A two-year randomized clinical trial of bulk-fill and ion-releasing composites with universal adhesives in class V carious lesions.

The aim of the current study was to evaluate the clinical performance of the novel radio-opaque universal adhesive “Scotchbond™ Universal Adhesive Plus” compared to conventional universal adhesive “Single Bond Universal” over 24 months in cervical carious lesions. Fifty participants with cervical carious lesions were randomly allocated into two groups (n = 25); either Scotchbond™ Universal Plus Adhesive (intervention) or Single Bond™ Universal Adhesive (control). Restorations were assessed at baseline, 12 and 24 months using the modified USPHS criteria. Data analysis was conducted using MedCalc software, version 22 for Windows. Intergroup comparisons at each follow-up were performed using the Chi-Square test (p ≤ 0.05). Intragroup comparisons within each intervention were conducted using Cochran’s Q test (p ≤ 0.016). After 24 months, all restorations in Scotchbond™ Universal Plus scored alpha, while in Single Bond™ Universal group, three restorations scored bravo after 24 months in marginal adaptation and discoloration. There was no statistically significant difference between both adhesives (p > 0.05) at all follow-up periods. Intragroup comparison within both adhesives has shown no statistically significant change across follow-up periods regarding all tested outcomes (p > 0.016) except for marginal adaptation within Single Bond Universal, where there was statistically significant difference (p = 0.005). Both adhesives exhibited satisfactory clinical performance in cervical restorations after 24-months. The present study emphasizes the clinical significance of using a new radio-opaque universal adhesive for restoring carious cervical lesions, providing radio-opacity, low viscosity, excellent handling, eliminating misinterpretation of MDP-based adhesive layer and generating reliable bonding performance to support long-term success in restorative dentistry.

Etch-and-rinse vs self-etch strategy of a universal adhesive in Class II bulk-fill restorations: A 96-month split-mouth evaluation.

ObjectiveTo evaluate the clinical performance of nitric acid associated with a mineral-enriched adhesive system compared to the conventional approach of phosphoric acid and a universal adhesive in cervical carious lesion restorations.Materials and methodsTwenty-six individuals with 44 cervical anterior carious lesions were randomized into two equal parallel groups. The intervention group received a nitric acid etch (Clean and Boost dentin enamel cleanser, Vista Apex, USA) in conjunction with a mineral-enriched adhesive and a flowable composite liner (RE-GEN, Vista Apex, USA). Control group treated with phosphoric acid (Scotchbond Universal Etchant, 3 M ESPE), a universal adhesive (Single Bond Universal Adhesive, 3 M ESPE), and a standard liner (Filtek Supreme, 3 M ESPE). All cavities were restored using nanohybrid resin composite (Filtek Z350XT, 3 M ESPE). Postoperative sensitivity was assessed both qualitatively, using the modified USPHS criteria, and quantitatively, using a visual analog scale (VAS), as the primary outcome. In addition, clinical performance regarding marginal discoloration, adaptation, secondary caries, and retention was evaluated as secondary outcomes using modified USPHS criteria. Outcomes were assessed at 24 h, 6, 12, and 18 months. The data was statistically analyzed using intention-to-treat analysis. Intergroup comparisons were performed using the Chi-Squared test with a significance level (p ≤ 0.05), and intragroup comparisons were analyzed using Cochran’s Q test with a confidence level of 95% and a study power of 80%. Relative risk was used to assess clinical significance. The survival rate was analyzed using the Kaplan-Meier and Log-rank tests. The study was conducted following the CONSORT 2025 guidelines.ResultsBoth groups demonstrated similar performance in terms of postoperative sensitivity, retention, secondary caries, and marginal adaptation, as assessed using modified USPHS criteria. However, there was a significant increase in marginal discoloration within the phosphoric acid groups after 18 months. There was 50% less risk of sensitivity with nitric acid compared to phosphoric acid using the VAS scale (CI (0.2512 to 0.9953); p = 0.0485). The tested groups showed an equal survival rate (p = 0.3771).ConclusionCombining nitric acid with a mineral-enriched system is a promising approach for restoring cervical carious lesions.

