Catechin-based Dentin Pretreatment and the Clinical Performance of a Universal Adhesive: A Two-year Randomized Clinical Trial

Impact of repair protocols on the bond strength to composite resin

This study evaluated the impact of different repair protocols on a composite resin substrate using distinct bonding agents submitted or not to artificial aging. Unopened sets of a single-step universal adhesive system (UA) and silane-coupling agents, a single-step pre-hydrolyzed (PH) or a two-step immediately hydrolyzed (IH), were used. Half of the sets were subjected to artificial aging being stored at 48 °C for 30 days, while the other half remained unaged. The composite resin substrates were prepared and aged in distilled water, sandblasted (Al2O3), and cleaned. Then the different repair protocols were applied according to the groups. UA was used without a previous silane layer, while PH and IH were applied followed by a single-step etch-and-rinse adhesive system. Adhesive systems were light-activated, and four composite resin cylinders were formed over the substrate. After 24 h, the specimens were subjected to microshear bond strength (μSBS) test and failure mode analysis. The μSBS data were subjected to two-way ANOVA followed by Tukey HSD; Kruskal-Wallis analysis was used for failure mode distribution (α = 0.05). After aging the products, UA showed higher bond strength, while PH had significantly lower results, and IH showed no significant differences (p = 0.157). No significant differences were found for bond strength among the repair protocols when using non-aged products (p > 0.05). The protocols using UA and IH showed no significant differences between aged and non-aged bottles, whereas PH exhibited lower bond strength when comparing aged and non-aged products. More cohesive failures were observed in the resin substrate for the IH group without aging.

Association between flavonoids intake and dental caries in children and adolescents: a cross-sectional study from the NHANES database

BACKGROUND

Worldwide, dental caries is a bacterial biofilm-mediated condition with a high morbidity in children and adolescents. Flavonoids are a class of active natural products with antibacterial and anti-inflammatory effect. In vivo and in vitro studies have shown that they can promote tooth mineralization and reduce inflammation. However, the association of flavonoids intake and dental caries in children and adolescents remain unclear.

AIM

This study was to evaluated the association of flavonoid and its subclass intake and dental caries in children and adolescents.

METHODS

Data of participants aged 2-17 years were extracted from the National Health and Nutrition Examination Survey (NHANES) database (2017-2018). Dental caries was measured via the decayed or filled surfaces in primary teeth or permanent teeth (dfs/DFS) index. The weighted univariable and multivariable logistic regression models were utilized to explore the association of flavonoids intake with dental caries in children and adolescents, with odds ratios (ORs) with 95% confidence intervals (CIs). Subgroups analyses based on age, and overweight/obesity were further assessed the association. Subgroup analysis were further performed to explore whether the association between subclasses of anthocyanidins and catechins with dental caries was robust stratified by age and individual with overweight/obesity.

RESULTS

Among totally 1,818 children and adolescents, 786 (43.2%) had dental caries. High intake of anthocyanidins (OR=0.69, 95%CI: 0.52-0.92) and catechins (OR=0.64, 95%CI: 0.44-0.92) were associated with lower odds of dental caries. Similar results were discovered in individuals aged ≥6 years (anthocyanidins, OR=0.62, 95%CI: 0.43-0.90; catechins, OR=0.62, 95%CI: 0.40-0.96), and without overweight/obesity (anthocyanidins, OR=0.58, 95%CI: 0.37-0.90; catechins, OR=0.51, 95%CI: 0.31-0.84). Further investigation found that high intake of cyanidin, petunidin, malvidin, peonidin, (+)-Catechin, (-)-Epigallocatechin, and (-)-epicatechin were associated with lower odds of dental caries in children and adolescents.

CONCLUSION

High intake of anthocyanidins and catechins were associated with lower odds of dental caries in children and adolescents and are a promising intervention to be further explored in children and adolescents.

Effect of different adhesive systems on dental defects and sensitivity to teeth in composite resin restoration: a systematic review and meta-analysis

OBJECTIVES

This meta-analysis aimed to elucidate the effects of various acid etching patterns on the sensitivity of teeth and their clinical effectiveness following composite resin repair.

MATERIALS AND METHODS

PubMed, Cochrane Library, Web of Science, and Embase databases were searched for relevant studies on the postoperative sensitivity (POS) of composite resin restorations after using different bonding systems. The retrieval was from the inception of the databases to August 13, 2022, with no filter of written language. Literature screening was conducted by two independent researchers. The Cochrane risk-of-bias assessment tool was adopted for quality evaluation, and Stata 15.0 for analysis.

