Clinical Trial Clinical Trial
Official title:
STRATEGIES FOR BONDING TO ENAMEL USING A UNIVERSAL ADHESIVE ON SELF-ETCHING MODE
Objective: This double-blind randomized clinical trial evaluates strategies for improving the
bonding of universal adhesive to enamel in non-carious cervical lesions (NCCL) of a new
universal multi-mode adhesive (Ambar Universal; FGM).
Methods: A total of 134 restorations were randomly placed in 19 patients according to the
following groups: SE - Self-etch; SEE - Selective etching; SE2X - Self-etch doble time; SE1+
- Self-etch additional layer. The resin composite Opallis (FGM) was placed incrementally. The
restorations were evaluated after one week (baseline), 6 and 12 months, using the FDI and
USPHS criteria. Statistical analyses were performed using appropriate tests (=0.05).
Interventions: restorative procedure All the patients selected for this study received dental
prophylaxis with a suspension of pumice and water in a rubber cup and signed an informed
consent form two weeks before the restorative procedures.
The degree of sclerotic dentin from the NCCLs was measured according to the criteria
described by Swift and others. The cavity dimensions in millimeters (height, width, and
depth), the geometry of the cavity (evaluated by profile photograph and labeled at <45o,
45o-90o, 90o<135o, and >135o), the presence of an antagonist, and the presence of attrition
facets were observed and recorded. Pre-operative sensitivity was also evaluated by applying
air for 10 s from a dental syringe placed 2 cm from the tooth surface and with an explorer.
These features were recorded to allow comparison of the baseline features of the dentin
cavities among experimental groups.
To calibrate the restorative procedure, the study director placed one restoration of each
group to identify all steps involved in the application technique. Then, the two operators,
who were resident dentists with more than five years of clinical experience in operative
dentistry, placed four restorations, one of each group, under the supervision of the study
director in a clinical setting. The restoration failures were shown to the operators prior to
starting the study. At this point, the operators were considered calibrated to perform the
restorative procedures.
The operators restored all teeth. All participants received four restorations, one of each
experimental group in different lesions previously selected according to the inclusion
criteria.
Before restorative procedures, the operators anesthetized the teeth with a 3% mepivacaine
solution (Mepisv, Nova DFL, Rio de Janeiro, RJ, Brazil) and cleaned all lesions with pumice
and water in a rubber cup, followed by rinsing and drying. Then, shade selection was made
using a shade guide.
Cleaning of all lesions with pumice and water in a rubber cup was carried out, followed by
rinsing and drying. Using a shade-selection guide, the proper shade of the composite was
determined. Following the ADA guidelines, the operators did not prepare any additional
retention or bevel.
The NCCLs received the multimode adhesive system applied in different modes: 1-step self-etch
approach (SE), selective enamel etching (SEE), 1-step self-etch applied for double time in
the enamel (SE2X), 1-step self-etch approach with additional layer (SE1+) was applied as
described below. The compositions, more details regarding the adhesion strategies used and
batch numbers are described in Table 2.
The adhesives were light-cured with a LED light-curing unit (1,000 mW/cm2) (Radii-cal),
according to the manufacturer's instructions (Table 2). Opallis (FGM) composite resin was
used in 2 to 3 increments, each one being light-cured (Radii-cal) for 30 s. The restorations
were finished immediately with fine #2200 diamond burs (KG Sorensen). Polishing was performed
with rubber points (Astropol, Ivoclar Vivadent, Liechtenstein).
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