Abstract
BackgroundMultimode adhesives incorporate the versatility of adapting to various clinical situations by its capacity to be used in different protocols. This study aimed to evaluate the clinical behavior of composite resin direct restorations (Class I and II) performed with different universal dentin adhesive application protocols comparing adapted FDI and adapted USPHS criteria.MethodsThe current study is a randomized, double-blind, split-mouth, and convenience sample controlled clinical trial. The participants (age ≥ 18 years) had restorative need of Class I and/or II due to the presence of carious lesions and/or unsatisfactory restorations in at least three dental elements. Each participant received three application protocols for Scotchbond Universal adhesive (3M ESPE), one in each tooth to be restored: ER = etch-and-rinse + adhesive (n = 50); SEE = selective enamel etch + adhesive (n = 50) and SE = self-etch adhesive (n = 50). All teeth were restored in a similar way using Filtek™ Supreme composite resin (3M ESPE). Restorations were evaluated using the adapted FDI and adapted USPHS criteria, at baseline after 7 to 21 (12.02 ± 5.68) days (T1; n = 50 per group) and after 12 to 20 (15.8 ± 2.7) months (T2; n = 46 per group) by two previously calibrated evaluators (Kappa > 0.80). The statistical tests were performed between groups (Friedman), intragroup (Wilcoxon), and between the criteria considering acceptable and not acceptable restorations (McNemar), α = 0.05.ResultsA statistically significant difference was observed only for the property “superficial staining”, between groups at T2 (p = 0.01) for ER (n = 13 with score 2 or more) and SEE (n = 3 with score 2 or more) and intragroup for ER (T1, n = 1 with score 2 or more; T2, n = 13 with score 2 or more, p = 0.001) and SE (T1, n = 0 with score 2 or more; T2, n = 8 with score 2 or more p = 0.007). For the other comparisons between groups, intragroup, and between the adapted FDI and adapted USPHS criteria, there were no statistically significant differences (p ≥ 0.05).ConclusionsIt can be concluded that the different application protocols of the universal adhesive resulted in clinically “acceptable” restorations after 15.8 ± 2.7 months of follow-up. Adapted FDI and adapted USPHS criteria provided similar results to each other.Trial registration.Number in Brazilian Registry of Clinical Trials (ReBEC): RBR-9p3hdp. Registered 24 May 2015.
Highlights
Multimode adhesives incorporate the versatility of adapting to various clinical situations by its capacity to be used in different protocols
It can be concluded that the different application protocols of the universal adhesive resulted in clinically “acceptable” restorations after 15.8 ± 2.7 months of follow-up
For a better comprehension of this process, it shall be understood that SE monomers are often less acidic than phosphoric acid, so that some minerals remain attached to the collagen fibers, allowing chemical bonds between the dental substrate and functional groups of the adhesive monomers [9]
Summary
Multimode adhesives incorporate the versatility of adapting to various clinical situations by its capacity to be used in different protocols. According to the form of demineralization of the dental substrate and the treatment given to the smear layer, the traditionally available adhesive systems can be divided into: etch-and-rinse (ER), self-etch (SE), and universal/ multimode [1, 2]. ER systems profess the removal of the smear layer by etching of the dental substrate in a separate step from the application of the adhesive [1, 2]. For a better comprehension of this process, it shall be understood that SE monomers are often less acidic than phosphoric acid, so that some minerals remain attached to the collagen fibers, allowing chemical bonds between the dental substrate and functional groups of the adhesive monomers [9]. Chemical bonding occurs with the interaction of functional acid monomers (carboxylic groups, phosphonic or phosphate) with hydroxyapatite crystals in dentin [10]. Chemical bonding occurs with the interaction of functional acid monomers (carboxylic groups, phosphonic or phosphate) with hydroxyapatite crystals in dentin [10]. 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) is an example of a functional monomer that can interact with calcium ions in hydroxyapatite crystals in a process that is conducted until the formation of calcium salts of MDP (MDP-Ca salts) [10]
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