A three-year clinical evaluation of two dentin bonding agents

Do bioactive materials show greater retention rates in restoring permanent teeth than non-bioactive materials? A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

To answer the following research question: does the clinical evaluation of restorations on permanent teeth with bioactive materials show greater retention rates than those with non-bioactive materials?

MATERIALS AND METHODS

A search strategy was used in the following databases: MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Embase, The Cochrane Library, and OpenGrey. Randomized controlled trials (RCTs), with a minimum of 2-year follow-up and evaluating at least one bioactive material in permanent teeth were included. Risk of bias was detected according to the Cochrane Collaboration tool for assessing the risk of bias (RoB 2.0), and network meta-analysis was performed using a random-effects Bayesian-mixed treatment comparison model.

RESULTS

Twenty-seven studies were included. The success of the restorations was assessed using modified USPHS system in 24 studies and the FDI criteria in 3 studies. Network meta-analysis revealed three networks based on restoration preparations. Resin composites were ranked with higher SUCRA values, indicating a greater likelihood of being the preferred treatment for class I, II, and III restorations. In class V, resin-modified glass ionomer cement was ranked with the highest value.

CONCLUSION

Bioactive restorative materials showed similar good clinical performance in terms of retention similarly to conventional resin composites.

CLINICAL SIGNIFICANCE

The findings must be interpreted with caution because many RCT on restorative materials aim to verify the equivalence of new materials over the gold standard material rather than their superiority. The present systematic review also suggests that new RCT with longer follow-up periods are necessary.

Evaluation of the clinical performance of GIOMERs and comparison with other conventional restorative materials in permanent teeth: a systematic review and meta-analysis

Aim The aim of this systematic review and meta-analysis was to analyse the clinical performance of GIOMER restorative composites and compare them with other conventional restorative materials in permanent teeth.Methods Searches in PubMed, Web of Science, Scopus, Ovid and Cochrane Library were conducted. Grey literature search was also performed. Clinical trials that evaluated the clinical performance of restorations with GIOMER restorative composites in permanent teeth compared to those using composite resin, glass ionomer cement, resin-modified glass ionomer cement (RMGIC) and other GIOMERs were included. Meta-analyses comparing GIOMER restorative composites with RMGIC at 6- and 12-month follow-ups and comparing two types of GIOMER were feasible.Results Ten studies fulfilled the inclusion criteria. In these studies, GIOMER was compared to different types of dental restoration materials. Dental restorations were evaluated by United States Public Health Service criteria in all included studies. Four studies were suitable for meta-analysis, which showed significant differences between GIOMER and RMGIC surface roughness at 6-month (odds ratio [OR] = 6.56; 95% confidence interval [CI] = 2.38-18.13) and 12-month (OR = 8.76; CI = 3.19-24.07) follow-ups. No significant differences between GIOMER restorative composites and RMGIC for marginal adaptation were found at 6- and 12-month follow-ups. When comparing two GIOMERs, significant differences were seen between Beautifil II and Beautifil Flowable Plus F00 for marginal staining (OR = 2.58; CI = 1.42-23.27; I2 = 0%) and surface roughness (OR = 4.59; CI = 1.11-18.97; I2 = 0%) at the 36-month follow-up. No significant differences between Beautifil II and Beautifil Flowable Plus F00 were seen for marginal adaptation and anatomic form at 6-, 18- and 36-month follow-ups.Conclusions GIOMER restorative composites presented similar performance concerning marginal adaptation and better surface roughness when compared to RMGIC. GIOMER Beautifil II presented similar performance to GIOMER Beautifil Flow Plus F00 concerning marginal adaptation and anatomic form and worse marginal staining and surface roughness when compared to Beautifil Flowable Plus F00.

Dental Applications of Carbon Nanotubes

Glass ionomer cements and resin-based composites are promising materials in restorative dentistry. However, their limited mechanical properties and the risk of bulk/marginal fracture compromise their lifespan. Intensive research has been conducted to understand and develop new materials that can mimic the functional behavior of the oral cavity. Nanotechnological approaches have emerged to treat oral infections and become a part of scaffolds for tissue regeneration. Carbon nanotubes are promising materials to create multifunctional platforms for dental applications. This review provides a comprehensive survey of and information on the status of this state-of-the-art technology and describes the development of glass ionomers reinforced with carbon nanotubes possessing improved mechanical properties. The applications of carbon nanotubes in drug delivery and tissue engineering for healing infections and lesions of the oral cavity are also described. The review concludes with a summary of the current status and presents a vision of future applications of carbon nanotubes in the practice of dentistry.

