except for marginal adaptation where ER was found to be superior to SEA.

Conclusion:

The clinical effectiveness of resin-based bonding agents is comparable among the three categories.

Correlation between microtensile bond strength data and clinical outcome of Class V restorations

OBJECTIVE

To determine if the results of resin-dentin microtensile bond strength (μTBS) is correlated with the outcome parameters of clinical studies on non-retentive Class V restorations.

METHODS

Resin-dentin μTBS data were obtained from one test center; the in vitro tests were all performed by the same operator. The μTBS testing was performed 8 h after bonding and after 6 months of storing the specimens in water. Pre-test failures (PTFs) of specimens were included in the analysis, attributing them a value of 1MPa. Prospective clinical studies on cervical restorations (Class V) with an observation period of at least 18 months were searched in the literature. The clinical outcome variables were retention loss, marginal discoloration and marginal integrity. Furthermore, an index was formulated to be better able to compare the laboratory and clinical results. Estimates of adhesive effects in a linear mixed model were used to summarize the clinical performance of each adhesive between 12 and 36 months. Spearman correlations between these clinical performances and the μTBS values were calculated subsequently.

RESULTS

Thirty-six clinical studies with 15 adhesive/restorative systems for which μTBS data were also available were included in the statistical analysis. In general 3-step and 2-step etch-and-rinse systems showed higher bond strength values than the 2-step/3-step self-etching systems, which, however, produced higher values than the 1-step self-etching and the resin modified glass ionomer systems. Prolonged water storage of specimens resulted in a significant decrease of the mean bond strength values in 5 adhesive systems (Wilcoxon, p<0.05). There was a significant correlation between μTBS values both after 8 h and 6 months of storage and marginal discoloration (r=0.54 and r=0.67, respectively). However, the same correlation was not found between μTBS values and the retention rate, clinical index or marginal integrity.

SIGNIFICANCE

As μTBS data of adhesive systems, especially after water storage for 6 months, showed a good correlation with marginal discoloration in short-term clinical Class V restorations, longitudinal clinical trials should explore whether early marginal staining is predictive for future retention loss in non-carious cervical restorations.

Alternative technique for class V resin composite restorations with minimum finishing/polishing procedures

Class V restorations are a very common occurrence in clinics. Some reasons include an increase in non-carious cervical lesions (NCCL), root caries and the elderly population. Unfortunately, Class V restorations also represent one of the less durable types of restorations and have a high index of loss of retention, marginal excess and secondary caries. Some causes for these problems include difficulties in isolation, insertion, contouring, finishing and polishing procedures. This technique demonstrates an alternative isolation and insertion method using photocured gingival barrier in association with a flowable resin and hybrid resin composite to recreate the gingival wall with minimum or no excess.

Effect of filler content of flowable composites on resin-cavity interface

The purpose of this in vitro study was to evaluate marginal integrity and wall adaptation in 1- and 2-mm-deep cavities restored with a high filler-loaded flowable composite in comparison to a flowable composite with lower filler content and a conventional hybrid composite. 1-mm-deep dentin and 2-mm-deep enamel-dentin Class I cavities were prepared and restored with a self-etch adhesive and with one of the composites. Samples were crosscut and evaluated for marginal integrity and gap formation using a digital microscope. Selected samples were also observed using a scanning electron microscope. For 1-mm-deep cavities, no differences in marginal integrity and wall adaptation were observed among the three composites. For 2-mm-deep cavities, those restored with the bulk technique and with the higher filler-loaded flowable composite demonstrated a similar outcome as that of the conventional hybrid composite. On the effect of restorative techniques, cohesive enamel defects were observed in bulk-filled 2-mm-deep cavities. However, when the incremental technique was used in conjunction with the higher filler-loaded flowable composite and the conventional hybrid composite for 2-mm-deep cavities, superior results were obtained.

Two-year clinical evaluation of resinous restorative systems in non-carious cervical lesions

This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch-and-rinse adhesive and resin composite system (Excite/Tetric Ceram) compared to a resin-modified glass ionomer cement (RMGIC) (Vitremer/3M) in non-carious cervical lesions. Seventy cervical restorations (35 resin composite - RC- restorations and 35 RMGIC restorations) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation. All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline, and after 6, 12 and 24 months. Data were analyzed statistically by Fisher's exact and McNemar tests. After 2 years, 59 out of 70 restorations were evaluated. As much as 78.8% retention rate was recorded for RC restorations, while 100% retention was obtained for RMGIC restorations. Fisher's exact test showed significant differences (p=0.011) for retention. However, there were no significant differences for marginal integrity, marginal discoloration, anatomic form and secondary caries between the RC and RMGIC restorations. The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention (p=0.02), marginal integrity (p=0.002) and anatomic form (p=0.04). Therefore, the one-bottle etch-and-rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC.

Three-year clinical evaluation of a flowable and a hybrid resin composite in non-carious cervical lesions

OBJECTIVES

This randomized controlled clinical trial evaluated the 3-year clinical performance of a hybrid (Clearfil AP-X; AP) and a flowable (Clearfil Flow FX; FX) resin composite in 98 non-carious cervical lesions.

METHODS

Twenty-two patients, 11 males and 11 females (mean age: 61.9 years, range: 29-78 years) regularly visiting the Nagasaki University Hospital, participated in the study. Each patient received both materials randomly. All restorations (48 restorations for AP and 50 restorations for FX) were placed in conjunction with an all-in-one system (Clearfil S(3) Bond) by one dentist. The restorations were blindly evaluated by two examiners at baseline, 6 months, 1, 2 and 3 years using modified USPHS criteria. The data were statistically analyzed using the Cochran's Q-test and Fisher's exact test.

RESULTS

All the patients were examined at each recall. However, five restorations could not be evaluated at 3-year recall as two teeth had been extracted and three restorations had been lost. The only minor problem was the integrity of the enamel margin. The incidence and extent of marginal staining increased with time, but it was still superficial. Marginal staining occurred adjacent to 11 restorations for AP and 12 restorations for FX after 3 years. Neither lesion size nor depth had influence on marginal staining adjacent to each type of resin composite. There were no significant differences in the clinical performances between AP and FX for each variable.

CONCLUSIONS

Under the protocol used in this study, both types of resin composite in conjunction with S(3) Bond demonstrated an acceptable clinical performance up to 3 years.