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J Am Dent Assoc, Vol 140, No 1, 28-37.
© 2009 American Dental Association
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COVER STORY

JADA Continuing Education

An eight-year clinical evaluation of filled and unfilled one-bottle dental adhesives

André V. Ritter, DDS, MS, Edward J. Swift Jr., DMD, MS, Harald O. Heymann, DDS, MEd, John R. Sturdevant, DDS and Aldridge D. Wilder Jr., DDS


   ABSTRACT
TOP
 ABSTRACT
SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Background. The strategies for accomplishing resin adhesion to dentin involve surface conditioning, priming and bonding. One-bottle adhesives combine the priming and bonding functions in a single solution. In this study, the authors compared the eight-year clinical performance of two one-bottle adhesives made by different manufacturers.

Methods. The authors placed a total of 99 Class V restorations using either a filled, ethanol-based adhesive (OptiBond Solo [OS], SDS Kerr, Orange, Calif.) or an unfilled, acetone-based adhesive (Prime & Bond 2.1 [PB] Dentsply Caulk, Milford, Del.) and a hybrid resin-based composite in 33 subjects with noncarious cervical lesions. The authors did not bevel the enamel margins and used no mechanical retention. They evaluated the restorations at baseline and for as long as eight years after placement using modified U.S. Public Health Service criteria. They analyzed differences between groups using appropriate statistical tests.

Results. The authors examined 56 restorations after eight years and found retention rates of 69 percent for OS and 59 percent for PB. These rates did not differ statistically (P = .449) and were not significantly affected by subject or lesion characteristics. The authors noted marginal discoloration on 55 percent of the retained OS restorations and on 31 percent of the retained PB restorations, but they detected no secondary caries around any restoration. They noted poor anatomical form and poor marginal adaptation in 15 percent and 40 percent of the retained OS restorations, respectively.

Conclusions. The performance of both adhesives was good during this eight-year clinical trial. The filled, ethanol-based adhesive OS demonstrated slightly better bond durability than did the unfilled, acetone-based adhesive PB, but the difference between the two materials was not statistically significant.

Clinical Implications. Despite a high incidence of marginal discoloration, the one-bottle adhesives evaluated in this study provided good clinical retention of Class V restorations without mechanical retention. When the materials are used properly, restorations are retained at an acceptable rate through at least eight years of clinical service.

Key Words: Dental adhesives; dental materials; dentin-bonding agents; restorative dentistry: operative; resin-based composites; randomized controlled clinical trials

Abbreviations: A: Alfa • B: Bravo • BIS-GMA: Bisphenol A glycidyl dimethacrylate • C: Charlie • DEJ: Dentinoenamel junction • IRB: Institutional review board • LTF: Lost to follow up • LVR: Low-viscosity resin • NCCLs: Noncarious cervical lesions • OS: Opti-Bond Solo • PB: Prime & Bond • UNC: University of North Carolina • USPHS: US Public Health Service.

Enamel and dentin bonding has evolved from a multistep, relatively complex task to a much simplified application protocol. The first clinically successful bonding agents ("three-step etch-and-rinse adhesives") comprised separate conditioning, priming and bonding steps. Most modern adhesives combine these functions into either two steps ("two-step etch-and-rinse" or one-bottle adhesives, and "two-step self-etching primers") or a single step ("all-in-one" adhesives). Although many simplified adhesives perform adequately in laboratory studies when compared with their traditional multistep counterparts,1–3 clinical trials are necessary to verify laboratory results and assess their clinical performance.

A 2005 review of the clinical effectiveness of contemporary dental adhesives revealed that few studies report clinical performance of one-bottle adhesives for three years or more, with retention rates up to three years ranging from 50 percent to 100 percent.4 The average annual failure rate for one-bottle adhesives is approximately 6 percent, which is slightly higher than the reported 5 percent annual failure rate of three-step etch-and-rinse and two-step self-etch adhesives. The retention curves for one-bottle adhesives typically show a decline in the first three years of evaluation,4 but the lack of long-term studies prevents a better understanding of their long-term performance. To our knowledge, there are only three published clinical trials of one-bottle adhesives beyond three years, showing retention rates of 85 percent at four years and 55 percent and 100 percent at five years.5–7 Long-term clinical trials are needed as supporting evidence of the longevity of these adhesives.

