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

OBJECTIVE: This controlled clinical trial evaluated the 5-year clinical performance of a self-etching primer system including selective enamel-etching with phosphoric acid and a one-bottle adhesive system. METHODS: Seventy-two non-carious cervical lesions in 8 patients (4 male and 4 female) with a mean age of 61.3 years (range 45-78) participated in the study. An enamel bevel was placed and dentin lightly ground, and cavities restored with clearfil liner bond II (LB) or single bond (SB) in conjunction with a hybrid resin composite (Clearfil AP-X). In the case of 27 cavities for LB, the enamel was pretreated with 37% phosphoric acid for 10 s. Each patient received both types of restoration, which were distributed on a random basis. All restorations (37 restorations for LB and 35 restorations for SB) were placed by one dentist. The restorations were evaluated blind after 5 years using modified USPHS criteria. The data were statistically analyzed using the Fisher's exact test. RESULTS: All but one restoration (which was replaced by a crown after the 2-year recall) were evaluated after 5 years. 100% retention rates were recorded for both restorative groups. No caries was detected in association with any restorations. The only minor problem was marginal discoloration; superficial and localized marginal discoloration occurred around 18% of the restorations, and mainly at the dentin margin. There were no significant differences in the marginal integrity between the LB and SB groups. CONCLUSIONS: Restorative materials used in this study demonstrated a good clinical effectiveness in the restoration of non-carious cervical lesions for 5 years.     

Three-year clinical performance of a HEMA-free one-step self-etch adhesive in non-carious cervical lesions

Despite the fact that one-step adhesives are currently used routinely in clinical practice, long-term studies on their clinical performance are scarce. The objective of this randomized controlled clinical trial was to test the hypothesis that a 2-hydroxyethyl methacrylate (HEMA)-free one-step self-etch adhesive performs worse than a conventional multistep etch-and-rinse adhesive. Two-hundred and seventy-six non-carious cervical lesions in 52 patients were restored with a micro-hybrid composite (Gradia Direct; GC). These restorations were bonded in random order either with the HEMA-free one-step adhesive G-Bond (GC) or with the 'gold-standard' (control) three-step adhesive Optibond FL (Kerr). The restorations were evaluated after 6, 12, 24, and 36 months of clinical service regarding retention, marginal adaptation, microleakage, caries occurrence, and sensitivity. After a medium-long period of 3 yr, similar success in clinical performance was observed for the simplified all-in-one adhesive and the conventional three-step adhesive. However, the one-step adhesive exhibited significantly more incisal marginal defects and discolorations. Whereas marginal degradation appeared to arrest for the multistep etch-and-rinse adhesive after 12 months, the enamel margins of the restorations bonded with the one-step self-etch adhesive continued to deteriorate. These incisal marginal defects were, however, small and could easily be removed by polishing. For both adhesives, large and sclerosed lesions appeared to be at higher risk of retention loss.     

One-year clinical evaluation of a flowable resin liner associated with a microhybrid resin in noncarious cervical lesions

The aim of this study was to compare the clinical performance over 1 year of a microhybrid composite resin for class V restorations both lined and not lined with a flowable composite resin. Nineteen patients having at least two pairs of cervical noncarious lesions under occlusion were enrolled in this study. A total of 38 restorations were placed, half for each group (Single-Bond + Filtek-Flow + Filtek Z250, and Single-Bond + Filtek Z250). Two calibrated operators placed all restorations according to the manufacturers instructions. Two other independent examiners evaluated the restorations at baseline and after a 12-month period according to the USPHS criteria and modified criteria for color match. The classic alpha score was divided into A1 for not detectable and A2 for slightly discernible filling. Statistical analysis was conducted using Fishers exact test and McNemars test (P=0.05). One restoration was lost after 12 months for each group (retention rate 95% for each group). After 12 months, 18 restorations showed a trend towards dark yellowing (color match A2). The use of Filtek Flow as a liner under Filtek Z250 restorations did not improve the clinical performance of class V restorations after 6 and 12 months of evaluation.     

