22 September 2021

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What’s the best adhesive protocol for non carious cervical lesions?

Co-authors: A. Comba, F. Florenzano

Lorenzo Breschi

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So far there is no consensus about the best universal adhesive system mode to use for restoring cervical lesion . For that reason, Dr. Josic and his research group conducted a systematic review and meta-analysis in which the autors analyzed all the randomized clinical trials published on PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, OpenGrey and Google ScholarTM about this topic: after screening, 20 articles were included for qualitative analysis and 14 were used for quantitative synthesis. Twelve studies ranked as “low”, while 8 studies scored as “unclear” for risk of bias.
The choice of the adhesive system can determine differences in terms of retention, marginal discoloration, marginal adaptation and postoperative sensitivity.

The aim of this systematic review conducted by the University of Bologna was to sentence the best adhesive approach :  etch-and- rinse (EAR) compared to self-etch (SE) or selective-enamel etch (SEE) mode for NCCLs restorations with universal adhesive.

Materials and methods
 To conduct the research the authors selected 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
Dr. Josic and his research group included 20 RCTs with splith mouth design setting. For loss of retention the authors found no significant difference between EAR and SE mode at different follow-up periods (6 and 36 months), but found a statistically significant difference for 12 months follow-up, favoring EAR groups. About the risk for marginal discoloration the research showed no statistically significant differences at 6-, 12- and 18/24- months follow-up period. Regarding marginal adaptation again no statistically significant differences were seen at 6-, 12- and 18/24-months follow up periods.  Lastly considering postoperative sensitivity Dr. Josic et al.- according to the RCTs analyzed- found different POS: the first based on the data derived from questionnaires (subjective POS) given to patients one week after the restorative procedure, showing no significant difference; and the second, obtained by applying stimuli during recall (objective POS) showing significantly increased likelihood for POS occurring in the EAR groups. No significant difference was observed (p = 0.80) when comparing EAR to SEE groups in terms of stimulated POS .

Conclusion
The research group of Bologna concluded that the application of universal adhesives in the EAR mode could lead to better medium-term retention of composite restorations for NCCLs compared to the SE application strategy, while the use of the SE strategy could lead to less immediate POS and therefore better short-term patient satisfaction. The SEE approach was comparable with the EAR approach in terms of retention (moderate level of evidence at 6 and 18/24 months) and POS (moderate level of evidence).

For additional information: 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