Clinical Performance of Filled/Nanofilled Versus Nonfilled Adhesive Systems in Noncarious Cervical Lesions: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions.

SUMMARY

Adhesive strategies in cervical lesions: systematic review and a network meta-analysis of randomized controlled trials

OBJECTIVES

A network meta-analysis (NMA) was performed to assess which adhesive strategy is most clinically effective in treating non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

Studies were identified by a systematic search of electronic databases including MEDLINE via PubMed, Brazilian Library in Dentistry (BBO), Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), Scopus, and Web of Science without restrictions on publication year or language. The grey literature was also consulted. Only randomized clinical trials that compared different adhesive strategies in NCCLs in adult patients were included. The risk of bias was evaluated by using the Cochrane Collaboration tool. A random-effects Bayesian mixed treatment comparison model was used to compare adhesive strategies (3ER, 2ER, 2SE, and 1SE) at different follow-up times. The surface under cumulative ranking curve (SUCRA) was estimated for each strategy. Heterogeneity was assessed by using the Cochran Q test and I² statistics. The quality of evidence was evaluated using the GRADE approach.

RESULTS

A total of 5058 studies were identified, 66 of which met the eligibility criteria and of these 5 were judged "low" risk of bias and 57 were meta-analyzed. We did not observe significant differences in the NMA analysis for any two pairs of adhesives, except for the shortest follow-up for 2ER vs 3ER. The material 2SE ranked highest, although it differed only slightly from the other bonding strategies.

CONCLUSIONS

No bonding strategy is better than the others.

CLINICAL RELEVANCE

Adhesive efficacy cannot be characterized by its bonding strategy.

Compliance of Randomized Clinical Trials in Noncarious Cervical Lesions With the CONSORT Statement: A Systematic Review of Methodology

The literature was reviewed to evaluate the compliance of randomized clinical trials (RCTs) with the CONsolidated Standards of Reporting Trials (CONSORT ) and the risk of bias of these studies through the Cochrane Collaboration risk of bias tool (CCRT). RCTs were searched at Cochrane Library, PubMed, and other electronic databases to find studies about adhesive systems for cervical lesions. The compliance of the articles with CONSORT was evaluated using the following scale: 0 = no description, 1 = poor description, and 2 = adequate description. Descriptive analyses about the number of studies by journal, follow-up period, country, and quality assessments were performed with CCRT for assessing risk of bias in RCTs. One hundred thirty-eight RCTs were left for assessment. More than 30% of the studies received scores of 0 or 1. Flow chart, effect size, allocation concealment, and sample size were more critical items, with 80% receiving a score of 0. The overall CONSORT score for the included studies was 15.0 ± 4.8 points, which represents 46.9% of the maximum CONSORT score. A significant difference among countries was observed (p<0.001), as well as range of year (p<0.001). Only 4.3% of the studies were judged as at low risk; 36.2% were classified as having unclear risk and 59.4% as having high risk of bias. The adherence of RCTs evaluating adhesive systems to the CONSORT is low with unclear/high risk of bias.

A Deep Morphological Characterization and Comparison of Different Dental Restorative Materials

Giomer is a relatively new class of restorative material with aesthetics, handling and physical properties of composite resins, and benefits of glass ionomers: high radiopacity, antiplaque effect, fluoride release, and recharge. To verify the superior properties of Giomers, in this study, a deep morphological characterization has been performed with an in vitro comparative study among a Giomer (Beautifil® II by Shofu Dental Corporation, Osaka, Japan), a Compomer (Dyract Extra by Dentsply, Caulk, Germany), glass ionomer cement (Ketac fil plus by 3M ESPE), and a composite resin (Tetric Evoceram by Ivoclar). In particular, mechanical and optical properties and ageing effects have been compared to investigate materials similarities and differences. Indentation tests, UV-Visible spectroscopy, Raman spectroscopy, and weight loss after storage in saliva or sugary drink have been carried out to analyze materials behavior in real conditions. The results confirm the high quality of Giomer material and indicate possible improvements in their usage.

