El tratamiento de las Lesiones Cervicales no Cariosas (LCNC) se ha circunscrito preferentemente a las Resinas Compuestas. Esfuerzos han sido hechos para introducir en este tipo de tratamientos al Ionómero de Vidrio y a sus parientes cercanos los Compómeros, sin embargo, la falta de una estética compatible ha forzado a los dentistas a volcarse preferentemente hacia los Composites.
Dr. Jorge Garat.
Aust Dent J. 2009 Sep;54(3):212-9.
The cervical wedge-shaped lesion in teeth: a light and electron microscopic study.
Daley TJ, Harbrow DJ, Kahler B, Young WG.
School of Dentistry, The University of Queensland, Brisbane, Australia.
BACKGROUND: The cervical non-carious wedged-shaped lesion is controversial in that its aetiology may involve attrition, erosion, abrasion and stress-corrosion (abfraction). This study examined the histopathology of anterior teeth with cervical wedge-shaped lesions by light and electron microscopy to elucidate their pathogenesis. METHODS: Ten undecalcified human teeth with cervical lesions were available for investigation. Patency of the dentine tubules was tested using red dye penetration from the pulp chamber. The morphology of normal and sclerotic dentine adjacent to the cervical wedge-shaped lesions was investigated by scanning electron microscopy. The numbers and diameters of dentinal tubules were measured at different levels beneath the surfaces of the lesions. RESULTS: The gross and microscopic features of the worn teeth were described. Red dye penetration tests showed white tracts of sclerotic tubules contrasted with red tracts of patent tubules. Numbers of tubules per square area and diameters of patent and sclerotic tubules varied at different levels within the dentine due to deposits of intratubular dentine. CONCLUSIONS: The cervical wedge is shaped by interactions between acid wear, abrasion and dentinal sclerosis. No histopathological evidence of abfraction was found. Clinical diagnosis, conservation and restoration of non-carious cervical lesions need to take into account the extent of sclerotic dentine beneath wedge-shaped lesions.
Oper Dent. 2009 Sep-Oct;34(5):507-15.
Two-year clinical effectiveness of adhesives and retention form on resin composite restorations of non-carious cervical lesions.
Kim SY, Lee KW, Seong SR, Lee MA, Lee IB, Son HH, Kim HY, Oh MH, Cho BH.
Dept of Conservative Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.
The current study investigated the clinical effectiveness of three adhesives and the use of retention form in Class V resin composite restorations of the non-carious cervical lesion (NCCL) over a two-year period. One-hundred and fifty NCCLs in 39 patients were restored with resin composites according to six experimental protocols combining the presence or absence of retention form and three adhesives: ScotchBond Multi-Purpose (MP, 3M ESPE), an experimental adhesive (EX, Vericom) and Adper Prompt (AP, 3M ESPE). All restorations were evaluated at baseline, 6, 12 and 24 months. Modified United States Public Health Service (USPHS) criteria were used to evaluate the restorations. MP was found to have significantly superior marginal adaptation than AP in cumulative logistic regression analysis (odds ratio, 2.12; 95% confidence interval, 1.05-4.31; p = 0.0397). In analysis using the Pearson’s Chi-square or Fisher’s Exact Test to compare the clinical performance of restorations with and without retention form, EX with retention form showed a significantly higher retention rate at two years than that without retention form (p = 0.0089). Restorations with retention form also showed significantly less marginal discoloration than those without retention form in all three adhesives (p = 0.0336).
Oper Dent. 2009 Jul-Aug;34(4):384-91.
A 36-month clinical evaluation of ethanol/water and acetone-based etch-and-rinse adhesives in non-carious cervical lesions.
Department of Restorative Dentistry, School of Dentistry, University Estadual de Ponta Grossa, Ponta Grossa/PR, Brazil. reis_ale@hotmail.com
This double-blind randomized clinical trial compared different ethanol/water and acetone-based systems in non-carious cervical lesions over 36 months. MATERIALS AND METHODS: Eighty-four patients having at least one non-carious cervical lesion [NCCL] under occlusion were enrolled in this study. A total of 84 restorations were placed, half for each group (Adper Single Bond [SB] + FiltekA110 or One Step [OS] + MicroNew). All the materials were placed by two calibrated operators. Two other independent examiners evaluated the restorations at baseline, 6, 12, 18 and 36 months, according to slightly modified USPHS criteria. Statistical analysis between materials in each period was conducted using the Fisher’s exact test (alpha=0.05), and performance of the materials in the baseline in comparison to each period was evaluated by McNemar’s test (alpha=0.05). RESULTS: The 12-, 18- and 36-month retention rates for SB were 95.2% (12 and 18 months) and 92.3% (36 months). For OS, the retention rates were 83.3%, 73.8% and 56.4%, respectively, for each recall period. After 36 months, 10 OS restorations (25.7%) and seven SB restorations (17.9%) were rated as Bravo in the marginal discoloration item. CONCLUSIONS: The ethanol/water-based adhesive (Single Bond) that was evaluated showed a higher retention rate than the acetone-based system (One Step) after 36 months of clinical service.
Dent Mater. 2009 Oct;25(10):1205-12. Epub 2009 May 21.
Chemical profile of the dentin substrate in non-carious cervical lesions.
University of Missouri-Kansas City School of Dentistry, Kansas City, 650 E. 25th St., Kansas City, MO 64108, USA.
