| Abstract|| |
Aim: Four bonding agents and a composite restorative resin were evaluated in patients having noncarious cervical defects.
Materials and Methods: This clinical trial was conducted in patients having at least 4 noncarious cervical defects in posterior teeth evaluating the clinical effectiveness in relation to retention, discoloration at margins, and postoperative sensitivity of 5th, 6th, 7th, and 8th generations of bonding agents over a period of baseline, 3, 6, 12, and 24 months.
Statistical Analysis: Data were recorded and put into statistical analysis using Chi-square tests.
Results: At 24 months, retention rate was found out to be 92.6% for the 7th generation which was better than 5th (66.7%) and 6th (70.4%) generation whereas significant marginal discoloration was seen at 6 months follow-up in which 5th generation showed maximum results. However, all the four generations have an equal score of postoperative sensitivity at all the time intervals.
Conclusions: The 7th generation adhesives performed better than other generations in terms of retention. Changes in marginal discoloration were detected at 6 months with maximum score in 5th generation adhesives.
Keywords: Adhesives; bonding; generations; noncarious cervical defects
|How to cite this article:|
Handa A, Bhullar KK, Batra D, Brar RS, Khanna M, Malhotra S. Clinical performance of various bonding agents in noncarious cervical defects. J Conserv Dent 2023;26:271-4
|How to cite this URL:|
Handa A, Bhullar KK, Batra D, Brar RS, Khanna M, Malhotra S. Clinical performance of various bonding agents in noncarious cervical defects. J Conserv Dent [serial online] 2023 [cited 2023 Nov 28];26:271-4. Available from: https://www.jcd.org.in/text.asp?2023/26/3/271/376904
| Introduction|| |
Noncarious cervical defects are deemed to be true test of adhesive-mechanic performance as no mechanical retention is available. The cervical defects due to abrasion, erosion, and abfraction are described as “noncarious cervical lesions” (NCCL).
The adhesion analysis of bonding adhesives has been performed on noncarious cervical defects by numerous mechanical testing methods because of inherent characteristics of NCCLs, an occlusal force that stresses the cervical one-third of teeth, margins that are in enamel and dentin/cementum and low retention form, making it the ideal surface to check the adhesion of the bonding system.
Krithikadatta reviewed the literature for 5 years span and analyzed that there were insignificant differences in relation to integration, retention, discoloration at margins and sensitivity in teeth restored using various types of bonding agents.
Furthermore, in vivo performance of 5th and 6th generations bonding agents were studied in defects of cervical 1/3rd region, and insignificant differences were noted.
In the present study, integrity and discoloration at margins, also the postoperative sensitivity of various dentin bonding agents in noncarious cervical defects restored with nanohybrid composite resin was evaluated. The clinical performance was analyzed with the follow-up of 24 months using modified United States Public Health Service (USPHS) criteria as depicted in [Table 1] with a follow up period of twenty four months.
| Materials and Methods|| |
This study evaluated the clinical behavior of four generations of bonding agents in 120 noncarious cervical defects in 30 patients for 24 months' follow-up. Ethical approval for this controlled clinical study was cleared by ethical committee of the institute. The patients were informed about the clinical procedure and consents were taken.
Patients having four noncarious cervical defects in any of the maxillary or mandibular posterior teeth were selected for the study.
- Patient with deep carious lesion presenting symptoms of irreversible pulpitis, any history of pain, swelling, or drainage with respect to associated teeth
- Patients with bruxism, teeth with fracture lines, and developmental defects.
Total 30 patients, each patient having 4 NCCL in any of the maxillary or mandibular posterior teeth were taken up for the study. Hence, an aggregate of 120 class-V tooth preparations were done.
After ruling out any drug allergy, 2% xylocaine and 1:200,000 adrenaline were injected locally. The tooth preparation was done using diamond bur under a high-speed air-rotor handpiece. The standardized Class-V tooth preparations were done in all selected cases with dimensions occluso gingivally 2 mm, mesiodistally 3 mm, and 1.5 mm in depth approximately.