Five-year clinical evaluation of One-Up Bond F in non-carious cervical lesions

PURPOSE: To evaluate the retention and marginal staining of restorations placed in non-carious cervical lesions using the all-in-one self-etching system, One-Up Bond F and Palfique Estelite resin composite. METHODS: Fifty-one non-undercut non-carious cervical lesions received restorations with One-Up Bond F and Palfique Estelite in 15 subjects (mean age 57.7 years) by one operator. Teeth were cleaned with pumice and water, restored following the manufacturer's instructions and evaluated at 6 months, 1, 2, 4 and 5 years for retention and presence of marginal staining. RESULTS: At 1 year, 42 restorations were evaluated, and all were intact with three restorations showing slight marginal staining. At 2 years, 37 restorations were evaluated from 11 subjects, and all were intact. Marginal staining was observed around nine restorations. At 4 years, 27 restorations and at 5 years, 24 restorations could be evaluated. Marginal staining showed a significant increase at the enamel and cervical margins over the 5 years of the study, with two restorations showing severe, nine mild and 13 no staining. Although a number of restorations could not be evaluated, the retention rate of 92% at 5 years showed One-Up Bond F/Palfique Estelite resin composite for the restoration of non-carious cervical lesions produced an excellent outcome. Marginal staining was limited to a small number of subjects and is unlikely to be a problem if margins are refurbished at recall visits.     

3-year clinical effectiveness of one-step adhesives in non-carious cervical lesions

ObjectivesDespite representing an important component of current dental adhesives, HEMA has been said to negatively influence the long-term stability of adhesion to dentine and enamel. The aim of this randomised clinical trial was to evaluate the 3-year clinical performance of two one-step self-etch adhesives.MethodsThirty patients had 175 non-carious cervical lesions restored with composite (Gradia Direct Anterior, GC) using either the HEMA-rich adhesive Clearfil Tri-S Bond (C3S; Kuraray) or the HEMA-free adhesive G-Bond (GB; GC). The restorations were evaluated by two examiners at baseline, 6, 12, 24 and 36 months regarding retention, caries recurrence, marginal integrity and discoloration and post-operative sensitivity. The data were statistically analysed with GEE and McNemar tests (p < 0.05).ResultsThe recall rate at 6 and 12 months was 100% and decreased to 96.7% at 24 and 36 months. At 3 years, the retention rate was 93.8% for C3S and 98.8% for GB (p = 0.14). A pairwise comparison showed no significant differences between the two adhesives for all the parameters evaluated, irrespective of the recall (p > 0.05). After 3 years, both adhesives presented an increase in the percentage of clinically acceptable marginal discoloration (C3S: 32.9% and GB: 26.8%) normally associated to clinically acceptable marginal defects (C3S: 35.8% and GB: 26.5%). Only 1 dentine margin of a GB restoration presented a severe marginal defect (1.2%) and 1 C3S restoration presented caries recurrence. The overall 3-year clinical success rate was 92.6% for C3S and 97.6% for GB (p = 0.16).ConclusionBoth one-step self-etch adhesives presented an equally favourable clinical effectiveness at 3 years.Clinical significanceHEMA is a monomer frequently present in dental adhesives in order to increase their wettability and hydrophilicity. However, this monomer negatively influences hydrolytic stability and durability of the adhesive interface complex. In this 3-year clinical trial no significant difference in bonding effectiveness was noticed between a HEMA-rich and HEMA-free one-step 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.     