OBJECTIVE: The molecular structural nature of the dentin substrate in non-carious cervical lesions (NCCLs) is poorly understood. This investigation characterized the chemical structure including inhomogeneities, composition, mineral crystallinity, collagen organization of normal dentin and affected dentin substrates within NCCLs using Raman microspectroscopic mapping/imaging. MATERIALS AND METHODS: Three extracted human pre-molars affected with NCCLs were selected and cavities matching the natural lesion with respect to size and location were prepared on the lingual/palatal surface of each tooth to serve as controls. The specimens were sectioned to expose the gingival and occlusal margins of the NCCLs and the control cavities. Micro-Raman spectra and imaging were acquired at 1.5 microm spatial resolution at positions perpendicular to the lesion surfaces. RESULTS: The Raman spectra and imaging comparisons showed the distinct compositional and structural alterations in mineral and matrix components of NCCL affected dentin. A heterogeneous hyper-mineralized layer, with characteristic features such as high phosphate/low carbonate content, high degree of crystallinity and partially denatured collagen were revealed in affected dentin substrate of NCCLs. SIGNIFICANCE: Generating Raman images based on different strategies from the same data set provides a powerful means to study the structural alterations within heterogeneous dental tissues. Direct overlay of the images indicated that the changes in chemical structure and composition are synchronized. Further studies are required to understand the role that these alterations play in response to acid etching and bonding to these clinically relevant substrates.
Oper Dent. 2009 May-Jun;34(3):273-9.
Effect of lateral excursive movements on the progression of abfraction lesions.
Wood ID, Kassir AS, Brunton PA.
Department of Fixed and Removable Prosthodontics, Leeds Dental Institute, Leeds, UK.
The theory of abfraction suggests that tooth flexure arising from occlusal loads causes the formation and progression of abfraction lesions. The current study investigated whether reducing occlusal loading by adjusting the occlusion on a tooth during lateral excursive movements had any effect on the rate of progression of existing abfraction lesions. Recruited were 39 subjects who had two non-carious cervical lesions in the maxillary arch that did not need restoration and were in group function during lateral excursive movements of the mandible. One of the teeth was randomly selected to have the excursive occlusal contacts reduced by using a fine grain diamond bur. Centric occlusal contacts were not reduced. Impressions of the lesion were taken over a 30-month period to enable monitoring of the wear rate, and duplicate dies were poured into epoxy resin to allow for sectioning. The size of the lesions was measured using stereomicroscopic analysis of the sectioned epoxy resin dies, and the results were analyzed using an Independent t-test. No statistically significant difference in wear rates between the adjusted and non-adjusted teeth was found (p > 0.05). Within the limitations of the current study, it was concluded that occlusal adjustment does not appear to halt the progression of non-carious cervical lesions; consequently, this procedure cannot be recommended.
2009 May;19(5):279-82.
Factors associated with Non-Carious Cervical Lesions (NCCLs) in teeth.
Ahmed H, Durr-E-Sadaf, Rahman M.
Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi. henaahmed5@hotmail.com
OBJECTIVE: To determine factors associated with Non-Carious Cervical Lesions (NCCLs) and the teeth most commonly involved in such lesions. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Operative Dentistry, Section of Dentistry at Aga Khan University Hospital, Karachi, Pakistan, from December 2005 to January 2006. METHODOLOGY: A total number of 95 patients with 671 teeth were evaluated using a pre-coded questionnaire. Subject of evaluation was teeth. Patients with symptomatic or asymptomatic NCCLs and permanent dentition were included. Patients exhibiting active, untreatable periodontal disease, rampant uncontrolled caries, xerostomia, primary dentition, patients undergoing orthodontic treatment or bleaching procedure were excluded from the study. Data analysis was done using Spearman’s correlation, Mann Whitney test and Kruskal-Wallis test. RESULTS: Mean age of patients was 50.3 years (r=0.22, p=0.028); males (73%) had more NCCLs than females (23%). Majority (45.3%) of them brushed their teeth twice a day, with medium type of brush (48.4%) and horizontal (73.7%) brushing technique. Most of the patients were non-bruxists (90.5%), with Angles Class 1 occlusion (48.4%) and canine guidance (50.5%). Majority (74.7%) of the patients did not have sensitivity. CONCLUSION: First premolars in all the quadrants were the most frequently involved teeth in NCCLs. More males had NCCLs. Middle aged patients were more involved. A weak positive correlation was found between age and NCCLs. No association was observed between hand used and site of NCCLs, between wear facets and NCCL, Excursive guidance and NCCL, Angles classification and NCCL.
Braz Oral Res. 2008 Jan-Mar;22(1):11-7.
Assessment in vitro of brushing on dental surface roughness alteration by laser interferometry.
Azevedo AM, Panzeri H, Prado CJ, De-Mello JD, Soares CJ, Fernandes-Neto AJ.