Influence of adhesive strategy on clinical parameters in cervical restorations: A systematic review and meta-analysis

OBJECTIVES

We aimed to answer the following PICO question: "Is the risk of postoperative sensitivity (POS), retention rates and marginal discoloration of composite restorations [CR] bonded with self-etch (SE) in non-carious cervical lesions (NCCLs) of adults equals to etch-and-rinse (ER) adhesives?".

METHODS

A comprehensive search was performed in May 2016 in the MEDLINE, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE, abstracts of IADR, unpublished and ongoing trials registries, dissertations and theses without restrictions. Only randomized clinical trials that compared composite resin restorations placed with self-etch and etch-and-rinse in NCCLs were included. After removal of duplicates and non-eligible articles, 50 articles from 42 studies (follow-ups of the same study were merged) remained for synthesis of the risk of bias (Cochrane Risk of bias tool).

RESULTS

Thirteen studies were at "high" risk of bias, yielding 29 studies for meta-analysis. No difference on the POS after restoration placement (risk ratio [RR] 1.04; 95% CI 0.81 to 1.34) as well as in the retention rates for all follow-up periods was observed. The etch-and-rinse approach produced less marginal discoloration at 18 months to 2 years (RR 1.51; 95% CI 1.21 to 1.90) and at 4 to 5 years (RR 1.81; 95% CI 1.28 to 2.55) (p<0.0007).

CONCLUSIONS

The adhesive strategy did not influence the POS and the retention rates of composite resin in NCCLs in any of the follow-up periods; but less marginal discoloration was found in etch-and-rinse adhesives.

CLINICAL SIGNIFICANCE

Composite resin restorations placed with self-etch and etch-and-rinse adhesives produce restoration with the similar clinical service and POS, however using etch-and-rinse adhesives one can reduce marginal discoloration. PROSPERO registration number: CRD42015019533.

Classification & prevalence of dental surface defects in areas of gingival recession- a clinical study

BACKGROUND

Apical migration of the gingival margin beyond the cement-enamel junction (CEJ) is called as gingival recession. Various classifications of gingival recession have been proposed to evaluate different degrees of damage to periodontal tissues, but do not consider the condition of the exposed root surface: presence of an identifiable CEJ and presence of root abrasion. Sometimes these lesions may be associated with enamel abrasion. Therefore, the aim of this paper is to propose the new classification of dental surface defects in gingival recession area.

METHODS

Two factors were evaluated to set up a classification system: presence (A) or absence (B) of CEJ and presence (+) or absence (-) of dental surface discrepancy caused by abrasion (step). Four classes (A+, A-, B+, and B-) were identified on the basis of these variables. The classification was used on 1,000 gingival recessions to examine the distribution of the four classes.

RESULTS

Out of 1,000 exposed root surfaces, 380 showed an identifiable CEJ associated with step (Class A+, 38%); 280 an identifiable CEJ without any associated step (Class A-, 28%); 200 an unidentifiable CEJ with a step (Class B+, 20%); and 140 an unidentifiable CEJ without any associated step (Class B-, 14%).

CONCLUSION

The proposed classification describes the dental surface defects that are of paramount importance in diagnosing gingival recession areas which might help in selecting the definite treatment approach.

Retention of tooth-colored restorations in non-carious cervical lesions--a systematic review

OBJECTIVES

The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs).

METHODS

Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013.

RESULTS

Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed.

CONCLUSION

The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.

Effects of ion-releasing tooth-coating material on demineralization of bovine tooth enamel

We compared the effect of a novel ion-releasing tooth-coating material that contained S-PRG (surface-reaction type prereacted glass-ionomer) filler to that of non-S-PRG filler and nail varnish on the demineralization of bovine enamel subsurface lesions. The demineralization process of bovine enamel was examined using quantitative light-induced fluorescence (QLF) and electron probe microanalyzer (EPMA) measurement. Ion concentrations in demineralizing solution were measured using inductively coupled plasma atomic (ICP) emission spectrometry and an ion electrode. The nail varnish group and the non-S-PRG filler group showed linear demineralization. Although the nail varnish group and the non-S-PRG filler group showed linear demineralization, the S-PRG filler group did not. Further, plane-scanning by EPMA analysis in the S-PRG filler group showed no changes in Ca ion distribution, and F ions showed peak levels on the surface of enamel specimens. Most ions in the demineralizing solution were present at higher concentrations in the S-PRG filler group than in the other two groups. In conclusion, only the S-PRG filler-containing tooth-coating material released ions and inhibited demineralization around the coating.