不同排龈方法修复龈下楔状缺损临床疗效观察

目的:评估不同排龈方法修复龈下楔状缺损(楔缺)的临床疗效。方法:选择颈部边缘位于龈下0～2 mm内较难充填的楔缺,分3组:I组:龈边缘位于龈下0～1 mm的楔缺40个,使用排龈线排龈;II组:龈边缘位于龈下0～1 mm的楔缺40个,使用推龈器排龈;III组:龈边缘位于龈下1～2 mm的楔缺20个,使用推龈器排龈;IV组:龈边缘位于龈上的楔缺40个,直接充填,作为对照。各组均使用可乐丽菲露自酸蚀粘接剂粘接,3M Z250树脂进行充填。治疗后1年随访,以改良的USPHS直接临床评价系统评估疗效。数据行卡方检验。结果:I-III组病例修复体均无脱落,对照组有2个脱落。楔缺修复1年后4组成功率差异无显著性;在充填体脱落、边缘适合性、继发龋、边缘着色、新发缺损、牙龈反应及牙髓反应7个方面,4组间差异均无显著性(P>0.05);对于任何一组,基线与1年后复查的差异均无显著性(P>0.05)。结论:在采用有效排龈方法的前提下,龈下楔状缺损的修复可取得满意疗效,颈部边缘于龈下的深度并不影响治疗效果;推龈器的使用对于龈下楔状缺损的治疗有较大帮助。     

One-year clinical evaluation of tooth-colored materials in non-carious cervical lesions

The purpose of this study was to assess the clinical performance of bonded composite (Excite/Tetric Ceram - Vivadent) versus a resin-modified glass ionomer cement (Vitremer - 3M) for restoring non-carious cervical lesions. A total of 70 restorations (thirty-five per material) were placed in 30 patients, 18-50 aged, by one operator. Rubber dam was employed in all cases, lesions were pumiced, enamel margins were not beveled, and no mechanical retention was placed. The restorations were directly assessed by two independent evaluators using modified-USPHS criteria for six clinical categories. The ratings for clinical acceptability restorations (alfa plus bravo) were as follows (Tetric Ceram/Vitremer): retention (86%/100%), marginal integrity (100%/100%), marginal discoloration (100%/100%), wear (97%/100%), postoperative sensitivity (100%/100%) and recurrent caries (100%/100%). Statistical analysis was completed with Fisher's exact or Pearson Chi-square tests at a significance level of 5% (P<0.05). Results showed that almost all restorations were clinically satisfactory with no significant differences between materials groups. Five restorations of Excite/Tetric Ceram failed. No restorations of Vitremer have yet failed.     

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.     

48-month clinical evaluation of a copper-containing universal adhesive in non-carious cervical lesions: A double-blind randomised clinical trial

ObjectivesThis study aimed to evaluate the effect of copper nanoparticles (CuNp) on the clinical performance of a universal adhesive system used as an etch-and-rinse or self-etch strategy.MethodsA total of 216 class V (non-carious lesions) restorations were randomly placed in 36 subjects according to the following groups: ERcu, adhesive in etch-and-rinse with 0.1% CuNp; ERct, adhesive in etch-and-rinse without CuNp; SEcu, adhesive in self-etch with 0.1% CuNp; and Sect, adhesive in self-etch without CuNp. Restorations were evaluated at baseline and at 6, 12, 18, 36, and 48 months, using the FDI and USPHS criteria. Appropriate statistical analyses were performed (α = 0.05).ResultsAfter 48 months, 14 restorations were lost (two for ERcu, five for SEcu, and seven for SEct) and the retention rates (95% confidence interval [CI]) were 74.1% for ERcu (95% CI 61.1–83.8); 81.5% for ERct (95% CI 69.2–89.6); 64.8% (95% CI 51.5–76.2) for SEcu; and 64.8% (95% CI 51.5–76.2) for SEct, with statistical differences between SEct vs. ERct and SEcu vs. ERct (p < 0.05). No significant differences between the groups were observed when the secondary parameters were evaluated (p > 0.05). Nineteen restorations (two for ERcu, two for ERct, six for SEcu, and nine for SEct) showed minor marginal staining, and 44 restorations (7 for ERcu, 8 for ERct, 14 for SEcu, and 15 for SEct) presented minimal marginal adaptation defects.SignificanceThis is the first long-term clinical trial to show that the addition of CuNp to a universal adhesive system does not affect clinical performance.     

