Bond strength of self-etch adhesives after saliva contamination at different application steps

Effect of contamination and decontamination methods on the bond strength of adhesive systems to dentin: A systematic review

INTRODUCTION

In a suitable condition, it is important to perform any dental restorative procedure using an operatory field isolated. Then, the aim of this study was to compare the bond strength of composite restorations to dentin affected by any contamination agent through a systematic review.

METHODS

This systematic review was performed following the PRISMA 2020 guidelines. The literature search was conducted until September 2022 by scanning the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts evaluated the bond strength of resin-based materials to permanent human dentin contaminated with blood or saliva were selected for full-text review. The risk of bias was assessed by the RoBDEMAT tool.

RESULTS

A total of 3750 papers resulted from the search from all databases. After the full-text reading, a total of 62 articles remained for the qualitative analysis. The contamination agents used were blood, saliva, and hemostatic agents. A great variety of protocols were used to contaminate the dentin surface, and the contamination process occurred in several steps of the bonding process, including before and after the etching process, after the primer application and after the adhesive application. Also, several decontamination procedures were tested, including reapplication of the etching material, rinsing with water, chlorhexidine or sodium hypochlorite and reapplication of the adhesive system.

CONCLUSION

Any contamination with blood or saliva impaired the bond strength of resin-based materials to dentin. Decontamination procedures including water-spray and reapplication of the bonding system could revert the impairment produced by the saliva or blood contamination. The use of hemostatic agents as a method of blood decontamination is not recommended.

CLINICAL SIGNIFICANCE

Clinicians should avoid contamination during a bonding procedure, otherwise, a reduction in the bond quality is expected.

The Effect of Salivary Contamination on the Shear Bond Strength of Seventh- and Eighth-generation Adhesive Systems

Aim

To compare the effect of salivary contamination on the shear bond strength (SBS) of seventh- and eighth-generation adhesives.

Materials and methods

Specimens were randomly divided into group I and group II, subdivided into three subgroups of 11 samples. Subgroup IA-seventh-generation uncontaminated (control); adhesive; air-dried; light cured. Subgroup IB-seventh-generation adhesive; saliva application, air-dried; light cured. Subgroup IC-seventh-generation adhesive; saliva application, air-dried, reapplication of adhesive, air-dried, light cured. Subgroup IIA- eighth-generation uncontaminated (control); adhesive, air-dried; light cured. Subgroup IIB- eighth-generation adhesive; saliva application, air-dried; light cured. Subgroup IIC-eighth-generation adhesive, saliva application, air-dried, reapplication of adhesive, air-dried; light cured. Following bonding procedure, composite resin restoration was done and subjected to SBS analysis.

Results

Mean SBS of eighth-generation adhesive was higher compared to seventh with and without saliva contamination. Reduction of SBS in seventh- and eighth-generation after saliva contamination was regained by reapplication of adhesive, which was less compared to the control [statistically significant (p < 0.05) for seventh and statistically not significant for eighth-generations].

Conclusion

The eighth-generation adhesives show better SBS with and without saliva contamination and reapplication of eighth-generation adhesives significantly improved the SBS close to the control.

Clinical significance

Single-step self-etch adhesives are the adhesives which are currently used for bonding composite restorations to dentin. The adhesive bond strength can be adversely affected by moisture contamination, especially by saliva, which can lead to failure of restoration. So, it is imperative to study a material which gives better bond strength and is less affected by salivary contamination and effect of decontamination to regain the bond strength. The study concluded that eighth-generation adhesives showed higher mean SBS with and without saliva contamination and reapplication of eighth-generation adhesives significantly improved the bond strength close to the control group.

How to cite this article

Mohan MC, Geetha P, Soman D, et al. The Effect of Salivary Contamination on the Shear Bond Strength of Seventh- and Eighth-generation Adhesive Systems. Int J Clin Pediatr Dent 2023;16(S-1):S63-S66.

Effect of contamination of bulk-fill flowable resin composite with different contaminants during packing on its surface microhardness and compressive strength: in vitro study

Background

Proper isolation and restoration of class V subgingival cavities are technique sensitive, thus the resin composite restoration is liable to contamination. This in vitro study was conducted to evaluate the surface microhardness and compressive strength of bulk-fill flowable resin composite after being contaminated during its packing.