Evidence from laboratory studies suggests that filled adhesives can provide stress relief that compensates for composite polymerization shrinkage and occlusal forces.8–13 In 1998, we initiated a clinical trial at the University of North Carolina (UNC) at Chapel Hill to compare the clinical performance of a filled and an unfilled one-bottle adhesive used on noncarious cervical lesions (NCCLs). NCCLs are a good model with which to test the clinical performance of dental adhesives, because they provide no inherent macromechanical retention, typically include both enamel and dentin margins and are relatively simple to restore, thus minimizing the effect of operator variability.14 Preliminary results of this trial in 2001 indicated that the performance of both adhesives was excellent at 18 months and three years.15,16 We have continued to collect data since then.

The purpose of the study we conducted and describe here, therefore, was to evaluate the eight-year clinical performance of a filled and an unfilled one-bottle adhesive when used in restorations of NCCLs without retention grooves or enamel bevels. We tested the hypothesis that the two adhesives would provide similar clinical performance over time. The adhesives we tested were OptiBond Solo (SDS Kerr, Orange, Calif.) and Prime & Bond 2.1 (Dentsply Caulk, Milford, Del.). OptiBond Solo is an ethanol-based adhesive that is filled with barium glass and silica (approximately 25 percent by weight). It also contains bisphenol A glycidyl dimethacrylate (BIS-GMA), glycerol phosphate dimethacrylate, hydroxyethyl methacrylate, and sodium hexafluorosilicate. Prime & Bond 2.1 is an unfilled acetone-based adhesive that contains urethane dimethacrylate, dipentaerythritol pentaacrylate phosphate, R5-62-1 resin, BIS-GMA, butylated hydroxytoluene, 4-ethyl dimethyl aminobenzoate, camphorquinone and cetylamine hydrofluoride.


   SUBJECTS, MATERIALS AND METHODS
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Enrollment and sampling. We enrolled 33 subjects ranging in age from 27 to 77 years (mean = 53 years) in the study, and we excluded subjects with fewer than 20 teeth. We identified subjects from the university community, dental clinics and advertisements approved by the UNC Institutional Review Board (IRB). To be included, subjects had to have a dental health status considered normal in all respects—that is, subjects had no oral conditions such as periodontal disease, occlusion-related problems, unusually high caries rates or other soft- or hard-tissue related problems. We did not exclude subjects on the basis of their general health or medical history; they were in overall good health. Before participating in the study, all subjects signed a consent form that had been reviewed and approved by the UNC IRB.

We enrolled subjects who sought treatment for NCCLs that needed restorations with no undercuts. We made no attempt to determine the etiology of the lesions. In general, no more than 50 percent of the cavosurface margin involved enamel, and at least 75 percent of the surface area of the restoration was in contact with dentin. All restored teeth contacted the opposing teeth in a normal occlusal relationship and had normal periodontal health.

We used stratified randomization to assign restorations to subjects. For the first enrolled subject, we made the assignment of restorative system for the first restoration randomly. The subsequent subject then would receive as a first restoration the alternate restorative system. We assigned the consecutive restorations for each subject alternately. To minimize subject-related effects that might distort the outcome of the study, we did not allow more than three restorations per subject for each restorative system. Nearly all subjects received restorations of both types.

Baseline sample characterization. To ensure equivalence in the sample between the restorative systems, we collected subject, tooth and lesion characteristics at baseline. We collected information regarding subject’s age and sex on enrollment; determined the tooth’s occlusal status as traumatic or not (with traumatic occlusion defined by the presence of fremitus or wear facets); and determined the lesion’s location (maxillary or mandibular arch), tooth (anterior, premolar, molar), internal angle (in four categories: 0–45o, 45–90o, 90–135o, 135–180o), percentage of enamel margin (in three categories: 0–12 percent, 25–50 percent, 50–75 percent), dimensions (height, width and depth in millimeters) volume (in cubic millimeters) and score on the Dentin Sclerosis Scale17,18 (Table 1Go). We measured the aforementioned variables visually, with the aid of a periodontal probe where appropriate. We calculated lesion volume via extrapolation from the height, width and depth measurements.


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  		TABLE 1 Criteria used for clinical evaluation of a filled and an unfilled one-bottle dental adhesive on the Dentin Sclerosis Scale.*

 
Restorative procedures. Four of the authors (E.J.S., H.O.H., J.R.S. and A.D.W.) and three other operators placed restorations in this study. We usually placed the restorations without local anesthetic. We recommend the use of a rubber dam for most direct restorations as the best method of moisture control, but we found that for these cervical restorations, proper isolation could be achieved with cotton rolls and retraction cords, as well as the vigilance of a dental assistant. Therefore, we isolated the operating sites with cotton rolls and retraction cords. During tooth preparation, we did not place retention grooves or enamel bevels; however, we lightly roughened dentin and enamel walls of the preparation with a coarse diamond. We used the same tooth isolation and preparation techniques for all restorations placed in this study.