Five-year clinical performance of a HEMA-free one-step self-etch adhesive in noncarious cervical lesions

Objectives

The objective of this randomized controlled trial was to evaluate the clinical performance of a 2-hydroxyethyl methacrylate (HEMA)-free one-step adhesive.

Materials and methods

Two hundred sixty-seven cervical lesions in 52 patients were restored with the composite Gradia Direct (GC), bonded with either the one-step self-etch adhesive G-Bond (GC) or the three-step etch-and-rinse adhesive Optibond FL (Kerr) in a random order. The restorations were evaluated for retention, marginal integrity, marginal discoloration, and caries occurrence after 5 years. Specific statistics were used to account for the clustered data (multiple restorations per patient).

Results

The clinical success rate for G-Bond (87.4 %) was not significantly different from that of Optibond FL (90.9 %). Both adhesives showed progressive marginal deterioration, but G-Bond exhibited more small enamel defects and marginal discoloration, and unlike previous recalls, several restorations failed because of deep microleakage. Large sclerotic lesions were a significant risk factor for retention loss with G-Bond. Irrespective of the adhesive, almost all restorations with retention loss were located in the lower jaw.

Conclusion

After 5 years of clinical service, restorations bonded with the HEMA-free one-step adhesive did not need repair or replacement more often than those with the three-step etch-and-rinse adhesive, and both adhesives had a high retention rate (>90 %). There were indications that G-Bond did not (self-)etch enough in some clinical situations, as G-Bond exhibited more incisal defects and marginal discolorations, and sclerotic lesions were at higher risk of retention loss.

Clinical relevance

The clinical performance of the HEMA-free one-step adhesive was clinically acceptable after 5 years.     

Two-year clinical evaluation of one-step self-etch systems in non-carious cervical lesions

Objectives

This randomized controlled clinical trial evaluated the 2-year clinical performance of S³ Bond (S3) and G-Bond (GB) in 108 non-carious cervical lesions.

Methods

Twenty-three patients, 12 male and 11 female (mean age: 61.8 years, range: 30–79 years) regularly visiting the Nagasaki University Hospital of Medicine and Dentistry, participated in the study. Each patient received both materials randomly. All restorations (53 restorations for S3 and 55 restorations for GB) were placed by one dentist. The restorations were blindly evaluated by two examiners at baseline, 6 months, 1 and 2 years using modified USPHS criteria. The data were statistically analyzed using the Cochran Q test and Fisher's exact test.

Results

One restoration of each material was lost during 2 years. The only minor clinical problem was the integrity of the enamel margin. Slight marginal staining occurred adjacent to 11 restorations of both S3 and GB. There was no significant difference in the clinical performance between S3 and GB for each variable.

Conclusions

Under the protocol used in this study, S3 and GB have demonstrated an acceptable clinical performance up to 2 years.     

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.     

Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review

ObjectivesThe aim of this systematic review was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions (NCCLs) in terms of restoration retention as a function of time.MethodsMedline Ovid and IADR abstracts were reviewed for NCCLs clinical trials from 1950 to 2013. The reference list of all eligible trials and relevant review articles was checked to find additional studies. The review did not have any language restrictions. Only randomized controlled clinical trials that evaluated at least two adhesives for a follow-up period of at least 18 months were included. Materials with adhesive potential were categorized into 6 main classes: 3-step etch&rinse adhesives (3E&Ra's), 2-step etch&rinse adhesives (2E&Ra's), 2-step self-etch adhesives (2SEa's), 1-step self-etch adhesives (1SEa's), glass-ionomers (GI's) and self-adhesive composites (SAC's). The first four can bond restorative composite to tooth tissue. Both 2SEa and 1SEa were further sub-divided in ‘mild’ and ‘intermediately strong (1/2SEa_m), with a pH ≥ 1.5, and ‘strong’ (1/2SEa_s), with a pH < 1.5. From the restoration retention rates as a function of time the average annual failure rate (AFR) per adhesive and adhesive class was calculated.ResultsThe lowest AFR scores [mean (SD)] were recorded for GI [2.0 (1.4)] shortly followed by 2SEa_m [2.5 (1.5)], 3E&Ra [3.1 (2)] and 1SEa_m [3.6 (4.3)] (Tukey Contrasts: p > 0.05). Significantly higher AFR scores were recorded for 1SEa_s [5.4 (4.8)], 2E&R [5.8 (4.9)], and 2SEa_s [8.4 (7.9)] (p > 0.05). In addition, significant differences in AFR were noticed between adhesives of the same class (Kruskal–Wallis sum test: p > 0.05), except for GI (p = 0.7) and 2SEa_m (p = 0.1). Finally, selective enamel etching did not significantly influence the retention rate of SEa (AFR SEa_etch = 0.43 (0.49), AFR SEa_non-etch = 1.43 (1.77).SignificanceThe adhesive approach significantly influences the clinical effectiveness of adhesives in NCCLs. Within each class, except for GI, there was a wide variation in clinical bonding effectiveness.     