Effects of Food-simulating Liquids on Surface Properties of Giomer Restoratives

This study examined the effects of food-simulating liquid (FSL) on the hardness and roughness of giomer restoratives based on pre-reacted glass ionomer (PRG) technology. The materials investigated included a regular (Beautifil II [BT]) and a recently introduced injectable (Beautifil Flow Plus F00 [BF]) hybrid PRG composite. A direct hybrid composite (Filtek Z250 [ZT]) and an indirect hybrid composite (Ceramage [CM]) were used for comparison. The materials were placed into customized square molds (5 mm × 5 mm × 2.5 mm), covered with Mylar strips, and cured according to manufacturers' instructions. The materials were then conditioned in air (control), distilled water, 50% ethanol solution, and 0.02 N citric acid at 37°C for seven days. Specimens (n=6) were then subjected to hardness testing (Knoop) and surface profilometry. Data were analyzed using one-way analysis of variance and post hoc Scheffe test (p&lt;0.05). Mean Knoop hardness values for the control group (air) ranged from 53.4 ± 3.4 (BF) to 89.5 ± 5.2 (ZT), while mean surface roughness values values ranged from 0.014 ± 0.002 (ZT) to 0.032 ± 0.001 (BT). All materials were significantly softened by FSL. The degree of softening by the different FSLs was material dependent. The hardness of giomers was most affected by citric acid and ethanol. The smoothest surface was generally observed with the control group. Giomer restoratives were significantly roughened by citric acid.

Clinical evaluation of giomer- and resin-modified glass ionomer cement in class V noncarious cervical lesions: An in vivo study

OBJECTIVES

To evaluate and compare the clinical performance of Giomer (Beautifil II) and RMGIC (Fuji II LC) in noncarious cervical lesions.

MATERIALS AND METHODS

Thirty-two subjects with one or two pairs of noncarious cervical lesions were included in the study. Each pair of lesion was restored with either giomer or RMGIC assigned randomly. Clinical evaluation of restorations was done using USPHS criteria. Data was formulated in a predesigned format and subjected to statistical analysis using the chi square test.

RESULTS

Statistically significant difference was found between RMGIC and Giomer with respect to surface roughness with P value <0.001.

CONCLUSION

Giomer showed superior surface finish compared to RMGIC. Both Giomer and RMGIC showed equal retention ability.

A 36-month Clinical Evaluation of Ethanol/Water and Acetone-based Etch-and-Rinse Adhesives in Non-carious Cervical Lesions

Based on the findings of this clinical trial, one may conclude that non-carious cervical lesions should be restored with the ethanol/water-based two-step etch-and-rinse adhesive Single Bond, instead of the acetone-based One Step, as the latter presents a high number of debonded restorations after short- and long-term recalls. However, other literature findings should also be taken into account before reaching a clinical decision.

Mechanical evaluation of cervical glass-ionomer restorations: 3D finite element study

OBJECTIVES

The aim of this paper was to investigate the influence of lesion shape and depth as well as the direction of occlusal loading on the mechanical response of cervical GIC restorations.

METHODS

A finite element model of a lower first premolar was created. Both wedged and rounded lesions were then modelled with incremental depth after which the tooth was loaded at different angles. First principal stress (tension) was employed as an indicator of material failure, by contrasting our calculated stresses with the ultimate tensile strength of the GIC and known values of bond strength between material and tooth substrate.

RESULTS

Obliquely loaded teeth exhibited significantly higher tensile stress in the cervical region of the restoration. For forces inclined at angles of 30 degrees and higher to the vertical tooth axis, the tensile stresses in the cervical margin of the restoration exceeded the ultimate material and bond strength. In contrast, lesion shape and depth have only a minor influence on tensile stress development.

CONCLUSIONS

Lesion depth and shape are not of primary concern from a mechanical perspective for a restorative treatment decision. By contrast, occlusal diagnosis and subsequent re-adjustments of tooth contacts do form a critical part of the treatment of non-carious cervical lesions (NCCLs).

In Vitro Evaluation of Giomers Microleakage After Exposure to 33% Hydrogen Peroxide: Self-etch vs Total-etch Adhesives

Microleakage of a total-etch adhesive system was not influenced by the application of hydrogen peroxide; conversely, enamel dye penetration significantly increased for a self-etching primer.