Methods

Resin composite discs were prepared using split mold. The contaminated specimens were allocated into four groups (n = 20) according to the contaminant used: hemostatic agent (Group 1), alcohol (Group 2), artificial saliva (Group 3) and powdered gloves (Group 4). The non-contaminated specimens (n = 20) were used as control group. The surface microhardness and compressive strength of each group were tested 1-day post-photocuring (n = 5) and 1 month post-photocuring (n = 5). Values were presented as mean, standard deviation values and confidence intervals.

Results

The surface microhardness of all groups didn’t show a significant difference for different tested groups except for alcohol which showed a significant reduction on surface microhardness compared to control at 1 day post-photocuring (p = 0.001). The highest compressive strength mean values at 1 day and 1 month post-photocuring were recorded in control groups (110.42 MPa and 172.87 MPa respectively), followed by alcohol groups, then hemostatic agent groups, followed by artificial saliva with the least value recorded in powdered gloves groups (56.71 MPa and 49.5 MPa respectively).

Conclusions

Contamination of bulk-fill flowable resin composite with hemostatic agent, alcohol, artificial saliva, or powdered gloves during its packing decreased its compressive strength after 1 month post-photocuring rather than affecting its surface microhardness.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02495-6.

Development and Assessment of Bioactive Coatings for the Prevention of Recurrent Caries Around Resin Composite Restorations

OBJECTIVE

To develop hydrophilic resin-based surface coatings containing bioactive agents (proanthocyanidins from Vitis vinifera and calcium silicate) and assess their protective role at the dentin and enamel margins of cervical restorations against demineralization under simulated conditions of high and low caries activity.

METHODS

Suboptimal resin composite restorations were placed on cervical cavity preparations on buccal and lingual surfaces of thirty-two molars after a contamination protocol. Groups were divided according to the resin-based coatings (n=8): resin without bioactive (C), resin containing 2% enriched Vitis Vinifera (VVE), and resin coat containing 10% calcium silicate (CaSi). The control group did not receive a resin (NC). To simulate a hydrolyticenzymatic degradation, specimens were subjected to 2-month storage followed by incubation in esterase at 37°C for 8 days. Afterwards, recurrent caries was induced using a pH-proteolytic model on half of the specimens to simulate high caries activity, and the other half remained in simulated body fluid (SBF). Measurements of cross-section microhardness (KHN) and infiltration with rhodamine-B assessed the micropermeability (MP), the extent of demineralization (ED), and the demineralization area (DA). Data were analyzed using analysis of variance (ANOVA) and post-hoc tests (α=0.05).

RESULTS

VVE and CaSi presented higher cross-sectional KHN values for enamel and dentin (p<0.001). The bioactive coatings resulted in lower MP, ED, and DA compared to NC (p<0.005) in enamel and dentin. CaSi coating preserved the enamel from demineralization (p=0.160).

CONCLUSION

The application of bioactive coatings represents a potential strategy to protect the enamel-dentin margins of resin restorations.

New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial

Background

The clinical performance of new restorative materials must be evaluated before recommending its use in primary teeth.

Aim

This randomized clinical trial evaluated the survival rates of restorations in single and occluso-proximal cavities of primary teeth performed with a new dual-cure resin-based material in comparison with a resin-modified glass ionomer cement after 12 months of follow-up.

Materials and methods

A total of 107 restorations were placed in 27 children by one experienced pediatric dentist. Two materials were tested: Vitremer and a dual-cure resin-based material with (CentionN+Adh) and without (Cention N-Adh) adhesive system application. Two calibrated and blinded examiners evaluated the restorations at 3, 6, and 12-month. The longevity of the restorations was analyzed using Kaplan-Meier survival curves and Log-rank test (α = 5%).

Results

The overall survival rates after 12-month were 81.9% for Vitremer, 70.4% for Cention N+Adh, and 66.7% for Cention N-Adh, which had the poorer performance (HR = 0.54; 95% CI= 0.31-0.95; p = 0.031). When considering the type of the cavities, the difference was significant only for occluso-proximal cavities when Cention N-Adh was used (HR = 0.46; CI = 0.26-0.81; p = 0.008).

Conclusion

All evaluated materials are suitable for restoring occlusal cavities after selective caries removal. However, Cention N needs to be used with adhesive in occluso-proximal cavities.

Clinical significance

Cention-N can be used for deciduous teeth restorations, with similar longevity rates as resin modified glass ionomer cements.