School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. aleazevedopa@yahoo.com.br
Noncarious cervical lesions (NCCLs) are considered to be of multifactorial origin, normally associated with inadequate brushing. This study assessed the influence in vitro of simulated brushing on NCCL formation. Fifteen human premolars were submitted to brushing in the cementoenamel junction region, using hard-, medium- and soft-bristled brushes associated with a toothpaste of medium abrasiveness under a 200 g load, at a speed of 356 rpm for 100 minutes. The surface topography of the region was analyzed before and after brushing, by means of a laser interferometer, using “cut-off” values of 0.25 and considering roughness values in mm. The initial roughness (mm) results for dentin (D / bristle consistency: 1–soft, 2–medium and 3–hard) were as follows: (D1) 1.25 +/- 0.45; (D2) 1.12 +/- 0.44; (D3) 1.05 +/- 0.41. For enamel (E / bristle consistency: 1–soft, 2–medium and 3–hard), the initial results were: (E1) 1.18 +/- 0.35; (E2) 1.32 +/- 0.25; (E3) 1.50 +/- 0.38. After brushing, the following were the values for dentin: (D1) 2.32 +/- 1.99; (D2) 3.30 +/- 0.96; (D3) Over 500. For enamel, the values after brushing were: (E1) 1.37 +/- 0.31; (E2) 2.15 +/- 0.90; (E3) 1.22 +/- 0.47. Based on the results of the ANOVA and Tukey statistical analyses (a = .05) it was concluded that soft, medium and hard brushes are not capable of abrading enamel, whereas dentin showed changes in surface roughness by the action of medium- and hard-bristled brushes.J Dent. 2008 Oct;36(10):759-66. Epub 2008 Jul 25.
Non-carious cervical tooth surface loss: a literature review.
Wood I, Jawad Z, Paisley C, Brunton P.
Restorative Dentistry, Manchester University, England, United Kingdom.
OBJECTIVES: As the population ages and teeth are increasingly retained for life the incidence of non-carious cervical tooth surface loss is increasing but little is understood about the aetiology and management of these lesions. The purpose of this literature review was to review and critically appraise the literature as it relates to the prevalence, aetiology and treatment of non-carious cervical tooth surface loss. SEARCH STRATEGY: An electronic search, using OVID electronic bibliographic databases was performed with no restriction on the language of publication. CONCLUSIONS: Despite the paucity of research into non-carious cervical tooth surface loss it was concluded that the number and size of lesions increases with age, lesions are more common on the facial aspects of teeth and the formation of lesions appears to be multi-factorial with lesion shape not being a predictor of aetiology. It was also concluded that the value of restoring these lesions, where indicated, is unclear and that occlusal adjustment to increase the retention of restorations placed to restore lesions or to halt lesion progression cannot be supported.
J Dent. 2008 Oct;36(10):774-9. Epub 2008 Jul 1.
Correlations of noncarious cervical lesions and occlusal factors determined by using pressure-detecting sheet.
Takehara J, Takano T, Akhter R, Morita M.
Department of Preventive Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine, Nishi 7, Kita 13, Kita-ku, Sapporo 060-8586, Japan. jtake@den.hokudai.ac.jp
OBJECTIVES: The purpose of this clinical study was to examine the relationships of v-shaped noncarious cervical lesion (NCCL) formation with occlusal factors. METHODS: A total of 159 male self-defense force officials with a mean age of 36.2 years participated in this study. All present teeth were examined for the presence and type of NCCL using the Tooth Wear Index (TWI). The subjects were then interviewed about bruxing and toothbrushing habit. Finally, occlusal force, occlusal contact area and average pressure were measured using a pressure-detecting sheet. Subject-level logistic regression was carried out to assess the associations of factors with presence of v-shaped NCCL teeth. Subjects without v-shaped NCCL were designated as control subjects. RESULTS: Totally, 4518 teeth were examined. Seventy-eight subjects (49.1%) had one or more teeth with typical v-shaped NCCL (259 teeth). The number of teeth with v-shaped NCCL of grade 2 (defect less than 1mm in depth) was 195 (4.3%), and the number of teeth with v-shaped NCCL of grade 3 (defect 1-2mm in depth) was 54 (1.2%). The prevalence of teeth with v-shaped NCCL was significantly higher in the maxilla than in the mandible. Most of the NCCL teeth were premolars. There was no significant difference between teeth with NCCL on the right side and those on the left side. Subject-level logistic regression analysis revealed that age (OR=1.11), toothbrushing pressure (400g, OR=2.43) and occlusal contact area (>23.0mm(2), OR=4.15) were associated with the presence of NCCL teeth. CONCLUSIONS: It is concluded that aging, toothbrushing pressure and occlusal contact area are associated with the presence of NCCLs.
Clinical evaluation of an all-in-one adhesive in non-carious cervical lesions with different degrees of dentin sclerosis.
Ritter AV, Heymann HO, Swift EJ Jr, Sturdevant JR, Wilder AD Jr.
University of North Carolina at Chapel Hill, School of Dentistry, Department of Operative Dentistry, Chapel Hill, NC, USA. rittera@dentistry.unc.edu
This randomized clinical trial compared the performance of an all-in-one adhesive (iBond) applied in sclerotic and non-sclerotic non-carious cervical lesions with that of a three-step etch-prime-bond adhesive (Gluma Solid Bond, SB). One-hundred and five lesions were randomly assigned to four groups according to adhesive, sclerosis scale and technique: 1) SB applied to lesions with sclerosis scale 1 and 2 (n=26); 2) iBond applied to lesions with sclerosis scale 1 and 2 (n=28); 3) iBond applied to lesions with sclerosis scale 3 and 4 (n=25) and 4) iBond applied with prior acid-etching to lesions with sclerosis scale 3 and 4 (n=26). A microfilled composite (Durafill VS) was used as the restorative material. The restorations were evaluated for retention, color match, marginal adaptation, anatomic form, cavosurface margin discoloration, secondary caries, pre- and post-operative sensitivity, surface texture and fracture at insertion (baseline), 6, 18 months and at 3 years using modified USPHS evaluation criteria (Alfa=excellent; Bravo=clinically acceptable; Charlie=clinically unacceptable). There was a high percentage of Bravo scores for marginal adaptation (4%-32%) and marginal discoloration (18%-60%) in Groups 2, 3 and 4, but all groups had <5% Charlie scores at 6 months and <10% Charlie scores at 18 months for retention and marginal discoloration, respectively. However, it should be noted that 13% of the restorations in Group 4 were not retained at three years.
