11 July 2022

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Which adhesive strategy and dental material can reduce secondary caries risk?

Simona Chirico

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The accumulation of plaque, which determines poor oral hygiene in the patient or the presence of incongruous restorations, can lead to the development over time of a secondary caries, or a carious lesion that occurs in elements already treated. But are there any factors that can intervene in decreasing the risk of developing this injury?

The study conducted by Askar et al and published in the Journal of Dentistry answered this question by analyzing the risk of secondary caries formation using different types of adhesive systems and restorative materials.

Materials and methods
50 studies were examined by Pubmed research: 19 evaluated the appearance of secondary caries in different adhesive strategies, 31 studies evaluated the appearance of secondary caries in different restorative materials. The risk of bias was unclear for most studies. The studies included a mean of 40 (range: 8–90) participants and 46 (range: 14–200) restorations placed. The mean follow-up was 43 (range: 24–180) months.

Results
Secondary caries was found to be a rare event; most studies did not find secondary carious lesions in the follow-up periods considered. The meta-analysis revealed great uncertainty. 3-step etch-and-rinse adhesives showed the lowest risk of secondary caries formation, while those with 2-step etch and rinse had the highest risk of secondary caries. For restorative materials, however, resin-modified glass ionomers showed the lowest risk of secondary caries. Most resin composites showed similar risks.

Conclusions
From the data of this review it can be concluded that data from randomized studies comparing different adhesive strategies or restorative materials are unfortunately extremely scarce. However, based on the limited data in the literature, resin-modified glass ionomers and 3-step etch-and-rinse adhesives showed the lowest risk of secondary caries formation.

For additional information: Secondary caries risk of different adhesive strategies and restorative materials in permanent teeth: Systematic review and network meta-analysis