Trial registration number RBR-9nqszr

How to cite this article

da Cunha CM, Wambier LM, Paris Matos TD, et al. New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial. Int J Clin Pediatr Dent 2022;15(1):38-46.

Challenges, standards and prospects in the therapy of orthodontic traction of impacted maxillary canine: A surgical phase

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[Effects of three self-etch adhesives and mild salivary contamination on the bonding durability of deciduous teeth]

OBJECTIVE

To compare the bonding durability of three different self-etch adhesives to primary enamel and dentin, and to investigate the effect of mild salivary contamination followed by air drying on the bonding durability.

METHODS

Two hundred and forty enamel specimens were divided randomly into 16 groups (n=15/group)according to the adhesive system [self-etch adhesives: Clearfil SE Bond(SE), AdperTM Easy One (EO), Scotchbond Universal (SBU); total-etch adhesive: AdperTM Single Bond Plus(SL)], contamination status (non-contaminated vs. salivary-contaminated) and storage condition (stored in distilled water for 24 h vs. aging mode 5 000 thermal cycles in 5 ℃ and 55 ℃). Two hundred and forty dentin specimens were assigned in the same way. Shear bond strength for 12 specimens in each group were measured. The adhesive interface for the residual specimens in each group was observed by scanning electron microscopy(SEM). Data were analyzed by three-way analysis of variance and Tukey test(P < 0.05).

RESULTS

For primary enamel, total-etch adhesive showed higher initial shear bond strength values (28.92±1.83) MPa and shear bond strength values (27.27±3.03) MPa after thermal cycles compared with the other groups, and the difference between the groups was statistically significant (P < 0.01). Shear bond strength values of EO decreased significantly in salivary-treated groups, regardless of storage conditions, and the difference was statistically significant (P < 0.01). For primary dentin, shear bond strength values of EO decreased significantly in salivary-treated groups after 24 h (P < 0.01). After 5 000 thermal cycles, total-etch adhesive showed significantly lower shear bond strength values (14.31±1.97) MPa compared with the other groups, and the difference between the groups was statistically significant (P < 0.01), and shear bond strength values of EO were significantly lower than those in SE and SBU groups (P < 0.01), regardless of contamination status.

CONCLUSION

Total-etch adhesive SL has better bonding durability to primary enamel. SE and SBU have better bonding durability to primary dentin and have a certain resistance to salivary contamination, while the bonding performance of EO is compromised greatly by mild salivary contamination followed by air drying.

The long-term consequence of salivary contamination at various stages of adhesive application and clinically feasible remedies to decontaminate

OBJECTIVE

To analyse the bond quality in dentine post-ageing after salivary contamination and decontamination at different stages of dental adhesive application.

MATERIALS AND METHODS

A total of 1120 human dentine specimens were randomly allocated to 14 groups for four intervals (n = 20) to be treated with a self-etching (SE) and universal (U) adhesive. The saliva contamination and decontamination were implemented after surface preparation, after primer application (for SE) and after adhesive curing. The decontamination groups were either rinsed and air-dried or rinsed, air-dried and reapplied with adhesive. They were stored (37 °C, distilled water) for four intervals (1 week, 1 month, 3 months and 1 year) and subjected to shear bond strength (SBS) test at a crosshead speed of 0.5 mm/min.

RESULT

One-way ANOVA with Tukey's test (α = 0.05) revealed significant reduction in SBS in all the groups in U adhesive compared with the control group at 1 week (p < 0.0001) and in SE when the contamination took place after primer application. However, decontamination improved the SBS in SE but not in U adhesive. The univariate analysis confirmed significant influences (p < 0.0001) seen by treatment procedure ([Formula: see text]=0.075), type of adhesive ([Formula: see text] = 0.328), ageing ([Formula: see text] = 0.13), experimental groups ([Formula: see text] = 0.518), and the stage of influence ([Formula: see text] = 0.60).

CONCLUSION

Saliva contamination is detrimental after primer application in SE but, decontamination regained the SBS and maintained it over time. In U adhesive, SBS deteriorated over time irrespective of the contamination.

CLINICAL RELEVANCE

Salivary contamination showed different influences on SBS at various stages of restoration with contemporary dental adhesives.