J Prosthet Dent. 2008 Jul;100(1):1-10.
In vitro reproduction of noncarious cervical lesions.
Private practice, Arlington Heights, IL, USA. drrro1@sbcglobal.net
STATEMENT OF PROBLEM: A review of the dental literature indicates that noncarious cervical lesions (NCCLs) are formed by erosion, abrasion, and/or abfraction of tooth structure, but their etiology remains scientifically unsubstantiated. PURPOSE: The purpose of this study was to reproduce noncarious cervical lesions in vitro. This study was not designed to statistically quantify the amount of lost tooth structure via abrasion, but rather to attempt to create NCCLs in the various shapes and sizes that are clinically observed. MATERIAL AND METHODS: Three pairs of toothbrush types (generic and name-brand) with soft, medium, or firm bristles were tested with 3 different toothpastes of varying abrasive potentials (low, medium, and high) or with water only, on mounted human teeth with and without simulated gingival tissues (6 toothbrushes x 4 brushing solutions (L, M, H, dentifrices, or water only) x 2 gingival mask conditions = 48 test/control groups of 4 teeth each = 192). RESULTS: The control sets, brushed in water only, demonstrated no visible loss of tooth structure. Each set brushed with toothpaste, regardless of the degree of abrasiveness or toothbrush bristle firmness, demonstrated visible wear at the level of the CEJ. CONCLUSIONS: Significant noncarious cervical lesions were created via horizontal brushing with common commercial toothpaste, while brushing with water only did not create these cervical lesions.
Dent Mater. 2007 Dec;23(12):1562-9. Epub 2007 Mar 27.
Restoration of non-carious cervical lesions Part II. Restorative material selection to minimise fracture.
Ichim IP, Schmidlin PR, Li Q, Kieser JA, Swain MV.Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9001, New Zealand. ionut.ichim@stonebow.otago.ac.nz
OBJECTIVE: It is still largely unknown as to what material parameter requirements would be most suitable to minimise the fracture and maximising the retention rate of the restoration of cervical non-carious lesions (NCCL). The present paper, as a first of its kind, proposes a radical approach to address the problems of material improvement, namely: numerical-based, fracture and damage mechanics materials optimisation engineering. It investigates the influence of the elastic modulus (E) on the failure of cervical restorative materials and aims to identify an E value that will minimise mechanical failure under clinically realistic loading conditions. METHOD: The present work relies on the principle that a more flexible restorative material would partially buffer the local stress concentration. We employ a “most favourable” parametric analysis of the restorative’s elastic modulus using a fracture mechanics model embedded into finite element method. The advanced numerical modelling adopts a Rankine and rotating crack material fracture model coupled to a non-linear analysis in an explicit finite element framework. RESULTS: The present study shows that the restorative materials currently used in non-carious cervical lesions are largely unsuitable in terms of resistance to fracture of the restoration and we suggest that the elastic modulus of such a material should be in the range of 1GPa. We anticipate that the presented methodology would provide more informative guidelines for the development of dental restorative materials, which could be tailored to specific clinical applications cognisant of the underlying mechanical environment.
J Periodontol. 2007 Apr;78(4):615-23
Coronally positioned flap for treatment of restored root surfaces: a 6-month clinical evaluation.
Lucchesi JA, Santos VR, Amaral CM, Peruzzo DC, Duarte PM.
Department of Periodontics, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
BACKGROUND: The aim of this study was to evaluate clinically the treatment of gingival recession associated with non-carious cervical lesions (NCCLs) by resin modified glass ionomer cement (RMGI) or microfilled resin composite (MRC) and coronally positioned flap (CPF) at 6 months following surgery. METHODS: Fifty-nine patients were assigned to one of three treatments: root exposure without NCCL treated with CPF (group 1); root exposure with NCCL treated with RMGI restoration plus CPF (group 2); or root exposure with NCCL treated with MRC restoration plus CPF (group 3). Clinical measurements that were assessed at baseline and at 3 and 6 months after surgery included plaque index (PI), bleeding on probing (BOP); probing depth (PD), recession reduction (RR), clinical attachment level gain (CALG), keratinized tissue height (KTH), keratinized tissue thickness (KTT), percentage of root coverage (RC), and percentage of restored root coverage (RRC). RESULTS: Intra- and intergroup analyses demonstrated no significant differences in PI, BOP, PD, RR, CALG, KTH, or KTT (P >0.05) among the groups at any time. At 6 months, the mean RC was 80.83% +/- 21.08% for group 1; the mean RRCs were 71.99% +/- 18.69% and 74.18% +/- 15.02% for groups 2 and 3, respectively. There were no statistically significant differences in RRC between groups 2 and 3. CONCLUSION: All treatments showed root coverage improvement without damage to periodontal tissues, supporting the use of CPF for treatment of root surfaces restored with RMGI or MRC as being effective over the 6-month period.
Dent Mater. 2007 Dec;23(12):1562-9. Epub 2007 Mar 27
Restoration of non-carious cervical lesions Part II. Restorative material selection to minimise fracture.
Ichim IP, Schmidlin PR, Li Q, Kieser JA, Swain MV.
Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9001, New Zealand.