We applied the adhesive systems (OptiBond Solo or Prime & Bond 2.1) according to directions given by the manufacturers. For OptiBond Solo, we etched enamel and dentin for 15 seconds using 37.5 percent phosphoric acid, rinsed the tooth surface and lightly dried it with compressed air, avoiding desiccation. We applied OptiBond Solo with a light brushing motion for 15 seconds. In accordance with the manufacturer’s instructions, we did not dry the material with air but immediately light-activated it for 20 seconds. We applied a second coat and cured it in the same manner.

For Prime & Bond 2.1, we etched the enamel and dentin for 15 seconds with 34 percent phosphoric acid, rinsed the surface and blotted excess moisture with a moistened cotton pellet. We applied Prime & Bond 2.1 and replenished the solution as needed during a 20-second period. We gently air-dried the treated surface for five seconds. If the surface did not appear glossy, we applied more adhesive. We light-activated the material for 10 seconds. We applied a second coat but, following the manufacturer’s directions, did not light-activate it.

We restored all lesions with light-activated hybrid resin-based composite restorative materials (Prodigy, SDS Kerr, for OptiBond Solo; TPH Spectrum, Dentsply Caulk, for Prime & Bond 2.1). Prodigy contains BIS-GMA, triethylene glycol dimethacrylate, ethoxylated BIS-GMA and UV-9 resins and is 79 percent by weight (59 percent by volume) filled with barium, aluminium, zinc oxide and fumed silica particles. TPH Spectrum contains urethane-modified BIS-GMA resin and is 77.5 percent by weight (57.1 percent by volume) filled with barium aluminosilicate glass and fumed silica particles.

We inserted the composites in increments of 2 mm or smaller. We light-activated each increment for 40 seconds using a quartz-tungsten-halogen visible light-curing device (Optilux 401, Kerr Demetron, Danbury, Conn.) that had an output of > 500 milliwatts per square centimeter throughout the study. After curing, we finished the restorations using tapered and/or flame-shaped 12-fluted carbide finishing burs or microfine diamonds and polished the restorations with slow-speed polishing cups and points (Enhance, Dentsply Caulk).

Direct evaluation criteria and procedures. All authors (A.V.R., E.J.S., H.O.H., J.R.S. and A.D.W.) and four other examiners participated in the evaluation process. We examined the restorations at baseline, six months, 18 months, 36 months and eight years (mean 96 months ± SD 4 weeks) after placement. We recorded data regarding the following characteristics using modified U.S. Public Health Service (USPHS)19 direct evaluation procedures (Table 2Go):


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  		TABLE 2 Modified U.S. Public Health Service direct evaluation criteria.*

 
– retention;
– color match;
– marginal discoloration (interfacial staining);
– secondary caries;
– anatomical form (wear, loss of form or contour);
– marginal adaptation;
– postoperative sensitivity;
– other failure.

We recorded postoperative sensitivity as present (Charlie) or absent (Alfa) after subject inquiry or if the tooth was sensitive to a stream of compressed air 2 to 3 centimeters from the restoration for three seconds. In terms of retention, we recorded restorations as completely retained (Alfa) or partially (Bravo) or completely lost (Charlie).

We obtained intraoral photographs of the teeth and restorations before and immediately after insertion and at each follow-up appointment for evaluation by a second investigator. The clinical photographs were 35-mm color transparencies obtained at an original magnification of x 1.5. For the eight-year follow-up visit, we obtained digital images instead of film transparencies. Whenever the clinical evaluation and the evaluation based on the transparencies or images did not agree, we obtained forced consensus by meeting to view and evaluate the photographs as projected on a screen.

In addition to the absolute retention rate, we calculated cumulative retention failure rates for each follow-up time using the following equation:20


Formula

where PF = Number of previous failures before the current follow-up; NF = Number of new failures during the current follow-up; and RR = Number of restorations examined at the current follow-up.

Statistical analyses. We designed this study as an equivalence trial—that is, we tested the hypothesis that both restorative systems (adhesive and composite) would demonstrate similar clinical performance across time. Therefore, we based the power calculation not on expected differences between restorative systems, but rather on differences in performance of the restorative system across time (baseline versus evaluation times). For an estimated 30 percent difference in clinically unacceptable scores between baseline and eight years, the sample size we used adequately powered the study at 85 percent.

