Three-year evaluation of different adhesion strategies in non-carious cervical lesion restorations: a randomized clinical trial

Gonçalves, Diego Felipe Mardegan; Shinohara, Mirela Sanae; Carvalho, Paulo Roberto Marão de Andrade; Ramos, Fernanda de Souza e Silva; Oliveira, Laryssa de Castro; Omoto, Érika Mayumi; Fagundes, Ticiane Cestari

doi:10.1590/1678-7757-2021-0192

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Journal of Applied Oral Science

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Original Article • J. Appl. Oral Sci. 29 • 2021 • https://doi.org/10.1590/1678-7757-2021-0192 copy

Three-year evaluation of different adhesion strategies in non-carious cervical lesion restorations: a randomized clinical trial^* * This clinical trial is a doctoral thesis follow-up and it can be found in the UNESP Institutional Repository since 12/19/2016. It is available in http://hdl.handle.net/11449/148789. In addition, the one-year follow-up article was published by Quintessence International and can be accessed via DOI number: 10.3290/j.qi.a44367.

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Acid etching; Adhesive systems; Non-carious cervical lesion; Glass-ionomer cements

Periods	Groups	Score	Retention	Marginal integrity	Marginal discoloration	Surface texture	Wear	Secondary caries	Anatomical form	Surface staining	Color	Gingival tissue
Baseline	SBU	A/B	50/-^Aa	49/1^Aa	50/- Aa	50/- Aa	50/- Aa	50/- Aa	49/1Aa	50/- Aa	36/14Aa	47/3Aa
		C	0	0	0	0	0	0	0	0	0	0
	SE-SBU	A/B	50/-^Aa	49/1^Aa	50/- Aa	50/- Aa	50/- Aa	50/- Aa	50/-Aa	50/- Aa	41/9Aa	47/3Aa
		C	0	0	0	0	0	0	0	0	0	0
	RMGI	A/B	50/-^Aa	50/-^Aa	50/- Aa	49/1 Aa	50/- Aa	50/- Aa	47/3Aa	50/- Aa	37/13Aa	47/3Aa
		C	0	0	0	0	0	0	0	0	0	0
	IV	A/B	50/-^Aa	48/2^Aa	50/- Aa	50/0Aa	50/- Aa	50/- Aa	48/2Aa	50/- Aa	39/11Aa	44/6Aa
		C	0	0	0	0	0	0	0	0	0	0
1 year	SBU	A/B	47/-^Aab	38/9^Ab	41/6Ab	45/2Aa	47/-Aa	47/-Aa	46/1Aa	45/2Aa	36/11^Aa	46/1^Aa
		C	2	0	0	0	0	0	0	0	0	0
	SE-SBU	A/B	48/-^Aa	43/5^Aab	43/5ABb	43/5Ab	48/-^Aa	48/-^Aa	48/-^Aa	47/1^Aa	38/10^Aa	48/-^Aa
		C	1	0	0	0	0	0	0	0	0	0
	RMGI	A/B	48/-^Aa	44/4^Aab	45/3A^Bab	47/1^Aa	48/-^Aa	48/-^Aa	46/2^Aa	48/-^Aa	33/15^Aa	48/-^Aa
		C	1	0	0	0	0	0	0	0	0	0
	E-RMGI	A/B	49/-^Aa	44/5^Aa	48/1^Ba	47/2^Aab	49/-^Aa	49/-^Aa	46/3^Aa	49/0^Aa	38/11^Aa	49/-^Ab
		C	0	0	0	0	0	0	0	0	0	0
2 years	SBU	A/B	44/-^Aa	35/9^Ab	35/9^Abc	43/1^Aa	44/-^Aa	44/-^Aa	43/1^Aa	43/1^Aa	36/8^Aa	43/1^Aa
		C	4	0	0	0	0	0	0	0	0	0
	SE-SBU	A/B	47/-^Aa	40/7^Abc	37/10^Abc	43/4^Ab	46/1^Aa	47/-^Aa	47/-^Aa	45/2^Aa	38/9^Aa	47/-^Aa
		C	1	0	0	0	0	0	0	0	0	0
	RMGI	A/B	47/-^Aa	38/8^Abc	42/5^Ab	43/4^Aab	46/1^Aa	47/-^Aa	45/2^Aa	46/1^Aa	33/14^Aa	47/-^Aa
		C	1	1	0	0	0	0	0	0	0	0
	E-RMGI	A/B	47/-^Aa	37/10^Aa	41/6^Ab	42/5^Abc	47/-^Aa	47/-^Aa	44/3^Aa	47/-^Aa	35/12^Aa	47/-^Ab
		C	1	0	0	0	0	0	0	0	0	0
3 years	SBU	A/B	37/-^Bb	25/12^Ab	25/12^Ac	35/2^Aa	36/1^Aa	37/-^Aa	36/1^Aa	35/2^Aa	29/8^Aa	36/1Aa
		C	5	0	0	0	0	0	0	0	0	0
	SE-SBU	A/B	41/-^ABa	30/11^Ac	25/16^Ac	36/5^Ab	38/3^Aa	41/-^Aa	41/-^Aa	39/2^Aa	32/9^Aa	41/-^Aa
		C	1	0	0	0	0	0	0	0	0	0
	RMGI	A/B	42/-^Aa	30/11^Ac	29/13^Ac	34/8^Ab	39/3^Aa	42/-^Aa	40/2^Aa	40/2^Aa	27/15^Aa	42/-^Aa
		C	1	1	0	0	0	0	0	0	0	0
	E-RMGI	A/B	40/-^ABa	30/10^Aa	30/10^Ab	32/8^Ac	38/2^Aa	40/-^Aa	38/2^Aa	40/-^Aa	32/8^Aa	40/-^Ab
		C	2	0	0	0	0	0	0	0	0	0