OBJECTIVE: It is still largely unknown as to what material parameter requirements would be most suitable to minimise the fracture and maximising the retention rate of the restoration of cervical non-carious lesions (NCCL). The present paper, as a first of its kind, proposes a radical approach to address the problems of material improvement, namely: numerical-based, fracture and damage mechanics materials optimisation engineering. It investigates the influence of the elastic modulus (E) on the failure of cervical restorative materials and aims to identify an E value that will minimise mechanical failure under clinically realistic loading conditions. METHOD: The present work relies on the principle that a more flexible restorative material would partially buffer the local stress concentration. We employ a “most favourable” parametric analysis of the restorative’s elastic modulus using a fracture mechanics model embedded into finite element method. The advanced numerical modelling adopts a Rankine and rotating crack material fracture model coupled to a non-linear analysis in an explicit finite element framework. RESULTS: The present study shows that the restorative materials currently used in non-carious cervical lesions are largely unsuitable in terms of resistance to fracture of the restoration and we suggest that the elastic modulus of such a material should be in the range of 1GPa. We anticipate that the presented methodology would provide more informative guidelines for the development of dental restorative materials, which could be tailored to specific clinical applications cognisant of the underlying mechanical environment.
Oper Dent. 2007 Jan-Feb;32(1):11-5
Clinical evaluation of three adhesive systems for the restoration of non-carious cervical lesions.
Burrow MF, Tyas MJ.
School of Dental Science, The University of Melbourne, Victoria, Australia. mfburrow@unimelb.edu.au
The use of adhesive materials to restore non-carious cervical lesions (NCCL) has become the standard practice. Until recently, the most reliable material for restoring NCCL is glass ionomer cement, but the esthetics can be problematic. This study compared the retention of a self-etching adhesive, Clearfil SE Bond, with Clearfil ST resin composite (SE), with the phosphoric acid-etch single bottle adhesive Single Bond with A110 resin composite (SB) and a resin-modified glass ionomer cement, Fuji II LC, (FJ). Ninety-two restorations in 20 patients (mean age 61 years) were placed. The teeth were restored randomly and manufacturers’ instructions were followed. Patients were recalled at 6 months, 1, 2 and 3 years and the restorations were evaluated for marginal staining. The restorations were photographed at baseline and at recall periods. At one year, 80 restorations were available for evaluation; at 2 years, 65 restorations were evaluated and at 3 years, 55 restorations were evaluated. The cumulative retention rates at 1 year, 2 years and 3 years, respectively, were SE: 97%, 93%, 90%; SB: 86%, 77%, 77%; FJ: 100%, 100%, 97%. At 3 years, RM-GIC performed the best, followed by Clearfil SE Bond/Clearfil ST. Single Bond/A110’s performance was significantly less than the other 2 materials (p = 0.012).
Am J Dent. 2006 Oct;19(5):289-92
Clinical evaluation of self-etch adhesives in Class V non-carious lesions.
Abdalla AI, García-Godoy F.
Department of Restorative Dentistry, Faculty of Dentistry, University of Tanta, Egypt. aliebraheem01@yahoo.com
PURPOSE: To evaluate the clinical performance of two self-etching and one total-etch adhesives in Class V non-carious cervical lesions (NCCL). METHODS: Two self-etching primers, Clearfil SE Bond and Hybrid Bond, and one total etch adhesive, Admira Bond, were placed in 195 NCCL. Restorations were evaluated at baseline, 1 and 2 years using the USPHS criteria. RESULTS: No restoration was lost after 1 and 2 years for all materials. There was no significant difference between the baseline and 2-year results for Admira Bond and Clearfil SE Bond restorations. In contrast, Hybrid Bond restorations showed significant deterioration in marginal adaptation and cavosurface marginal discoloration after 2 years. Also, there was no significant difference between Admira Bond and Clearfil SE Bond at each recall period.
Am J Dent. 2005 Apr;18(2):135-40.
Clinical performance of a self-etching adhesive at 18 months.
Perdigão J, Carmo AR, Anauate-Netto C, Amore R, Lewgoy HR, Cordeiro HJ, Dutra-Corrêa M, Castilhos N.
University of Minnesota School of Dentistry, 515 SE Delaware St., 8-450 Moos Tower, Minneapolis, MN 55455, USA. perdi001@umn.edu
PURPOSE: To test the null hypothesis that beveling and/or etching enamel would not affect the 18-month clinical performance of the self-etching adhesive Clearfil SE Bond (CSEB) in noncarious cervical lesions (NCCL). METHODS: With Institutional Review Board approval, 34 patients were enrolled in this study. A total of 120 NCCL was selected and assigned to four groups: (1) CSEB was applied without any cavity preparation; (2) CSEB was applied after beveling enamel; (3) CSEB was applied after etching enamel for 15 seconds with 35% phosphoric acid; (4) CSEB was applied after beveling and etching enamel. A microfilled composite resin was used for all restorations. RESULTS: At 6 months after initial placement, 120 restorations (a 100% recall rate) were evaluated. At 18 months, 87 restorations (a 72.5% recall rate) were available for evaluation. A survival rate of 100% was measured for all groups at both 6 and 18 months. Sensitivity to air decreased significantly only for Group 3 (no bevel+acid etch) from baseline to 18 months without statistical changes from 6 months to 18 months. None of the other parameters resulted in significant differences for any of the four groups. However, when data were pooled, both the overall marginal discoloration and the overall marginal adaptation were significantly worse at 18 months than at baseline, while sensitivity to air decreased significantly from baseline to 18 months. The 18-month survival rate of the self-etching adhesive Clearfil SE Bond was not improved by enamel bevel or by enamel etching. Both overall marginal adaptation and overall marginal discoloration were worse at 18 months than at baseline.