At baseline, we compared data on subjects’ age, sex and occlusion, lesion characteristics and operator between the two restorative systems using two-sample t tests (continuous variables) and {chi}2 (categorical variables), to determine if the two groups were equivalent. The lesion characteristics we evaluated were internal angle, percentage of enamel margin, sclerosis scale value, and lesion size (height, width and depth) and volume.

We compared modified USPHS direct evaluation criteria scores of restorations placed with OptiBond Solo or Prime & Bond 2.1 at eight years for statistically significant differences using the Fisher exact test (P = .05). We used lesions/restorations as the unit of analysis (cases). Although restorations placed in the same subject were not totally independent cases, the assignment of restorations to subjects was randomized. Therefore, subject and lesion characteristics were not expected to affect outcomes. However, to test for the influence of such characteristics on the performance of the restorative systems, we used logistic regression to control for factors such as operator; subject’s age, sex and occlusion; and lesion’s location, size and score on the sclerosis scale.

Finally, we ran a survival analysis and derived a Kaplan-Meier survival estimate curve on the clinically unacceptable (Charlie) scores for any of the USPHS criteria at the different follow-up times. We used a log rank test for equality of survivor function to compare the survival estimates of the two restorative systems. We used Stata 10 data analysis and statistical software (StataCorp, College Station, Texas) for all statistical analyses.


   RESULTS
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Table 3Go presents baseline, lost-to-follow-up and eight-year sample characteristics, which were similar overall for both restorative systems throughout the study. At baseline, we found no statistically significant differences between restorative systems for subject (age, sex), tooth (occlusion) and lesion (location, internal angle, percentage of enamel margin, sclerosis scale value, and lesion height, width, depth and volume) characteristics (P > .05). The distribution of restorations was approximately equal between maxillary and mandibular arches, and approximately one-half of restorations were placed in premolars, 30 percent in anterior teeth and the rest in molars. Differences in lesion size and other characteristics between the two restorative systems were very minor. Mean lesion volumes were not significantly different between the two restorative systems (two-sample t test, P = .49). Approximately two-thirds of the lesions were relatively nonsclerotic, and these were distributed almost equally between the groups.


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  		TABLE 3 Sample characteristics of tested adhesives at baseline, lost to follow-up (LTF) and eight years.

 
At eight years, the restoration recall rate was 56.6 percent. We examined 56 restorations and, similar to our baseline findings, observed no statistically significant differences between restorative systems for the same subject and lesion characteristics (P > .05). The eight-year sample characteristics did not differ greatly from the baseline sample characteristics and from the lost-to-follow-up sample characteristics, which indicates that the eight-year sample is representative of the baseline population. We lost 43 restorations to follow-up during the eight-year study period for various reasons, such as teeth’s being included in other restorative treatments and subjects’ moving out of the Chapel Hill area, becoming sick or simply not being interested in participating in the eight-year follow-up visit.

Tables 4Go through 6GoGo present summaries of the clinical evaluations. We found no secondary caries or postoperative sensitivity in any of the evaluated teeth or restorations at eight years. We noted marginal discoloration around 55 percent of the retained OptiBond Solo restorations and 31 percent of the retained Prime & Bond 2.1 restorations, and poor marginal adaptation on 40 percent of the OptiBond Solo restorations. The unadjusted retention rates at eight years were 69 percent for OptiBond Solo and 59 percent for Prime & Bond 2.1. Using the American Dental Association Council on Dental Materials, Instruments, and Equipment’s revised Acceptance program guidelines for dentin and enamel adhesive materials19 formula, the cumulative eight-year retention rates were 65.6 percent for OptiBond Solo and 60.6 percent for Prime & Bond 2.1. None of the differences between the restorative systems was statistically significant for retention (P = .449), marginal discoloration (P = .293), anatomical form (P = .270) or marginal adaptation (P = .056).


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  		TABLE 4 Direct evaluations of Optibond Solo* and Prodigy* restorations, using modified U.S. Public Health Service criteria.{dagger}

 

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  		TABLE 5 Direct evaluations of Prime & Bond 2.1* and TPH* restorations using modified U.S. Public Health Service criteria.{dagger}

 

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  		TABLE 6 Rates of Alfa scores for the two restorative systems at eight years and statistical significance.