RESULTS

Twenty-five randomized controlled trials were included in the present study. Following resin composite restoration, 1309 restorations were bonded by self-etching (SE) adhesives, whereas 1271 restorations were bonded by total-etching (TE) adhesives. The meta-analyses showed that there is no evidence to prove the SE and TE will affect POS at present when measured using the modified United States Public Health Service (USPHS) criteria [RR = 1.00 (95% CI: 0.96, 1.04)], the World Dental Federation (FDI) [RR = 1.06 (95% CI: 0.98, 1.15)], or the visual analog scale (VAS) [SMD = 0.02 (95% CI: -0.15, 0.20)] scales. At a certain follow-up time, TE adhesives provide better outcomes in terms of color match, marginal staining, and marginal adaptation. In other words, TE adhesives have better esthetic results.

CONCLUSIONS

The type of bonding technique (ER and SE) does not affect the risk and degree of POS in class I/II and class V restorations. Further research is required to verify whether these findings apply to different forms of composite resin restorations.

CLINICAL RELEVANCE

Besides the fact that TE barely increase postoperative sensitivity, it also yields superior cosmetic results.

Effect of adhesive strategy of universal adhesives in noncarious cervical lesions - an updated systematic review and meta-analysis

OBJECTIVE

To determine the effect of adhesive strategy (total etch or self-etch) of universal adhesives in non-carious cervical lesions.

DATA SOURCE

A search was made in PubMed, Scopus, Cochrane, Web Of Science, Open Gray, Clinical Registries.

DATA SELECTION

Randomized Controlled Clinical Trials, studies on non-carious cervical lesions restored using Universal Adhesives, and studies in which universal adhesives have been used in total etch and self -etch strategies were included in this systematic review.

DATA EXTRACTION

A total of 17 articles were included in the systematic review and 13 in the meta-analysis. Meta-analysis was conducted to assess the clinical performance of NCCLs in terms of retention, marginal adaptation, marginal discoloration, secondary caries and post-operative sensitivity at 18, 24, 36 month follow-up using USPHS as well as FDI criteria, separately.

DATA SYNTHESIS

Overall there was no significant difference between total etch and self etch adhesive strategies for any of the five outcome measures using either the FDI or the USPHS criteria. p > 0.05, 95% CI, I² value of 0%. A strongly suspected publication bias in the retention domain was seen at 18 month follow up under FDI criteria.

CONCLUSION

Most universal adhesives show acceptable clinical performance. There is no significant effect of the adhesive strategy of universal adhesives on their clinical performance according to the results of our meta-analysis.

Efficacy of adhesive strategies for restorative dentistry: A systematic review and network meta-analysis of double-blind randomized controlled trials over 12 months of follow-up

PURPOSE

The efficacy of etch-and-rinse, selective enamel-etching, and self-etching protocols for universal adhesives in follow-ups of over 12 months was compared in a network meta-analysis.

STUDY SELECTION

Randomized controlled trials (RCTs) published from 1998 to 2022 that compared marginal staining, marginal adaptation, retention and fractures, post-operative sensitivity, or recurrence of caries that took place over 12-months post-restoration were selected. A network meta-analysis determined the performance of each adhesive protocol.

RESULTS

After screening 981 articles, 16 RCTs were subjected to data extraction. Of which, 674 patients with 2816 restorations, were included in the network meta-analysis. The pooled risk of marginal discoloration following self-etching was significantly higher than that following etch-and-rinse at over 12, 24, and 36 months, which was time-dependent. The pooled risks of unfavorable marginal adaptation and unfavorable retention and fractures following self-etching were also significantly higher than that following etch-and-rinse, with the rates of unfavorable retention and fractures in non-carious cervical lesions increasing in a time-dependent manner. The pooled risks of marginal discoloration, unfavorable marginal adaptation, retention and fractures were similar between etch-and-rinse and selective enamel-etching protocols. Post-operative hypersensitivity and recurrence of caries were not significantly different among etch-and-rinse, selective enamel-etching, and self-etching protocols.

CONCLUSIONS

In follow-ups over 12 months, esthetic and functional outcomes of restorations completed with an etch-and-rinse adhesive protocol were superior to the ones achieved with a self-etching strategy without selective enamel-etching. Selective enamel etching is recommended for self-etching systems. Biological responses were similar for all three adhesive strategies.