After the application of rubber dam, four preparations were grouped according to the application of the different of bonding agents [Table 2]:-
- Group I – Each isolated cervical lesion was conditioned with 37% phosphoric acid and fifth generation bonding agent (Adper™ Single Bond 2, 3M ESPE) was applied
- Group II – One step, sixth-generation bonding adhesive (Futurabond NR, Voco, Germany) was applied
- Group III – One step, seventh generation bonding adhesive in rubbing motion (Single Bond Universal, 3M ESPE) was applied
- Group IV – One step, eighth-generation bonding adhesives in rubbing motion (Futurabond DC, Voco, Germany) was applied.
Each tooth preparation received 2 layers of respective bonding agents and cured, then filled incrementally with nanocomposite resin (Filtek Z350 XT, 3M ESPE).
Clinical performance of these restorations was made for marginal discoloration, retention, and postoperative sensitivity at the baseline, 3, 6, 12, and 24 months of their placement using a modified USPHS scale.
The data were recorded and put into statistical analysis using Chi-square tests.
| Results|| |
In the present study, on evaluating retention at different time of follow-up, statistically significant difference was seen between Group-I & Group-III at 12 months (p-value=0.011) and 24 months (p-value=0.018). Also, the difference was statistically significant between Group-II & Group-III at 12 months (p-value=0.022) and 24 months (p-value=0.036) as depicted in [Table 3].
|Table 3: Statistical analysis of retention at different times of follow-up|
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While evaluating marginal discoloration, significant difference was seen as early as 6 months in Group-I & Group-III (p-value=0.031) and in Group-II & Group-III (p-value=0.021). However, no significant difference was seen afterwards [Table 4].
|Table 4: Statistical analysis of marginal discoloration at different times of follow-up|
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However, in post-op sensitivity evaluation, statistically insignificant difference has been seen in all the groups at all-time intervals [Table 5].
|Table 5: Statistical analysis of postoperative sensitivity at different times of follow-up|
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| Discussion|| |
Restoration in Class-V cervical defect is technique sensitive and may attract adhesive failures due to factors such as poor isolation, minimal retention form, and stresses generated by tooth flexure in the cervical region or bonding to dentin/cementum tissues in cervical third. Furthermore, the presence of sclerotic dentin in the cervical one-third region may prevent achieving maximum adhesion of the restoration.
Lesions in the cervical one-third have multifactorial etiology which can be manifested as cervical abrasion, erosion, and abfraction. In addition, faulty tooth brushing is one of the contributing factor as suggested by Handa et al. The patients who participated in the study, who had faulty brushing techniques were reinforced and motivated to use the correct tooth brushing or oral hygiene techniques and were evaluated upon subsequent follow-ups.
In this study, the clinical performance of composite restoration using four generations of dentin bonding agents in defects of cervical one-third was carried out at different time intervals, i.e., baseline, 3, 6, 9, and 24 months evaluating retention, marginal adaptation, and postoperative sensitivity according to modified USPHS scale.
The clinical performance of the dentin bonding agents and restorative material as a system can be verified by its retention in the tooth defects. Upon clinical evaluation among several of dentin bonding agents, in terms of retention, statistically remarkable difference was detected in between Group I versus III at 12 and 24 months' follow-up. Furthermore, statistically remarkable difference was found between Groups II versus III at 12 and 24 months [Table 3]. In addition, Group III out-performed Groups I and II after 24 months' follow-up.
The application of two layers of bonding agents could have led to the longevity of restorations. Also, link the high retention rates of the restoration to the mechanical rubbing motion of dentin bonding adhesives application.
However, on the contrary, Oz et al. observed significantly higher retention for total-etch adhesive (100%) than that of self-etch adhesive (72.2%) as the etched enamel had an adequate seal and the tooth restorative substrate was prevented from further disintegration.
Quality of restoration as well as the adaptability of the prepared tooth margins can also be predicted by marginal discoloration. In this study, statistically significant difference in relation to marginal discoloration was seen only at 6 months among groups as depicted in [Table 4]. Marginal discoloration observed in the total-etch group may be due to excessive enamel etching as well as highly acidic bonding adhesive (pH = 1.3).
Also, Lawson et al. and Atalay et al. observed down trends in the clinical performance of all adhesives upon follow-ups (p < 0.05).
However, on the contrary, Schroeder et al. detected less marginal discoloration for total-etch bonding agents. As explained by very shallow enamel etching in case of self-etch bonding agents, leading to loss of micro-porosities for the infiltration of resins. Hence, failure at the tooth-restoration margin allowed penetration of food stains or microbial biofilm leading to margin pigmentation.,
Dentin bonding agents have the ability to seal all the exposed dentinal tubules is crucial in diminishing sensitivity. In this study, all different types of adhesives used showed similar performance in terms of postoperative sensitivity without any significant differences over the followed time periods [Table 5]. However, the sensitivity reduced for all the bonding adhesives as compared to that of preoperative levels.