Oper Dent 2001 Sep-Oct;26(5):491-7
Microleakage of class V resin composite restorations after bur, air-abrasion or Er:YAG laser preparation.
Corona SA, Borsatto M, Dibb RG, Ramos RP, Brugnera A, Pecora JD.
Universidade de Sao Paulo, Faculdade de Odontologia de Ribeirao Preto, Departamento de Odontologia Restauradora, Brazil.
This in vitro study compared the microleakage of Class V resin composite restorations placed in cavities prepared with a high-speed dental bur, air-abrasion or Er:YAG laser. Twenty sound extracted human third molars were selected and randomly assigned to four equal Groups (n=10): Group I, cavities were cut by dental drill at high-speed; Group II, aluminum oxide air-abrasion was used for cavity preparation, and in Groups III and IV, cavities were prepared by Er:YAG laser. Following cavity preparation, Groups I and II were acid-etched, Group III was treated only by Er:YAG laser and Group IV was conditioned by Er:YAG laser followed by acid-etching. Cavities were restored (Single Bond + Z-100) and the teeth stored for seven days in distilled water. Then, the restorations were polished and the specimens thermocycled, immersed in a 0.2% Rhodamine solution, sectioned and analyzed for leakage at the occlusal (enamel) and cervical (dentin/cementum) interfaces using an optical microscope connected to a video camera. The images were digitized and software was utilized for microleakage assessment. Upon analyzing the results, statistically significant differences (p<0.01) between the occlusal and cervical regions for all groups was observed, and, as a rule, there was better marginal sealing at the enamel margins. The highest degree of infiltration was observed for cavities prepared and treated exclusively by Er:YAG (Group III). The other experimental groups showed statistical similarities in the amount of marginal leakage at the enamel margins. However, at the cervical margins, there was a significant difference (p<0.05) between Group I and the remaining groups. None of the techniques completely eliminated marginal microleakage at the dentin/ cementum margins.
J Dent 2001 Jan;29(1):1-6
Eighteen-month clinical evaluation of a filled and unfilled dentin adhesive.
Swift EJ Jr, Perdigao J, Heymann HO, Wilder AD Jr, Bayne SC, May KN Jr, Sturdevant JR, Roberson TM.
Department of Operative Dentistry, School of Dentistry, University of North Carolina, CB#7450, 302 Brauer Hall, 27599-7450, Chapel Hill, NC, USA. ed_swift@dentistry.unc.edu
OBJECTIVE: The purpose of this study was to evaluate the performance of a filled (OptiBond Solo) and an unfilled (Prime & Bond 2.1) “one-bottle” adhesive in Class V restorations after 18 months of clinical service. METHODS: Thirty-three patients with non-carious cervical lesions were enrolled in the study. A total of 101 lesions were restored using one of the adhesives and a hybrid composite resin. Enamel was not beveled, nor was any mechanical retention placed. The restorations were evaluated at baseline, and at 6 and 18 months after placement using modified USPHS criteria. RESULTS: Cumulative 18-month retention rates were 93.6% for OptiBond Solo and 98.0% for Prime & Bond 2.1. The difference in retention rates was not statistically significant. For OptiBond Solo, the only notable problems were interfacial staining and marginal adaptation, both of which were less than ideal in 9% of restorations. Marginal problems were slightly less frequent for Prime & Bond 2.1 restorations, but the difference was not significant. CONCLUSIONS: Both adhesives provided Class V retention rates exceeding the 18-month, full acceptance guidelines set by the American Dental Association. Any additional benefit provided by the use of a filled adhesive was not detected in this 18-month clinical trial.
Oper Dent 2001 Jan-Feb;26(1):12-6
Two-year clinical performance of a polyacid-modified resin composite and a resin-modified glass-ionomer restorative material.
Brackett WW, Browning WD, Ross JA, Brackett MG.
Department of Adult Restorative Dentistry, College of Dentistry, University of Nebraska Medical Center, PO Box 830740, Lincoln, NE 68583-0750, USA.
This study compared the clinical performance of a polyacid-modified resin composite and a resin-modified glass-ionomer restorative material over two years. Thirty-four pairs of restorations of Compoglass and Fuji II LC were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline, 6, 12, 18 and 24 months using modified Ryge/USPHS criteria. A significantly higher incidence of failed restorations was found with the polyacid-modified resin composite (p < 0.05).
Oper Dent 2000 Sep-Oct;25(5):382-7
Cervical compomer restorations: the role of cavity etching in a 48-month clinical evaluation.
Di Lenarda R, Cadenaro M, De Stefano Dorigo E.
Institute of Odontology and Stomatology, Department of Dental Materials, University of Trieste Erta dei pruni 22/1-34136 Trieste, Italy.