Influence of artificial saliva contamination on adhesion in class V restorations

This study aimed to evaluate the effects of artificial saliva contamination on a glass ionomer cement (GIC), a resin-modified GIC (RMGIC), and a composite resin (CR) that was used with two different etching adhesive systems. Three surface conditions were created on bovine teeth using artificial saliva: control (group I), mild saliva contamination (group II), and severe saliva contamination (group III). The microtensile bond strength (μTBS) of CR with dentin was significantly lower in group III than in group I. However, the μTBS of GIC and RMGIC with both enamel and dentin showed no significant intergroup differences. Moreover, CR exhibited significantly greater microleakage on cementum in group III than in group I, whereas both GIC and RMGIC showed no significant differences for both enamel and cementum. Thus, GIC and RMGIC may be suitable for preventing secondary caries after class V restorative treatments when contamination by saliva cannot be avoided.

Efficacy of a Light-cured Tetracaine-based Anesthetic Gel for Rubber Dam Clamp Placement: A Triple-blind Randomized Clinical Trial

OBJECTIVES

To evaluate the efficacy of a new light-cured anesthetic gel for pain control in adults undergoing rubber dam isolation for the restorative treatment of noncarious cervical lesions (NCCLs).

METHODS AND MATERIALS

This study was a randomized, split-mouth, triple-blind, controlled trial. The sample comprised 50 adults with at least one pair of NCCLs located in the same arch but on opposite sides. Simple randomization defined the tooth to receive the light-cured tetracaine-based anesthetic gel or the placebo gel. After cotton roll isolation, the gels were applied in the gingival tissue around the tooth with the aid of the applicator tip of a syringe, left in place for 15 seconds, and light-cured for 15 seconds. Then, a #212 clamp was positioned on the tooth. If the patient reported pain, the clamp was removed, the patient filled out a pain intensity form (a 0-10 visual analog scale [VAS] and a 0-4 verbal rating scale [VRS]) and an injectable anesthetic was applied before rubber dam isolation for the restorative procedure. The absolute risk, intensity of pain, and need for rescue anesthesia were analyzed by the McNemar test and the Wilcoxon signed rank test (α=5%).

RESULTS

The odds ratio [OR] for pain (OR=3.5; 95% confidence interval [CI]=1.1 to 14.6; p=0.03) showed lower reports of pain for the light-cured anesthetic gel. One in five patients will benefit from placement of the light-cured anesthetic gel. On average, pain intensity was one VAS unit lower in those using the light-cured anesthetic gel than in those using the placebo gel. For the VRS, the pain intensity for the light-cured anesthetic gel was 0.4 units lower than the pain intensity for the placebo gel (95% CI=-0.9 to 0.07). The OR for rescue anesthesia was 2.5 (95% CI=0.7 to 10.9; p=0.18).

CONCLUSIONS

The light-cured, tetracaine-based anesthetic gel reduced the absolute risk of pain by 20% in NCCLs.

Effect of the manual manipulation of composite resin with latex gloves

Purpose: This in vitro study aimed to evaluate the influence of the manual manipulation of two composite resins: Filtek™ Z350XT (3M ESPE) and Herculite Précis® (Kerr), with latex gloves contaminated with powder, human saliva and alcohol, on the microhardness values. Material and Methods: Manual manipulation was evaluated using latex gloves with powder, latex gloves without powder, latex gloves without powder with saliva, latex gloves without powder with alcohol, and without hand manipulation or contaminants (control). Each resin was manually manipulated for 10 seconds and photoactivated for 20 seconds with a light intensity of 1000mW/cm2 using a VALO –Ultradent LED light– cured unit, and then each sample was evaluated on the microhardness Vickers tester Leitz (Wetzlar). The collected data were analyzed using Kruskal –Wallis and Mann – Whitney post-test (p<0.05). Results. Microhardness values showed a significant difference between the evaluated and control groups, showing lower microhardness values in the group of latex glove with powder for Filtek™ Z350XT and the group of latex glove without powder with saliva for Herculite Précis®. Conclusion. The manual manipulation of composite resins decreases their surface microhardness.

An Overview of Dental Adhesive Systems and the Dynamic Tooth-Adhesive Interface

From the conception of resin-enamel adhesion to today's contemporary dental adhesive systems, clinicians are no longer afraid of exploring the many advantages brought by adhesive restorative concepts. To maximize the performance of adhesive-based restorative procedures, practitioners must be familiar with the mechanism of adhesion, clinical indications, proper handling, the inherent limitations of the materials and the biological challenges. This review provides an overview of the current status of restorative dental adhesives, their mechanism of adhesion, mechanisms of degradation of dental adhesive interfaces, how to maximize performance, and future trends in adhesive dentistry.