 
We deemed 14 Opti-Bond Solo restorations and 16 Prime & Bond 2.1 restorations to be clinically unacceptable (Charlie score) during the study, predominantly owing to retention failures. The average annual failure rate for OptiBond Solo was 3.6 percent (1.75 restorations); for Prime & Bond 2.1, it was 3.9 percent (two restorations). At eight years, more than 80 percent of the retained restorations still were clinically acceptable (Alfa and Bravo scores). The logistic regression—adjusted for operator; subject’s age, sex and tooth occlusion; and lesion’s location, size and sclerosis scale score—revealed no statistically significant differences between the two restorative systems at eight years (P = .875). The Kaplan-Meier survival estimate curves are presented in the figureGo. Results of the log rank test for equality of survivor function comparing the clinical performance of the two restorative systems across time were nonsignificant (P = .61).


Figure 1
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  		Figure. Kaplan-Meier survival estimates of Class V restorations bonded using filled (OptiBond Solo) or unfilled (Prime & Bond 2.1) adhesive up to eight years (96 months) after insertion (log rank test P = .61). OptiBond Solo is manufactured by SDS Kerr, Orange, Calif. Prime & Bond 2.1 is manufactured by Dentsply Caulk, Milford, Del.

 

   DISCUSSION
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
CONCLUSIONS
 REFERENCES
 
Results of laboratory and short-term clinical studies of dental materials are more commonly published than are those of long-term trials, but long-term clinical trials provide better information about the performance of a restorative system or technique. Long-term clinical trials allow the controlled evaluation of treatments and techniques, frequently compared with equivalent or control treatments. In the study reported here, the favorable results observed for both restorative systems at the three-year evaluation,16 and the availability of most of the subjects initially enrolled, led us to conduct an eight-year evaluation.

At this eight-year follow-up, cumulative retention rates were 65.6 percent for OptiBond Solo and 60.6 percent for Prime & Bond 2.1. These rates are equivalent to approximately 70 percent and 68 percent of the retention rates of the respective restorative systems at the three-year follow-up (cumulative retention rates of 93.3 percent for OptiBond Solo and 89.4 percent for Prime & Bond 2.1 at the three-year evaluation). Most publications regarding similar one-bottle etch-and-rinse adhesives show retention rates ranging from 32 percent to 100 percent with observation times up to five years.5–7,21–28 It is not surprising that the retention rates we report here fall within the wide range of the rates in previously published data. Similar retention rates have been reported for clinical trials of three-step etch/prime/bond systems.24,28–35

At the three-year follow-up evaluation, both the OptiBond Solo/Prodigy and the Prime & Bond 2.1/TPH restorative systems performed very well, with retention rates and all other evaluation criteria rated "Alfa" for 88 to 100 percent of the examined restorations. The clinical performance for both systems appears to have deteriorated substantially between the three-year and eight-year evaluations. At eight years, of the retained OptiBond Solo/Prodigy restorations, 55 percent had interfacial staining (compared with 12 percent at three years); 40 percent had less than ideal marginal adaptation (compared with 5 percent at three years); and 15 percent had loss of anatomical form (compared with 2 percent at three years). Of the retained Prime & Bond/TPH restorations, 31 percent had interfacial staining (compared with 12 percent at three years) and 25 percent had a color mismatch (none had color mismatch at three years). ADA acceptance criteria call for less than 10 percent Charlie microleakage at 18 months.20 Although some authors define microleakage as being clinically undetectable,36 the ADA guidelines clearly reflect an interest in marginal integrity. In this study, we noted both marginal adaptation problems and interfacial staining in many of the retained restorations at eight years. We should note, however, that there were very few Charlie scores for the retained restorations, which may indicate that the noted marginal adaptation and staining problems might be related to clinically acceptable "aging" of the restorations.

In this study, we evaluated the clinical performance of both a filled (OptiBond Solo) and an unfilled (Prime & Bond 2.1) adhesive system. Filled adhesives or intermediate resins are designed to act as "elastic buffers" to relieve stresses within resin-based composite restorations caused by polymerization contraction, thermal changes and occlusal loading.8,9,13 Some systems that include a filled adhesive or a filled, intermediate low-viscosity resin (LVR) have been shown to significantly reduce marginal gaps and/or leakage around resin-based composite restorations in vitro.10,11,37–44

