How effective are contemporary adhesives for the restoration of non-carious cervical lesions? A systematic review

This summary is based on the article published in Dental Materials: Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review (August 2014)

M. Peumansa, J. De Munck, A. Mine, B. Van Meerbeek

Context

• Non-carious cervical lesions (NCCLs) should be restored as minimally invasive as possible. Currently, adhesive materials indicated to restore NCCLs include glass-ionomers and their resin-modified version, poly-acid modified composites (most frequently referred to as ‘compomers’), composite (1) and recently also self-adhesive composites (2, 3).
• Contemporary adhesives can be classified according to their mode of action into etch & rinse (E&Ra) and self-etch (SEa) adhesives (4).
• To determine the clinical effectiveness of adhesives [12], NCCLs are considered most ideal because NCCLs in need of restoration:

1. Are relatively highly prevalent,
2. Are most frequently present at the easily accessible buccal surface,
3. Do not require complicated restorative techniques,
4. Can be restored with a large ‘free’ versus ‘bonded’ surface, (low C-factor),
5. Involve both enamel and dentin, and
6. Commonly, do not provide any or only minimal macro-retention, by which ineffective bonding will result in de-bonding and thus restoration loss.

• Dental adhesive technology evolves quickly and continuously with a rapid turnover of commercial adhesives, and an up-to-date systematic review on the clinical effectiveness of contemporary adhesives for the restoration of NCCLs is useful.

Purpose of the Review

The aim of this systematic review was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions (NCCLs) in terms of restoration retention as a function of time.

Key Findings

• The chemical bonding potential of adhesives is important for the quality and durability of the bond in NCCLs, as the best results in clinical bonding effectiveness were obtained by the GI and milder types of self-etch adhesives (SEa’s).
• By introducing 1SEA_m, a clear improvement in bonding effectiveness was noticed for these all-in-one adhesives, so that more recent versions are almost comparable with more proven multi-step golden standard approaches.
• 3E&Ra’s also still show favorable bonding efficiency, while inadequate bonding effectiveness was noticed for 2E&Ra’s and SEa s.
• In addition to the best adhesive strategy, the dentist should select a product with a good proven clinical performance, as there is wide variation among adhesives of the same adhesive approach.

References

1. Overton JD, LittleStar ML, Starr BC. Class 5 restorations. In: Fundamental of operative dentistry. A contemporary approach. 3rd ed. Chicago: Quintessence Publishing Co. Inc.;2006. p. 420–36.
2. Ferracane JL. Resin composite – state of the art. Dent Mater2011;27:29–38.
3. Poitevin A, De Munck J, Van Ende A, Suyama Y, Mine A,Peumans M, et al. Bonding effectiveness of self-adhesive composites to dentin and enamel. Dent Mater2013;29:221–30.
4. Van Meerbeek B, Peumans M, Poitevin A, Mine A, Van EndeA, De Munck J. Relationship between bond strength tests and clinical outcome. Dent Mater 2010;26:e100–21.

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