The effect of oxalate-based desensitizers on the microleakage and shear bond strength of resin modified glass ionomer

Background

The first line of intervention to alleviate tooth sensitivity is to use dentin desensitizers such as oxalate-based desensitizers. When the dentin sensitivity continues even after application of desensitizers the next intervention would be restoration of the lesion. The aim of this in vitro study was to investigate the effect of prior application of oxalate-based desensitizer on the marginal microleakage and shear bond strength of resin modified glass ionomer (RMGI) restorations.

Material and Methods

In order to prepare the specimens for microleakage test standard class v cavities were prepared on buccal surfaces of 45 teeth. The specimens were randomly divided into three equal groups. In control group, the cavities were restored with RMGI. In group 2, oxalate-based desensitizer was applied and the specimens were kept in distilled water for 14 days before restoration. In group 3 the specimens were prepared similar to group 2 and the surface of the cavities were slightly cut with bur before restoration. Methyleneblue penetration was evaluated using stereomicroscope. The data were analyzed using non-parametric tests. For shear bond strength test cervical dentin specimens were prepared and were divided into 3 groups. Surface treatments were similar to microleakage test. RMGI was packed into cylindrical plastic molds which were placed on the cut surface of the tooth and light cured. The data were analyzed by one-way ANOVA.

Results

There was not any significant difference in dye penetration in dentin margins among the groups, but microleakage in enamel margins of group 2 and 3 was higher than group 1. There was no significant difference in shear bond strength among the groups (p =0.285).

Conclusions

Non carious cervical lesions which were treated for hypersensitivity with oxalate-based desensitizers could be restored with resin modified glass ionomer if the hypersensitivity persists.

Key words:Dentin hypersensitivity, oxalate-based desensitizers, microleakage, shear bond strength.

Effect of artificial saliva contamination on adhesion of dental restorative materials

The purpose of this study was to evaluate the effects of artificial saliva contamination on three restorative materials, namely, a glass ionomer cement (GIC), a resin-modified GIC (RMGIC), and a composite resin (CR), for which two different etching adhesive systems were used. Thus, three surface conditions were created on bovine teeth using artificial saliva: control, mild saliva contamination, and severe saliva contamination. The dentin bond strength for CR was significantly lower after artificial saliva contamination. There were, however, no significant differences among the three surface conditions in terms of the dentin and enamel bond strengths of GIC and RMGIC. Moreover, CR exhibited significantly greater microleakage after artificial saliva contamination, whereas no significant differences were found in GIC and RMGIC. The results showed that artificial saliva contamination did not affect the shear bond strengths of GIC and RMGIC or their degrees of microleakage.

Effect of decontamination on micro-shear bond strength of silorane-based composite increments

AIM

The aim of the present study was to evaluate the micro-shear bond strength of silorane-based composites after saliva/blood decontamination.

METHODS

A transparent mold (1 × 2 × 1 cm) was used to make 11 flat, silorane-based composite blocks. One block served as the control. After contamination, the blocks were treated as follows: group 1: 10-s air spray; group 2: 10-s water spray + 10-s air spray; group 3: 10-s water spray + 10-s air spray + 10-s etching with phosphoric acid; group 4: 10-s air spray + 10-s etching + bonding; group 5: 10-s water spray + 10-s air spray + 10-s etching + bonding; and groups 6-10: treated the same as groups 1-5, the only difference being that blood was used instead of saliva. Ten tubes (0.7 mm × 1 mm) containing silorane-based composites were attached to each decontaminated block and light cured for 40 s. After 24-h storage in distilled water, specimens were tested under micro-shear loading at a cross-head speed of 0.5 mm/min. Data were analyzed using one-way anova and Tukey's honest significant difference (HSD) test (P < 0.05).

RESULTS

One-way anova showed significant differences in the micro-shear bond strength among the experimental groups (P < 0.001). Tukey's HSD test revealed that the bond strengths in groups 5, 9, and 10 were similar to the control group (P > 0.05).

CONCLUSION

Decontamination by water and air spray, etching, and bonding was effective in restoring the bond strength of silorane-based composite increments.

Influence of salivary contamination on the dentin bond strength of two different seventh generation adhesive systems: In vitro study

AIM

To investigate the effect of salivary contamination on the bond strength of two different seventh generation adhesive systems.