The resin-dentin interdiffusion zone, or hybrid layer, also has been shown to have a relatively low modulus of elasticity and also may relieve polymerization contraction stresses.13 One study showed that removal of surface collagen from demineralized dentin before primer application resulted in somewhat higher shear bond strengths, but also larger marginal gaps in complex restorations.45 However, removal of collagen prevented formation of this transition zone and resulted in wider marginal gaps, suggesting that the hybrid layer does function as a stress-absorbing layer between resin composite and dentin. The resin-dentin interdiffusion zone is not as thick as the adhesive layer (or combination of adhesive and LVR) that lies above it, so is expected to play a smaller role than does LVR in relieving stresses and maintaining marginal integrity.9

It is possible that filled adhesives provide a clinical benefit by acting as shock absorbers between relatively stiff resin composites and tooth substrates. For example, the original Opti-Bond maintains its marginal seal well when tested under simulated occlusal loading in vitro.37,40,41 In our study, the unfilled adhesive Prime & Bond 2.1 performed slightly (although not significantly) better than the filled adhesive OptiBond Solo at 18 months after placement. At three and eight years, however, the retention rates were reversed; that is, OptiBond Solo had a higher retention rate than Prime & Bond 2.1 (Tables 4Go through 6GoGo). Although the difference between the two restorative systems was not statistically significant, this finding may indicate that the filled adhesive is more resistant to fatigue forces and could provide more durable retention than the unfilled adhesive. These clinical differences may be related to the adhesives’ module of elasticity (higher for OptiBond Solo than for Prime & Bond 2.1), although further research is needed to verify this hypothesis. The nonsignificant difference noted at three years did not change substantially at eight years, however.

We selected the restorative composites used in this study because they were recommended by the respective manufacturers of the dental adhesives tested. One well-controlled study noted no significant difference in adhesive performance when different composites were used (microfilled versus hybrid).46 Because the composition of the restorative composites used in this study are similar, we do not believe that the observed results are related to or influenced by them.

Finally, there has been some discussion about whether or not the roughening of the noncarious Class V lesions before placement of the adhesive restorations has any influence on their adhesion and, ultimately, their clinical performance.47 Although we did not intentionally place mechanical retentions or enamel bevels, roughening the exposed dentin and enamel may have increased the surface area available for bonding, hence improving the clinical performance of the restorations. However, little evidence exists comparing both techniques (roughening versus nonroughening). Two studies showed no difference in retention rates between Class V restorations placed in NCCLs with or without roughening.24,26


   CONCLUSIONS
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
REFERENCES
 
Both an ethanol-based, filled adhesive and an unfilled, acetone-based adhesive provided acceptable retention of Class V restorations during eight years of clinical service. The incidence of marginal discoloration and marginal adaptation problems was relatively high at eight years for both adhesive restorative systems, but more than 80 percent of the evaluated restorations were still clinically acceptable. Despite the differences in their chemical composition and filler content, the clinical performance of the two materials was similar.


   FOOTNOTES
 

Dr. Ritter is an associate professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina, 441 Brauer Hall, Chapel Hill, N.C. 27599-7450, e-mail "rittera{at}dentistry.unc.edu". Address reprint requests to Dr. Ritter.


Dr. Swift is a professor and the chair, Department of Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill.


Dr. Heymann is a professor and the graduate program director, Department of Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill.


Dr. Sturdevant is an associate professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill.


Dr. Wilder is a professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill.


Disclosures. Dr. Swift holds a research contract with 3M ESPE, St. Paul, Minn. He also has received an honorarium from Dentsply, York, Pa. Dr. Heymann’s son is an employee of SDS Kerr, Orange, Calif. None of the other authors reported any disclosures.


This study was supported by SDS Kerr, Orange, Calif.


The authors thank Stephen C. Bayne, MS, PhD; Kenneth N. May Jr., DDS; Jorge Perdigão, DDS, MS. PhD; Patrícia N.R. Pereira, DDS, PhD; Theodore M. Roberson, DDS; and Ginger Couch for their contributions to this study.