Compomers are defined as polyacid-modified resin composites. They are supposed to combine the advantages of traditional glass-ionomer cements with resin composites. This study clinically evaluated a compomer in cervical cavities. Sixty cervical cavities in premolars and molars (24 with cervical caries and 36 with abrasions) randomly divided into two groups of 30 teeth (Group 1 and Group 2) were restored with Dyract (DeTrey-Dentsply, York, PA 17405-0872). The cavities of Group 2 were etched for 30 seconds with orthophosphoric acid before compomer application, while the Group 1 cavities received no treatment. All the restorations were evaluated every six months, up to 48 months: characteristics assessed according to USPHS-modified standards were retention, secondary caries, post-operative sensitivity, marginal adaptation and discoloration, color and wear. The Kaplan-Meier’s survival analysis was performed. In both groups, retention was high without any statistically significant difference. No difference was found between the two groups for caries, post-operative sensitivity and wear–that all had a low incidence. Color was not perfectly matched, however, there was no statistically significant difference between the two groups. Marginal discoloration and marginal adaptation loss were significantly higher in non-etched group (p < 0.05). Clinically relevant failure required 17.2% of restorations in the non-etched group and 10% in the etched group to be replaced: this difference was not statistically significant. Dyract has an acceptable clinical behavior when used in cervical cavities. Its marginal adaptation is enhanced by etching.
Quintessence Int 2000 Oct;31(9):668-72
Use of a compomer in Class V restoration: a microleakage study.
Tung FF, Estafan D, Scherer W
Advanced Education Program in Prosthodontics, Division of Restorative and Prosthetic Sciences, New York University, College of Dentistry, 345 East 24th Street, New York, New York 10010, USA. fft1@is4.nyu.edu.
OBJECTIVE: The purpose of this investigation was to evaluate the microleakage of Class V lesions restored with a compomer material (Dyractflow) using 2 single-bottle bonding systems. METHOD AND MATERIALS: Sixty-four Class V cavity preparations were made on 32 sound, extracted human premolars, 1 preparation on the facial surface and 1 on the lingual surface. Teeth were then randomly divided into 2 groups. Group 1, which served as the control group, was restored as follows: group 1a, facial surface with PQ1 single-bottle bonding system plus TPH resin composite; group 1b, lingual surface with Prime & Bond NT single-bottle bonding system plus TPH. Group 2 was restored as follows: group 2a, facial surface with PQ1 plus Dyractflow compomer material; group 2b, lingual surface with Prime & Bond NT plus Dyractflow. After 24 hours of storage in water and subsequent thermocycling, each specimen was immersed in 0.2% basic fuchsin dye for 24 hours. The teeth were sectioned longitudinally and horizontally, and dye penetration at enamel and cementum margins was viewed at x30 magnification by 2 independently calibrated evaluators. Specimens were evaluated as either having leaked or not having leaked. RESULTS: No statistically significant differences in microleakage were noted between group 1 and group 2 specimens. CONCLUSION: Both single-bottle bonding systems, PQ1 and Prime & Bond NT, demonstrated equal effectiveness in reducing microleakage beneath compomer and composite restorations.
J Adhes Dent 1999;1(4):333-41 Related Articles, Books
A three-year evaluation of restorations placed with a smear-layer-mediated dentin bonding agent in non-carious cervical lesions.
Brunton PA, Cowan AJ, Wilson MA, Wilson NH
Unit of Operative Dentistry and Endodontology, University Dental Hospital of Manchester, UK. paul.brunton@man.ac.uk
PURPOSE: To evaluate the handling characteristics, clinical behavior, and effectiveness of Coltene ART Bond/Brilliant restorations in mixed Class V preparations in maxillary premolar and canine teeth of adult patients over a three-year period. MATERIALS AND METHODS: Single-center, uncontrolled, clinical evaluation of 50 restorations in 26 patients extending over 36 months. RESULTS: At three years, 34 restorations, or 68% of those originally placed, in 20 patients were available for review. One of the 34 restorations had been lost 15 months after placement. In terms of marginal integrity and staining, anatomic form, surface texture and staining, and postoperative sensitivity, over 90% of the restorations reviewed at three years were rated alpha. Following difficulties in obtaining excellent color match in relation to 14 (28%) of the restorations at the time of placement, only 44% of the restorations were rated alpha at three years. CONCLUSION: It was concluded that with the possible exception of excellent color match, ART Bond/Brilliant restorations may be found to perform favorably in mixed Class V lesions in selected adult patients over a period of at least three years. The findings indicate that resin composite restorations placed with a smear-layer mediated dentin bonding agent may be found to have a favorable clinical outcome in non-carious cervical lesions.
Quintessence Int 1999 Sep;30(9):607-14
Published erratum appears in Quintessence Int 1999 Dec;30(12):845
Evaluation of esthetic parameters of resin-modified glass-ionomer materials and a polyacid-modified resin composite in Class V cervical lesions.
Gladys S, Van Meerbeek B, Lambrechts P, Vanherle G
BIOMAT-Department of Operative Dentistry and Dental Materials, Catholic University of Leuven, Belgium.
OBJECTIVE: The purpose of this study was to compare the esthetics of 3 resin-modified glass-ionomer materials and 1 polyacid-modified resin composite to the esthetics of a conventional glass-ionomer control material. METHOD AND MATERIALS: One hundred eighty-seven Class V cervical restorations were observed clinically over 18 months. The esthetic index system that was used evaluated color match, translucency or opacity, and surface roughness. RESULTS: The tested materials behaved very dissimilarly and inconsistently. In general, the esthetic results of the resin-modified glass-ionomer materials and the polyacid-modified resin composite were far from optimal. The esthetic appearance of restorations seriously deteriorated during clinical service, mainly because of discoloration of margins, changes in translucency and opacity, and rapidly appearing roughness or dullness on the surface. Both the resin-modified glass-ionomer materials and the polyacid-modified resin composite evaluated in this study performed better esthetically than did the conventional glass-ionomer material. CONCLUSION: Indications for these combination materials are limited to areas where esthetics is not a primary concern but where their ease of application may guarantee a more durable function
Compend Contin Educ Dent 1999 Jan;20(1):11-5; quiz 16
Clinical effectiveness of a Class V flowable composite resin system.
