Abstract
:Objective:To evaluate non-carious cervical lesions (NCCLs) restored with different adhesion strategies.Methodology:This is a prospective, randomized, double-blind, split-mouth study. An adhesive restorative system (Single Bond Universal/Filtek Z350XT – SBU) was evaluated both without and with selective enamel conditioning (E-SBU), resin-modified glass-ionomer cements (Vitremer; RMGIC), and ethylenediaminetetraacetic acid pretreatment (EDTA; E-RMGIC). In total, 200 restorations, placed in 50 patients, were evaluated at baseline and at a 3-year follow-up using the modified United States Public Health Service (USPHS) criteria. Data were analyzed using the two-proportion equality test, multinomial logistic regression, Wilcoxon test, and Kaplan-Meier survival curves.Results:In total, 42 (84%) patients returned for the 3-year follow-up. SBU showed restoration losses statistically different from RMGIC. Retention was also statistically different in SBU between baseline and the 3-year follow-up. Marginal defects and surface texture were statistically significant for all groups in the period studied, except for the surface texture of SBU and the marginal integrity in E-RMGIC. We observed no statistically significant difference in wear, secondary caries, anatomical form, surface staining, and color over time. Recession degree was the only factor to influence retention rates. Cumulative survival (%) was 89, 98, 98, and 95.3, for SBU, SE-SBU, RMGIC, and E-RMGIC, respectively, without significant differences among them. There was a statistically significant difference between survival curves; however, multiple comparison procedures found no statistical differences.Conclusion:Selective enamel etching affected the retention of non-carious cervical restorations. Adhesion using EDTA and resin-modified glass-ionomer cements delayed marginal defects over time. The degree of gingival recession influenced retention rates. Resin composite restorations showed initial marginal defects, and ionomer restorations, reduced surface luster. EDTA pre-treatment followed by resin-modified glass-ionomer cements may be a promising adhesion strategy for NCCL restorations.
Highlights
MethodologyNon-carious cervical lesions (NCCL) are defined as the loss of tooth structure at the cemento-enamel junction area unrelated to dental caries, and their etiology has been described as multifactorial.1 Resin composites and glass-ionomer cements are currently the material of choice for non-carious cervical lesions (NCCLs) restorations.2-11Resin composites have some advantages, such as rapid polymerization, easy handling and reparability, and good mechanical and aesthetic properties;12 they entail biological effects due to monomers release.13 This material peculiar features pose challenges for its adhesion to the dentin substrate in NCCL.14 With the advent of universal adhesives, their composition enables the formation of chemical bonds, being less susceptible to hydrolytic degradation.15Resin-modified glass-ionomer cements (RMGIC) can chemically bond to dental substrates
ethylenediaminetetraacetic acid pretreatment (EDTA) pre-treatment followed by resin-modified glass-ionomer cements may be a promising adhesion strategy for NCCL restorations
Since they can mechanically interlock with dentin, they are a good option for restoring NCCLs due to their excellent retention rates: between five and ten years
Summary
MethodologyNon-carious cervical lesions (NCCL) are defined as the loss of tooth structure at the cemento-enamel junction area unrelated to dental caries, and their etiology has been described as multifactorial. Resin composites and glass-ionomer cements are currently the material of choice for NCCL restorations.2-11Resin composites have some advantages, such as rapid polymerization, easy handling and reparability, and good mechanical and aesthetic properties; they entail biological effects due to monomers release. This material peculiar features pose challenges for its adhesion to the dentin substrate in NCCL. With the advent of universal adhesives, their composition enables the formation of chemical bonds, being less susceptible to hydrolytic degradation.15Resin-modified glass-ionomer cements (RMGIC) can chemically bond to dental substrates. Resin composites and glass-ionomer cements are currently the material of choice for NCCL restorations.. Resin composites have some advantages, such as rapid polymerization, easy handling and reparability, and good mechanical and aesthetic properties; they entail biological effects due to monomers release.. Resin composites have some advantages, such as rapid polymerization, easy handling and reparability, and good mechanical and aesthetic properties; they entail biological effects due to monomers release.13 This material peculiar features pose challenges for its adhesion to the dentin substrate in NCCL.. Resin-modified glass-ionomer cements (RMGIC) can chemically bond to dental substrates. Since they can mechanically interlock with dentin, they are a good option for restoring NCCLs due to their excellent retention rates: between five and ten years.. The use of ethylenediaminetetraacetic acid (EDTA) before cement application is relevant, given that an in vitro study showed increased bond strength. EDTA may be considered a metalloproteinases inhibitor (MMP).
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