Introduction: Composite resins are currently the most popular restorative materials due to their superior esthetics, strong mechanical properties and high resistance to dissolution. However, in spite of the improvements in resin composite formulations over the years, polymerisation shrinkage which necessitates incremental placement techniques still presents clinical challenges. Aim: To compare and evaluate cavosurface marginal integrity in Class I restorations by assessing microleakage scores using Tetric N-Flow Bulk fill, SureFil Bulk fill composites and Filtek Z350 XT and using selective etch and self etch modes of a universal adhesive. Materials and Methods: This in-vitro research study was carried out in the Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India from April, 2018 to May, 2018. Sixty extracted non-carious, intact human mandibular molar teeth were selected for this study. Standardised Class I cavities of 4 mm depth were prepared by a single operator with a high-speed hand piece using carbide fissure # 245 (SS White Inc) bur under air-water coolant. Samples were randomly divided into two main groups in which Single Bond Universal was used: Group I: Selective Etch Mode (30), Group II: Self Etch Mode (30). These main groups were then divided into 3 subgroups each Subgroup TF: Tetric N- Flow Bulk fill (Ivoclar Vivadent), Subgroup SB: SureFil Bulk fill (Dentsply) and Subgroup FC: Filtek Z350 XT (3M ESPE). All the specimens were then sectioned longitudinally along the mesio-distal direction towards the center of the restoration. Each specimen was viewed under a stereomicroscope and grading was done according to dye penetration at the tooth-restoration interface. Kruskal-Wallis and Mann-Whitney U-test were used to analyse the results. Results: The results showed that there was statistically significant difference in the microleakage scores of Tetric N- Flow Bulk fill, Filtek Z350 XT and SureFil Bulk fill (p<0.001). Group I Subgroup TF yielded lower microleakage score 0.70±0.675 as compared to Group II Subgroup TF which had a higher score 1.60±1.578. This difference was not statistically significant. (p-value=0.266). Group I Subgroup SB yielded lower microleakage score 1.20±0.919 as compared to Group II Subgroup SB which had a higher score 2.10±0.568. This difference was statistically significant. (p-value=0.017). Group I Subgroup FC yielded lower microleakage score 2.50±1.354 as compared to Group II Subgroup FC which had a higher score 3.20±0.789. This difference was not statistically significant (p-value=0.260). Conclusion: Tetric N flow bulk fill flowable composite resin can be considered as a better choice when compared to SureFil bulk fill and Filtek Z350XT composite resins. Selective enamel etching with SureFil bulk fill should be considered as the better choice as compared to self-etch for providing adequate seal in mild universal adhesives in Class I cavities.

The aim of this study was to evaluate the 24-month clinical performance of universal adhesives on the restoration success of Class I carious lesions. Five different universal adhesives (Gluma Bond Universal (GU), Clearfil Universal (CU), Prime&Bond Elect Universal (PU), All bond Universal (AU), and Single Bond Universal (SU)) were used in the self-etch and etch-and-rinse modes in 42 patients. The study was conducted with 10 groups, with 20 restorations in each group. The restorations were evaluated at baseline and during a 24-month recall using World Dental Federation (FDI) and the US Public Health Service (USPHS) criteria. The changes in the parameters were analyzed using the chi-square test. At the end of 24months, there was no loss of restoration in any group. According to the USPHS, there was no difference in the baseline and 24-month clinical behavior of the restorations (P˃0.05). However, according to the FDI, when adhesives were used in the self-etch mode, three adhesives (GU, SU, PU) showed marginal incompatibility, and one adhesive showed (GU) marginal discoloration between baseline and the 24-month follow-up evaluation (P < 0.05). There was no significant difference after 24months between etch-and-rinse and self-etch groups according to the results based on both the USPHS and FDI criteria (P˃0.05). The 24-month clinical performance of the evaluated universal adhesives depends on the adhesive strategy. This study helps clinicians to decide in which mode (etch-and-rinse or self-etch) universal adhesives can be safely used.

The present lab-based research aimed to assess the impact of different nanofillers: silver (Ag) chitosan (CH), and arginine nanoparticles (ArgNPs) infused in the eighth-generation universal adhesive (UA) on the antimicrobial potency, micro-tensile bond strength (μTBS), and degree of conversion (DC) bonded to carious-affected dentin (CAD) surface. Forty extracted human molars with Class 1 carious lesions were included. CAD was exposed and samples were allocated into four groups based on the type of adhesive (n = 10): Group 1 (UA), Group 2 (1 wt% AgNPs-UA), Group 3 (1 wt% CHNPs-UA), and Group 4 (1 wt% ArgNPs-UA). Survival rate assessment of inoculated Streptococcus mutans was performed after exposing them to different NPs. Characterization of tested nanoparticles (NPs) was also performed using scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDX). The DC of modified and unmodified eighth-generation adhesive cured and uncured was assessed using Fourier transform infrared spectroscopy (FTIR). Composite was bonded on the CAD and samples underwent artificial aging. Beams were prepared for scanning electron microscopy (SEM) and μTBS analysis followed by failure mode assessment using a stereomicroscope. Statistical analysis was conducted using one-way analysis of variance (ANOVA) and Tukey's post hoc test to compare the means and standard deviations (SDs) between the different experimental groups (p < 0.05). Group 2 (1 wt% AgNPs-UA) samples exhibited the lowest S. mutans survival (0.10 ± 0.02 CFU/mL). Whereas Group 1 (UA) displayed the highest survival of tested bacteria (0.41 ± 0.08 CFU/mL). The maximum score of bond strength of composite to the CAD was detected in Group 2 (1 wt% AgNPs-UA) (21.11 ± 0.59 MPa) samples. However, the μTBS was minimal in Group 1 (UA) (16.18 ± 0.91 MPa). DC between the modified adhesive with 1 wt% AgNPs and the unmodified adhesive was comparable (p > 0.05). The incorporation of 1 wt% AgNPs in eighth-generation adhesives represents a favorable and reasonable alternative to unmodified adhesives when used on caries-affected dentin.

Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p&lt;0.05). Results: OM and CM were similarly distributed across subgroups (p&gt;0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p&gt;0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.

The micro-tensile bond strengths (micro-TBSs) of four universal adhesive systems, applied in two different bonding techniques, to carries-affected dentin after Er:YAG laser irradiation were investigated. Twenty-four extracted human molars were divided into four groups, according to the adhesive systems used. Each group was subdivided into two subgroups, depending on the bonding method used: the etch-and-rinse procedure or self-etch procedure. The carious lesions were irradiated using an Er:YAG laser. Resin composites were used to restore the adhesive-treated dentin surfaces. After 2,500 thermal cycles, the vertical composite resin-dentin sticks obtained were subjected to micro-TBS tests. One tooth in each group was examined using scanning electron microscopy (SEM). There were statistically significant differences (p<0.001) in micro-TBS values between universal adhesives. The results of this study suggested that universal adhesives applied both with self and total etch technique can be used for adhesive restorations to caries-affected dentin after Er:YAG laser irradiation. If lasers are preferred as a caries removal method, choosing a dentin bonding agent containing MDP may be recommended in clinical practice due to the property of increasing the bonding strength.

BackgroundComparative analyses of different adhesive systems have illustrated that variations in the content can substantially influence the effectiveness of bonding. While in vitro studies provide essential insights, it is imperative that clinical recommendations derive from randomized clinical trials to ensure their reliability and validity. This double-blind, split-mouth, randomized clinical trial was conducted to assess the performance of various universal adhesives over a 24-month period, with a specific emphasis on monomer type, HEMA content, and solvent type, using the selective enamel etch approach in non-carious cervical lesion (NCCL) restorations.Materials and methodsThirty-two participants with two-hundred-fifty-six NCCLs were assigned to the two groups (n = 128): G-Premio Bond (GPB; GC) and Single Bond Universal (SBU; 3 M ESPE). The same composite resin (Essentia, GC) was used. Restorations were assessed at baseline, 12-month, and 24-month using the Revised FDI criteria by two blinded calibrated examiners. Statistical analysis included Fisher’s Exact Chi-Square test, Continuity (Yates) Correction, and McNemar tests (p < 0.05).ResultsThe 24-month success rate was 98.2%, with the loss of retention in four restorations—two from SBU and two from GPB. Throughout all evaluation periods, no significant differences were identified between the adhesives regarding any criteria (p > 0.05). Both adhesives exhibited a significant decline in marginal adaptation at both the 12-month and 24-month evaluations, as well as an increase in marginal staining at the 24-month interval (p < 0.05). Notwithstanding the observed decrease in marginal adaptation after 24 months, all restorations remained clinically acceptable and were classified as clinically satisfactory.ConclusionsA clinical analysis over a 24-month period demonstrated that variations in the composition of universal adhesives—specifically concerning monomer types, HEMA content, and solvent type—did not significantly affect the performance of NCCL restorations. Notably, all retained restorations met clinical acceptability standards.Trial registrationThe clinical trial was registered on 13/01/2021 at https//clinicaltrials.gov with the ID (NCT04707898).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-07081-0.

This double-blind, randomized clinical trial evaluated the influence of dentin moisture on postoperative sensitivity (POS), as well as, on clinical performance in posterior bulk-fill composite restorations, using a universal adhesive, until 12 months after clinical service. In accordance with a split-mouth design, 45 patients received posterior restorations, restored with a bulk-fill resin composite (Filtek Bulk Fill, 3M Oral Care) and a universal adhesive used in etch-and-rinse mode (SBU; Single Bond Universal Adhesive), which were applied on dry or moist dentin, with a cavity depth of at least 3 mm. Three operators placed 90 Class I/Class II restorations. Patients were evaluated for spontaneous and stimulated POS in the baseline, and after 48 hours, 7 days, and at 6 and 12 months. In addition, secondary parameters (marginal discoloration, marginal adaptation, fracture, and recurrent caries) were evaluated by World Dental Federation (FDI) criteria after 7 days and at 6 and 12 months. Statistical analyzes were performed using the Chi-square, Fisher exact, Friedman, Kruskall-Wallis, and Mann-Whitney tests (α=0.05). No significant spontaneous and stimulated POS was observed when SBU was applied in dry and moist dentin (p>0.05). A significant and higher risk of spontaneous POS (20.0%; 95%CI 10.9-33.82 for dry dentin and 22.22%; 95%CI 12.54-36.27 for moist dentin) occurred up to 48 hours after restoration placement for the dry and moist dentin groups (p<0.02). However, the POS intensity was mild up to 48 hours with no significant difference between dry and moist dentin groups (p>0.79). When secondary parameters were evaluated, no significant differences between the groups were observed. Dentin moisture did not influence POS in posterior bulk-fill composite restorations when associated with a universal adhesive applied in etch-and-rinse mode.