Estafan D, Schulman A, Calamia J
New York University College of Dentistry, Division of Restorative and Prosthodontic Science, New York, USA.
This clinical study evaluated a Class V flowable composite resin restoration system and its ability to reduce dentin sensitivity. Twenty-one patients required Class V restorations because of erosion, abrasion, or decay at the cervical area. Each patient exhibited moderate or severe sensitivity and required replacement of tooth structure. The degree of sensitivity was determined by either tactile scraping of the tip of an explorer over the surface of the tooth or by an air blast from a syringe for 5 seconds. A total of 52 restorations were performed. According to phone conversations and questionnaires, 1 patient experienced continued sensitivity on 1 treated tooth for a duration of 1 week, but this sensitivity was gone at 1-month, 3-month, 6-month, and 1-year recalls. None of the other patients exhibited sensitivity at any phone checks or during recall visits.
Am J Dent 1999 Jun;12(3):119-22
1-year clinical evaluation of Compoglass and Fuji II LC in cervical erosion/abfraction lesions.
Brackett WW, Browning WD, Ross JA, Gregory PN, Owens BM
Department of Adult Restorative Dentistry, College of Dentistry, University of Nebraska Medical Center, Lincoln 68583-0750, USA. wbracket@unmc.edu
PURPOSE: This study was undertaken to compare the clinical performance of a polyacid-modified resin-based composite and a resin-modified glass-ionomer restorative material over 1 year. MATERIALS AND METHODS: Thirty-four pairs of restorations of Compoglass (C) and Fuji II LC (F) were placed in 31 patients, with no patient receiving more than two pairs, and with materials assigned at random within the pairs. Caries-free cervical erosion/abfraction lesions of the facial surface were restored without tooth preparation according to manufacturers’ instructions, except that tooth structure to be restored was etched with 37% phosphoric acid prior to placement of Compoglass. Restorations were clinically evaluated by two blinded examiners at baseline, 6 months, and 1 year, using modified Ryge/USPHS criteria. Restorations receiving a score of “Charlie” in either retention or secondary caries were classified as failed restorations. The incidence of failures was statistically analyzed as a pairwise comparison, using an exact binomial test. RESULTS: Thirty-one pairs of restorations were available for recall at 1 year. The percentage of Alfa scores for each material in each category were: Retention (C = 84%, F = 100%), Color match (C = 81%, F = 100%), Marginal discoloration (C = 78%, F = 97%), Secondary caries (C = 88%, F = 100%), Anatomic form (C = 92%, F = 100%), and Marginal adaptation (C = 26%, F = 46%). Except for the failed restorations, no other Charlie scores were assigned. A significant difference in the incidence of failed restorations was found between the materials (P = 0.01).
Oper Dent 1999 Jan-Feb;24(1):9-13
Two-year clinical performance of a resin-modified glass-ionomer restorative material.
Brackett WW, Gilpatrick RO, Browning WD, Gregory PN
University of Tennessee-Memphis, College of Dentistry, Department of General Dentistry 38163, USA.
This study was a 2-year clinical evaluation of a conventional and a resin-modified glass-ionomer restorative material. Thirty-four restorations each of Ketac-Fil and Photac-Fil were placed without tooth preparation in cervical abrasion/abfraction lesions, primarily in premolar teeth. Patients ranged in age from 30 to 73 years, with a median age of 45 years. Isolation for the restorations was accomplished with cotton rolls. Restorations of both materials were retained at the rate of 93%, and both were comparable in appearance, receiving Alfa ratings for more than 85% of the restorations. One occurrence of secondary caries was observed for each material. No significant difference between the materials was observed for any evaluation category (exact binomial test, P > 0.05).
Minerva Stomatol 1999 Jun;48(6 Suppl 1):65-71
In vitro evaluation of four adhesive materials in the treatment of cervical lesions.
Negri P
Department of Operative Dentistry, University of Perugia.
BACKGROUND: The aim of this study was the evaluation of four adhesive restorative materials regarding the possible microleakage along margins of cervical lesions (class V lesions). METHODS: The comparative in vitro experience was performed in 24 healthy inferior human molars previously extracted and stored in saline. We realized 24 class V lesions with standard dimensions, occlusal margins placed in enamel, cervical margins placed in dentin/cement. The teeth were randomly divided into four groups (six each) and were filled with two light-cured glass ionomer cements (Fuji II LC and Fuji II LC Improved-GC) and with two enamel-dentin adhesive systems/composite resins (Scotchbond MP-3M-/Enamel Plus-Mice-rium-; Prodigy/Optibond-Kerr). All materials were treated according to manufacturers’ instructions. After thermocycling the restorations were placed in 2% methylene-blue aqueous solutions for 24 hours. Then we performed a SEM observation of the surface of margin restorations and a light-microscopy observation, after longitudinal section of specimens, to evaluate the marginal infiltration of the colouring solution. RESULTS: We submitted to statistical analysis the results of the light-microscopy observation. Differences in microleakage scores between materials were compared using Kruskall Wallis test. Although higher values of dye penetration were found at gingival margins all groups showed minimal microleakage. No statistical significative differences were seen between materials. Our results are in agreement with those of present in recent literature. CONCLUSIONS: On the basis of our results we can state that the treatment of cervical lesions is a safe and predictable clinical procedure either using light-cured glass ionomer cements or composite resins. Clinicians must take particular care of gingival margins of these lesions.
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