Effect of Collagen Crosslinkers on Dentin Bond Strength of Adhesive Systems: A Systematic Review and Meta-Analysis

This study aimed to identify the role of crosslinking agents in the resin–dentin bond strength (BS) when used as modifiers in adhesives or pretreatments to the dentin surface through a systematic review and meta-analysis. This paper was conducted according to the directions of the PRISMA 2020 statement. The research question of this review was: “Would the use of crosslinkers agents improve the BS of resin-based materials to dentin?” The literature search was conducted in the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts that reported the effect on the BS after the use of crosslinking agents were included. The meta-analyses were performed using Review Manager v5.4.1. The comparisons were performed by comparing the standardized mean difference between the BS values obtained using the crosslinker agent or the control group. The subgroup comparisons were performed based on the adhesive strategy used (total-etch or self-etch). The immediate and long-term data were analyzed separately. A total of 50 articles were included in the qualitative analysis, while 45 articles were considered for the quantitative analysis. The meta-analysis suggested that pretreatment with epigallocatechin-3-gallate (EGCG), carbodiimide, ethylenediaminetetraacetic acid (EDTA), glutaraldehyde, and riboflavin crosslinking agents improved the long-term BS of resin composites to dentin (p ≤ 0.02). On the other hand, the use of proanthocyanidins as a pretreatment improved both the immediate and long-term BS values (p ≤ 0.02). When incorporated within the adhesive formulation, only glutaraldehyde, riboflavin, and EGCG improved the long-term BS to dentin. It could be concluded that the application of different crosslinking agents such as carbodiimide, EDTA, glutaraldehyde, riboflavin, and EGCG improved the long-term BS of adhesive systems to dentin. This effect was observed when these crosslinkers were used as a separate step and when incorporated within the formulation of the adhesive system.

Is dentin biomodification with collagen cross-linking agents effective for improving dentin adhesion? A systematic review and meta-analysis

Objectives

The aim of this investigation was to evaluate the effectiveness of collagen cross-linking agents (CCLAs) used in combination with the adhesive technique in restorative procedures.

Materials and Methods

In this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An electronic search was performed using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and DOSS, up to October 2020. The gray literature was also researched. Only randomized clinical trials were selected.

Results

The selection process yielded 3 studies from the 838 retrieved. The addition of CCLAs in the retention of restorations increased the number of events. The postoperative sensitivity scores and marginal adaptation scores showed no significant difference between the CCLA and control groups, and the marginal pigmentation scores showed a significant increase in the CCLA group. There were no caries events in any group throughout the evaluation period.

Conclusions

This systematic review showed that there is no clinical efficacy to justify the use of CCLAs in the protocols performed.

Is clinical behavior of composite restorations placed in non-carious cervical lesions influenced by the application mode of universal adhesives? A systematic review and meta-analysis

OBJECTIVE

To answer the following PICOS question: "Is the risk of retention loss, marginal discoloration, marginal adaptation and postoperative sensitivity (POS) equal for etch-and-rinse (EAR) compared to self-etch (SE) or selective-enamel etch (SEE) mode when restoring non carious cervical lesions (NCCLs) with universal adhesives?".

METHODS

PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, OpenGrey and Google Scholar™ were searched. Randomized controlled clinical trials in which resin composites and universal adhesives were used for restoration of NCCLs were considered. Cochrane Risk of Bias Tool was used to assess the risk of bias. Meta-analyses were performed using Revman; random-effects models were applied, and heterogeneity was tested using the I² index. The significance level was set at p < 0.05. Certainty of evidence was assessed by GRADE tool.

RESULTS

After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis. Twelve studies ranked as "low", while 8 studies scored as "unclear" for risk of bias. At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups (p = 0.005; RR = 0.22, 95% CI [0.08, 0.63],[moderate certainty of evidence and p = 0.0002; RR = 0.32, 95% CI [0.17, 0.58], moderate certainty of evidence, respectively). No significant differences were observed for marginal discoloration and adaptation (p > 0.05). The probability of POS occurrence was less in SE than in EAR groups (RR = 2.12, 95% CI [1.23, 3.64], moderate certainty of evidence). The certainty of evidence for other outcomes was scored as "low" or "moderate", depending on the follow-up period.

SIGNIFICANCE

Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.