Aim To compare the clinical performance of composite restorations placed with a universal adhesive, one-step and two-step self-etch adhesives in class I and II posterior cavities. Materials and methods In this in vivo study, 46 volunteers presenting with at least three carious lesions were included. Each participant received the three restorative systems: universal adhesive/nanofilled composite (Scotchbond Universal/Filtek Z350 XT: SBU/FZXT), one-step self-etch adhesive/microhybrid composite (G-aenial bond/G-aenial Posterior: GB/GP) and the two-step self-etch adhesive/nanohybrid composite (OptiBond XTR/Herculite Ultra: OBX/HU). The adhesives were all placed in self-etch mode. In total, 138 restorations were evaluated at baseline and at 6,12 and 36 months using the modified United States Public Health Service criteria. Data were analysed using Kruskal–Wallis, Mann–Whitney U, Friedman and Wilcoxon non-parametric tests (p < .05). Ninety-one restorations were evaluated at 36 months. Results Seven restorations, three SBU/FZXT, three GB/GP and one OBX/HU failed during this study. The reasons for failure were marginal fracture and secondary caries. SBU/FZXT restorations showed significant marginal deterioration in all parameters. Overall success rates were: 93.5% (SBU/FZXT), 96.6% (GB/GP) and 96.8% (OBX/HU). Conclusions After three years, the three restorative systems have comparable clinical effectiveness and success rates, except for the marginal integrity, that was suboptimal for both the SBU/FZXT and GB/GP restorations in comparison to the OBX/HU restorations.

Is clinical behavior of composite restorations placed in non-carious cervical lesions influenced by the application mode of universal adhesives? A systematic review and meta-analysis

|Objective: To compare, through a systematic review and a meta-analysis, the clinical effect of the adhesive strategies of universal adhesives (UA) in the treatment of non-carious cervical lesions (NCCLs). Material and Method: A search of the literature was carried out up to January 2018, in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, SIGLE, LILACS, BBO, Google Scholar and the Central Register of Cochrane Clinical Trials. The selection criteria of the studies were as: randomized clinical trials, with a maximum age of 5 years and which report the clinical effects (marginal adaptation, discoloration or marginal staining, presence of secondary caries, postoperative sensitivity, retention and fractures) of the UA in the treatment of NCCLs. The risk of study bias was analyzed through the Cochrane Handbook of systematic reviews of interventions. Results: The search strategy resulted in eight articles that reported no difference in marginal adaptation, discoloration or marginal staining, presence of secondary caries and postoperative sensitivity among the adhesive strategies of the UA; however they reported a difference between the retention and the presence of fractures, with the conventional adhesive strategy resulting in a better clinical effect. Conclusion: The reviewed literature suggests that the conventional adhesive strategy of UAs results in greater retention and absence of fractures in the treatment of NCCLs.

The objective was to determine the postoperative hypersensitivity of two-step Total-etch as compared to one-step Universal adhesives followed by composite restorations on 100 patients by applying Total-etch on one tooth and Universal adhesive on another tooth. The bonds and teeth were randomly selected. Postoperative hypersensitivity was recorded by visual analog scale before, immediately after, and 24 h after the restoration using cold stimulus. The Mann–Whitney test was applied for statistical comparison of postoperative hypersensitivity between the two bonds as well as for any significant difference in genders with each bond. No significant difference was found between postoperative hypersensitivity of the two adhesives before (p-value = 0.57), immediately after (p-value = 0.604), and 24 h after (p-value = 0.728) the restoration. Males showed more hypersensitivity with Total-etch as compared to females before (p-value = 0.037), immediately after (p-value = 0.047), and 24 h after the restoration (p-value = 0.022). No significant difference was found between gender and Universal adhesive at all three stages (p-value > 0.05). The results suggest no significant difference in postoperative hypersensitivity between the two materials when good sample size and proper technique were observed along with the removal of bias like different patients having different pain perceptions and multiple operators having different operating skills. Males showed more hypersensitivity to Total-etch.Trial registration number: Australian New Zealand Clinical Trials. Registry number: ACTRN12622001213730. (Retrospectively registered: 09/09/2022).

Clinical behavior of universal adhesives in non-carious cervical lesions: A randomized clinical trial