   REFERENCES
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 

  1. Yazici AR, Celik C, Ozgünaltay G, Dayangaç B. Bond strength of different adhesive systems to dental hard tissues. Oper Dent 2007;32(2):166–172.[Medline]

  2. Knobloch LA, Gailey D, Azer S, Johnston WM, Clelland N, Kerby RE. Bond strengths of one- and two-step self-etch adhesive systems. J Prosthet Dent 2007;97(4):216–222.[Medline]

  3. Lopes GC, Cardoso PC, Vieira LC, Baratieri LN, Rampinelli K, Costa G. Shear bond strength of acetone-based one-bottle adhesive systems. Braz Dent J 2006;17(1):39–43.[Medline]

  4. Peumans M, Kanumilli P, De Munck J, Van Landuyt K, Lambrechts P, Van Meerbeek B. Clinical effectiveness of contemporary adhesives: a systematic review of current clinical trials. Dent Mater 2005;21(9):864–881.[Medline]

  5. Di Lenarda R, Cadenaro M, De Stefano Dorigo E. Cervical compomer restorations: the role of cavity etching in a 48-month clinical evaluation. Oper Dent 2000;25(5):382–387.[Medline]

  6. Van Dijken JW. Clinical effectiveness of 12 adhesive systems in Class V non-retentive lesions: a 5-year evaluation (abstract 42). J Dent Res 2001;80(4):1272.

  7. Kubo S, Kawasaki K, Yokota H, Hayashi Y. Five-year clinical evaluation of two adhesive systems in non-carious cervical lesions. J Dent 2006;34(2):97–105.[Medline]

  8. Kemp-Scholte CM, Davidson CL. Marginal integrity related to bond strength and strain capacity of composite resin restorative systems. J Prosthet Dent 1990;64(6):658–664.[Medline]

  9. Kemp-Scholte CM, Davidson CL. Complete marginal seal of Class V resin composite restorations effected by increased flexibility. J Dent Res 1990;69(6):1240–1243.[Abstract/Free Full Text]

  10. Staninec M, Kawakami M. Adhesion and microleakage tests of a new dentin bonding system. Dent Mater 1993;9(3):204–208.[Medline]

  11. Swift EJ Jr, Triolo PT Jr, Barkmeier WW, Bird JL, Bounds SJ. Effect of low-viscosity resins on the performance of dental adhesives. Am J Dent 1996;9(3):100–104.[Medline]

  12. Van Meerbeek B, Lambrechts P, Inokoshi S, Braem M, Vanherle G. Factors affecting adhesion to mineralized tissues. Oper Dent 1992;suppl 5:111–124.

  13. Van Meerbeek B, Willems G, Celis JP, et al. Assessment by nano-indentation of the hardness and elasticity of the resin-dentin bonding area. J Dent Res 1993;72(10):1434–1442.[Abstract/Free Full Text]

  14. De Munck J, Van Landuyt K, Peumans M, et al. A critical review of the durability of adhesion to tooth tissue: methods and results. J Dent Res 2005;84(2):118–132.[Abstract/Free Full Text]

  15. Swift EJ Jr, Perdigão J, Heymann HO, et al. Eighteen-month clinical evaluation of a filled and unfilled dentin adhesive. J Dent 2001;29(1):1–6.[Medline]

  16. Swift EJ Jr, Perdigão J, Wilder AD Jr, Heymann HO, Sturdevant JR, Bayne SC. Clinical evaluation of two one-bottle dentin adhesives at three years. JADA 2001;132(8):1117–1123.[Abstract/Free Full Text]

  17. Heymann HO, Bayne SC. Current concepts in dentin bonding: focusing on dentinal adhesion factors. JADA 1993;124(5):26–36.[Abstract]

  18. Ritter AV, Heymann HO, Swift EJ Jr, Sturdevant JR, Wilder AD Jr. Clinical evaluation of an all-in-one adhesive in non-carious cervical lesions with different degrees of dentin sclerosis. Oper Dent 2008;33(4):370–378.[Medline]

  19. Cvar JF, Ryge G. Criteria for the clinical evaluation of dental restorative materials. San Francisco: U.S. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, Bureau of Health Manpower Education, Division of Dental Health, Dental Health Center; 1971. DHEW publication 790–244.

  20. American Dental Association Council on Dental Materials, Instruments, and Equipment. Revised American Dental Association acceptance program guidelines for dentin and enamel adhesive materials. Chicago: American Dental Association; January 1994.

  21. Blunck U, Knitter K, Jahn KR. Six-month clinical evaluation of XP BOND in noncarious cervical lesions. J Adhes Dent 2007;9 suppl 2:265–268.[Medline]

  22. Burrow MF, Tyas MJ. 1-year clinical evaluation of one-step in non-carious cervical lesions. Am J Dent 1999;12(6):283–285.[Medline]

  23. van Dijken JW. Clinical evaluation of three adhesive systems in class V non-carious lesions. Dent Mater 2000;16(4):285–291.[Medline]

  24. Aw TC, Lepe X, Johnson GH, Mancl LA. A three-year clinical evaluation of two-bottle versus one-bottle dentin adhesives. JADA 2005;136(3):311–322.[Abstract/Free Full Text]