NCCL characteristics	Groups					p value
	SBU	SE-SBU	RMGI	E-RMGI	Total
Tooth distribution
Incisor	6	7	7	5 (1)	25	0.771
Canine	6 (1)	4	7	8	25
Premolar	29 (2)	33 (1)	32 (1)	31 (1)	125
Molar	9 (2)	6	4	6	25
Degree of sclerosis
1	18 (2)	16	13	18	65	0.201
2	15	21 (1)	22 (1)	21 (1)	79
3	15 (2)	9	11	8 (1)	43
4	2 (1)	4	4	3	13
Internal angles
45-90º	11 (2)	14 (1)	12	13 (2)	50	0.488
90-120º	12 (1)	16	16	14	58
>120º	27 (2)	20	22 (1)	23	92
Cervico-incisal height (mm)
<1.5	0	4	6	5 (1)	15	0.351
1.5-2.5	17 (1)	20 (1)	13 (1)	22 (1)	72
2.5-4.0	25 (3)	22	26	16	89
>4.0	8 (1)	4	6	6	24
Width (mm)
1-2	5	5	8	7 (1)	25	0.430
3-4	34 (3)	35 (1)	36 (1)	38 (1)	143
5-6	7 (1)	7	5	4	23
7-8	4 (1)	3	1	1	9
Depth (mm)
1-2	48 (3)	48 (1)	48 (1)	50 (2)	194	0.953
3-4	2 (2)	2	2	–	6	0.953
Degree of gingival recession
1	42 (3)	40	40 (1)	41 (1)	163	0.045
2	7 (1)	10 (1)	10	8 (1)	35
3	1 (1)	1	0	0	2
Pre-operative pain (air dry)
1	28 (3)	27	30 (1)	28 (2)	113	0.804
2	9	11 (1)	8	8	36
3	5	4	3	4	16
4	4 (2)	3	3	3	13
5	3	4	5	5	17
6	0	0	0	0	0
Pre-operative pain (spontaneous)
1	46 (4)	47 (1)	48 (1)	48 (2)	189	0.982
2	1 (1)	0	1	1	3
3	2	1	0	0	3
4	1	1	1	1	4
5	0	1	0	0	1
6	0	0	0	0	0

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[1] Corresponding address: Ticiane Cestari Fagundes, St. José Bonifácio, 1193, 16015-050 - Araçatuba - São Paulo - Brasil. Phone: (+55) 18 3636-3347 e-mail: ticiane.fagundes@unesp.br