MATERIALS AND METHODS

Sixty caries-free human premolars with flat dentin surfaces were randomly divided into six groups of 10 teeth each and bonding was done using seventh-generation bonding agents Adper Easy One (3M ESPE) and Xeno V (Dentsply). Following the bonding procedure, resin composite was bonded to the surfaces using a plastic mould. The prepared specimen with composite cylinders attached were placed in 37°C distilled water for 24 h and then subjected to shear bond strength (SBS) with 0 h universal testing machine and the data were subjected to one-way analysis of variance and unpaired t-test.

RESULTS

Statistical significant difference between the Groups I, II and III in which Adper Easy One was used and similarly for Groups IV, V, and VI in which Xeno V was used. When an intergroup comparison was made using unpaired t-test Group II and Group V showed the nonsignificant difference.

CONCLUSION

Salivary contamination significantly affects the SBS of both the seventh generation dentin bonding agents. However, 2-hydroxyethyl methacryate based adhesive has higher bond strength.

The effect of saliva decontamination procedures on dentin bond strength after universal adhesive curing

Objectives

The purpose of this study was to investigate the effectiveness of multiple decontamination procedures for salivary contamination after curing of a universal adhesive on dentin bond strength according to its etch modes.

Materials and Methods

Forty-two extracted bovine incisors were trimmed by exposing the labial dentin surfaces and embedded in cylindrical molds. A universal adhesive (All-Bond Universal, Bisco) was used. The teeth were randomly divided into groups according to etch mode and decontamination procedure. The adhesive was applied according to the manufacturer's instructions for a given etch mode. With the exception of the control groups, the cured adhesive was contaminated with saliva for 20 sec. In the self-etch group, the teeth were divided into three groups: control, decontamination with rinsing and drying, and decontamination with rinsing, drying, and adhesive. In the etch-and-rinse group, the teeth were divided into four groups: control, decontamination with rinsing and drying, decontamination with rinsing, drying, and adhesive, and decontamination with rinsing, drying, re-etching, and reapplication of adhesive. A composite resin (Filtek Z350XT, 3M ESPE) was used for filling and was cured on the treated surfaces. Shear bond strength was measured, and failure modes were evaluated. The data were subjected to one-way analysis of variation and Tukey's HSD test.

Results

The etch-and-rinse subgroup that was decontaminated by rinse, drying, re-etching, and reapplication of adhesive showed a significantly higher bond strength.

Conclusions

When salivary contamination occurs after curing of the universal adhesive, additional etching improves the bond strength to dentin.

Influence of Isolation Method of the Operative Field on Gingival Damage, Patients' Preference, and Restoration Retention in Noncarious Cervical Lesions

OBJECTIVES

To evaluate the retention rates, gingival damage, and patients' preferences for adhesive restorations in noncarious cervical lesions (NCCL) associated with the use of rubber dam vs cotton rolls/retraction cord isolation.

METHODS

Thirty patients having one pair of similar NCCL on opposing sides of the same arch were enrolled in this study. A total of 60 restorations were placed. In each patient one restoration was placed under rubber dam isolation (RD) using dental retainers, and the other one was placed using cotton rolls/retraction cord (CR/RC) isolation. Dental residents with more than 10 years of clinical experience restored all NCCL using the same adhesive (GO!, SDI Limited, Bayswater, Australia) and composite resin (Ice, SDI). The patients' preferences were recorded. The gingival condition (bleeding, gingival laceration, and gingival insertion level) was evaluated immediately after the restorative procedure and after one week. Gingival sensitivity was also assessed one week after the end of the restorative procedures. The clinical time required to perform each restoration was recorded. The performance of the restorations was assessed using the FDI criteria at baseline and six, 12, and 18 months after clinical service. All criteria evaluated were submitted to appropriate statistical analysis (α=0.05).

RESULTS

The retention rates of the restorations at each recall time were not affected by the isolation method (p>0.05). No significant difference between isolation methods was found in regard to patients' preferences (p=0.86), gingival bleeding (p=0.57), laceration (p=0.64), insertion (p>0.52), gingival sensitivity (p=0.52), or chairside time (p=0.77).

CONCLUSIONS

The use of CR/RC was shown to be similar to the use of RD in terms of retention rates, patient's preference, gingival damage, and chairside time for adhesive restorations in NCCL.