  25. van Dijken JW. Durability of three simplified adhesive systems in Class V non-carious cervical dentin lesions. Am J Dent 2004;17(1):27–32.[Medline]

  26. Aw TC, Lepe X, Johnson GH, Mancl L. One-year clinical evaluation of an ethanol-based and a solvent-free dentin adhesive. Am J Dent 2004;17(6):451–456.[Medline]

  27. Ianzano JA, Gwinnett AJ. Clinical evaluation of Class V restorations using a total etch technique: 1-year results. Am J Dent 1993;6(4):207–210.[Medline]

  28. 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(11):775–784.[Medline]

  29. Alhadainy HA, Abdalla AI. 2-year clinical evaluation of dentin bonding systems. Am J Dent 1996;9(2):77–79.[Medline]

  30. Bayne SC, Heymann HO, Wilder AD, et al. Clinical evaluation of pre-HL versus post-HL dentin bonding systems (abstract 1184). J Dent Res 1997;76(special issue):161.

  31. Boghosian A. Clinical evaluation of a filled adhesive system in Class 5 restorations. Compend Contin Educ Dent 1996;17(8):750–752, 754–757.[Medline]

  32. Browning WD, Brackett WW, Gilpatrick RO. Two-year clinical comparison of a microfilled and a hybrid resin-based composite in non-carious Class V lesions. Oper Dent 2000;25(1):46–50.[Medline]

  33. McCoy RB, Anderson MH, Lepe X, Johnson GH. Clinical success of Class V composite resin restorations without mechanical retention. JADA 1998;129(5):593–599.[Abstract/Free Full Text]

  34. Tyas MJ. Clinical evaluation of five adhesive systems: three-year results. Int Dent J 1996;46(1):10–14.[Medline]

  35. Tyas MJ, Burrow MF. Clinical evaluation of EBS dentine bonding agent: one year results. Aust Dent J 2000;45(2):115–117.[Medline]

  36. Kidd EA. Microleakage in relation to amalgam and composite restorations. A laboratory study. Br Dent J 1976;141(10):305–310.[Medline]

  37. Davidson CL, Abdalla AI. Effect of occlusal load cycling on the marginal integrity of adhesive Class V restorations. Am J Dent 1994;7(2):111–114.[Medline]

  38. Linden JJ, Swift EJ Jr. Microleakage of three new dentin adhesives. Am J Dent 1994;7(1):31–34.[Medline]

  39. Fortin D, Swift EJ Jr, Denehy GE, Reinhardt JW. Bond strength and microleakage of current dentin adhesives. Dent Mater 1994;10(4):253–258.[Medline]

  40. Krejci I, Häusler T, Sägesser, Lutz F. New adhesives in Class V restorations under combined load and simulated dentinal fluid. Dent Mater 1994;10(5):331–335.[Medline]

  41. Ausiello P, Davidson CL, Cascone P, DeGee AJ, Rengo S. Debonding of adhesively restored deep Class II MOD restorations after functional loading. Am J Dent 1999;12(2):84–88.[Medline]

  42. Castelnuovo J, Tjan AH, Liu P. Microleakage of multi-step and simplified-step bonding systems. Am J Dent 1996;9(6):245–248.[Medline]

  43. Sano H, Takatsu T, Ciucchi B, Horner JA, Matthews WG, Pashley DH. Nanoleakage: leakage within the hybrid layer. Oper Dent 1995;20(1):18–25.[Medline]

  44. Staninec M, Marshall GW Jr, Kawakami M, Lowe A. Bond strength, interfacial characterization, and fracture surface analysis for a new stress-breaking bonding agent. J Prosthet Dent 1995;74(5):469–475.[Medline]

  45. Uno S, Finger WJ. Function of the hybrid zone as a stress-absorbing layer in resin-dentin bonding. Quintessence Int 1995;26(10):733–738.[Medline]

  46. Van Meerbeek B, Kanumilli PV, De Munck J, Van Landuyt K, Lambrechts P, Peumans M. A randomized, controlled trial evaluating the three-year clinical effectiveness of two etch & rinse adhesives in cervical lesions. Oper Dent 2004;29(4):376–385.[Medline]

  47. Eliguzeloglu E, Omurlu H, Eskitascioglu G, Belli S. Effect of surface treatments and different adhesives on the hybrid layer thickness of non-carious cervical lesions. Oper Dent 2008;33(3):338–345.[Medline]





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