These observations corroborate Perdigão et al., who found insignificant difference between total-etch and self-etch bonding agents in terms of postoperative sensitivity. This could be due to the improper smear layer removal by self-etch bonding agents and double coat application of total-etch adhesives that prevent the contact of dentinal tubules. Furthermore, the protective effect of restoration resulted in diminished postoperative sensitivity.
| Conclusions|| |
- The four different generations of bonding adhesives had significant changes in relation to retention and discoloration at margins over the 24 months' period of evaluation out of which the Group III, i.e., Single Bond Universal performed better than other groups, but restoration evaluated for other parameters i.e., postoperative sensitivity displayed admissible clinical performance in noncarious cervical defects.
- The Groups I, II, and III showed remarkable changes in marginal discoloration with a period. There was no significant changes seen in all groups with respect to other parameters such as postoperative sensitivity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
De Munck J, Van Landuyt K, Peumans M, Poitevin A, Lambrechts P, Braem M, et al.
A critical review of the durability of adhesion to tooth tissue: Methods and results. J Dent Res 2005;84:118-32.
Van Meerbeek B, Peumans M, Gladys S, Braem M, Lambrechts P, Vanherle G. Three-year clinical effectiveness of four total-etch dentinal adhesive systems in cervical lesions. Quintessence Int 1996;27:775-84.
Krithikadatta J. Clinical effectiveness of contemporary dentin bonding agents. J Conserv Dent 2010;13:173-83.
] [Full text]
Digole VR, Warhadpande MM, Dua P, Dakshindas D. Comparative evaluation of clinical performance of two self-etch adhesive systems with total-etch adhesive system in noncarious cervical lesions: An in vivo
study. J Conserv Dent 2020;23:190-5. [Full text]
de Paris Matos T, Perdigão J, de Paula E, Coppla F, Hass V, Scheffer RF, et al.
Five-year clinical evaluation of a universal adhesive: A randomized double-blind trial. Dent Mater 2020;36:1474-85.
Handa A, Bal CS, Singh R, Khanna R, Handa RS. The prevalence of non-carious cervical lesions (NCCLS) in a North-Indian population. Indian J Compr Dent Care (IJCDC) 2014;4:416-21.
Zander-Grande C, Amaral RC, Loguercio AD, Barroso LP, Reis A. Clinical performance of one-step self-etch adhesives applied actively in cervical lesions: 24-month clinical trial. Oper Dent 2014;39:228-38.
Oz FD, Ergin E, Canatan S. Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL – A randomized controlled clinical trial. J Appl Oral Sci 2019;27:e20180358.
Lawson NC, Radhakrishnan R, Givan DA, Ramp LC, Burgess JO. Two-year randomized, controlled clinical trial of a flowable and conventional composite in class I restorations. Oper Dent 2015;40:594-602.
Atalay C, Ozgunaltay G, Yazici AR. Thirty-six-month clinical evaluation of different adhesive strategies of a universal adhesive. Clin Oral Investig 2020;24:1569-78.
Schroeder M, Correa IC, Bauer J, Loguercio AD, Reis A. Influence of adhesive strategy on clinical parameters in cervical restorations: A systematic review and meta-analysis. J Dent 2017;62:36-53.
van Dijken JW. Clinical evaluation of three adhesive systems in class V non-carious lesions. Dent Mater 2000;16:285-91.
Türkün LS. The clinical performance of one- and two-step self-etching adhesive systems at one year. J Am Dent Assoc 2005;136:656-64.
Perdigão J, Geraldeli S, Hodges JS. Total-etch versus self-etch adhesive: Effect on postoperative sensitivity. J Am Dent Assoc 2003;134:1621-9.
Van Landuyt KL, Peumans M, Fieuws S, De Munck J, Cardoso MV, Ermis RB, et al.
A randomized controlled clinical trial of a HEMA-free all-in-one adhesive in non-carious cervical lesions at 1 year. J Dent 2008;36:847-55.
Dr. Kanwalpreet Kaur Bhullar
Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]