An 18-month clinical evaluation of prolonged polymerization of a universal adhesive in non-carious cervical lesions: A double-blind randomized clinical trial

ObjectiveThis study aimed to evaluate the effect of prolonging polymerization time on the 18 months clinical performance of a universal adhesive system used as etch-and-rinse (ER) and self-etch (SE).Methods140 restorations were randomly placed in 35 subjects according to the following groups: ER10 (light-curing for 10 s); ER40 (light-curing for 40 s); SE10 (light-curing for 10 s) and; SE40 (light-curing for 40 s/1200 mW/cm²). A resin composite was placed incrementally. The restorations were evaluated at baseline and after 18 months by using the FDI criteria. The following outcomes were evaluated: marginal staining, marginal adaptation, spontaneous post-operative sensitivity and recurrence of caries. The differences among the groups were calculated using Friedman repeated measures analysis of variance rank (α = 0.05).ResultsAfter 18 months the retention/fracture rates were 88.9% (95%CI 74.1–95.6%) for ER10, 94.3% (95%CI 91.4–98.5%) for ER40, 77.2% (95%CI 60.1–87.9) for SE10 and 97.2% (95%CI 85.5–99.9%) for SE40. A significant difference was detected in the retention rate when SE10 was compared to the SE40 (p = 0.01). Also, ER40 showed a significant improvement of the marginal adaptation when compared to ER10 (p = 0.01).SignificanceThis is the first study that demonstrates an improvement in the clinical performance of universal adhesive systems in non-carious cervical lesions when prolonged light-cured was applied.     

5-year clinical performance of resin composite versus resin modified glass ionomer restorative system in non-carious cervical lesions

AIM: To comparatively assess the 5-year clinical performance of a 1-bottle adhesive and resin composite system with a resin-modified glass ionomer restorative in non-carious cervical lesions. METHOD AND MATERIALS: One operator placed 70 restorations (35 resin modified glass ionomer restorations and 35 resin composite restorations) in 30 patients under rubber dam isolation without mechanical preparation. The restorations were directly assessed by 2 independent examiners, using modified USPHS criteria at baseline and 6, 12, 24 and 60 months. RESULTS: Twenty-two patients were available for recall after 5 years (73.3% recall rate) and 55 out of 70 restorations were evaluated. Excellent agreement was registered for all criteria between examiners (kappa > or = 0.85). Sixteen composite restorations were dislodged (51.5% retention) and 1 ionomer restoration was lost (96.4% retention). The McNemar test detected significant differences in resin composite restorations between baseline and 5-year recall for marginal integrity (p<0.001) and retention (p=0.004). For resin modified glass ionomer restorations, no significant differences were identified for all criteria (p>0.05). When comparing both materials, the Fisher exact test pointed out significant differences in retention (p=0.002) after 5 years of clinical service. CONCLUSIONS: After 5 years of evaluation, the clinical performance of resin modified glass ionomer restorations was superior to resin composite restorations.     

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

Clinical Oral Investigations - In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite. Ninety non-carious...