Risk factors for noncarious cervical lesions: A case-control study.

OBJECTIVES: Noncarious cervical lesions (NCCLs) are multifactorial and can be caused by the anatomical structure of the teeth, erosion, abrasion and abnormal occlusion. The aim of this case-control study was to explore the risk factors for NCCLs. METHODS: Cone-beam computed tomography was used to determine whether a wedge-shaped defect existed at the cementoenamel junction. We compared 63 participants with NCCLs with 63 controls without NCCLs, matched for sex, age (±1 year) and toothbrushing-related factors (e.g., type of bristle and brushing patterns, frequency and strength). All participants were asked to complete a questionnaire about self-administered daily diet habits and health condition. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors for NCCLs. RESULTS: Significant variables in the univariate analysis (i.e., p < .2) included frequency of carbonated beverage consumption, sella-nasion-point B angle (SNB) and Frankfort-mandibular plane angle (FMA). Multivariate logistic regression demonstrated that the consumption frequency of carbonated beverages (odds ratio [OR] = 3.147; 95% confidence interval [CI], 1.039-9.532), FMA (OR = 1.100; 95% CI, 1.004-1.204) and SNB (OR = 0.896; 95% CI, 0.813-0.988) was independent influencing factors. The area under the receiver operating characteristic curve (AUC) value of regression Model 1 (established with the frequency of carbonated beverage consumption, FMA, SNB and sleep bruxism) was 0.700 (95% CI, 0.607-0.792; p < .001), and that of regression Model 2 (established using the frequency of carbonated beverage consumption, FMA and SNB) was 0.704 (95% CI, 0.612-0.796; p < .001). CONCLUSIONS: The consumption frequency of carbonated beverages and FMA was risk factors for NCCLs; the higher the frequency of carbonated beverage consumption and FMA, the higher was the probability of NCCLs. SNB was a protective factor for NCCL occurrence; the larger the SNB, the lower was the probability of NCCL occurrence. These findings have further clarified the aetiology of NCCLs and provided clinicians with valuable insights into strategies for preventing the loss of dental tissue.

Noncarious cervical lesions in the aging population analyzed through digital scanning: occlusal risk factors, dimensions, and morphology.

OBJECTIVES: To evaluate noncarious cervical lesions (NCCL) in older adults by analyzing each lesion's morphology, dimension, and occlusal risk factors using intraoral scanning and clinical evaluation. MATERIALS AND METHODS: Individuals over 60 treated at the School of Dentistry in Minas Gerais, Brazil, were invited to participate in this cross-sectional study. We clinically evaluated 1245 teeth for the presence of NCCL and dentin hypersensitivity (DH) in 53 individuals. Three-dimensional models were obtained using Omnicam, and occlusal risk factors were evaluated through the presence of wear facets, intense occlusal contacts, and interferences. The 3Shape 3DViewer software was used to classify NCCL morphology and to measure their height. NCCL depth, width, and area measurements were determined using ImageJ. Descriptive analyses were performed. The Kolmogorov-Smirnov test showed that quantitative data exhibited non-normal distribution. For bivariate analyses of quantitative data, the Mann-Whitney test was employed. The results were reported with mean, standard deviation, median, minimum, and maximum. For bivariate analyses of categorical data, the Pearson chi-square test was used. The results were reported with frequencies (counts) and percentages. A regression model evaluating the association between occlusal risk factors and the absence/presence of NCCL was built. RESULTS: Most participants were female (58.5%), with a mean age of 66. The frequency of NCCL was 28.27%, corresponding to 352 teeth. Of these, 68.18% exhibited saucer morphology and 31.82% wedge-shaped morphology. The frequency of DH was 13.92% in teeth with NCCL. Saucer NCCL exhibited significantly greater height (p = 0.02), while wedge-shaped lesions showed greater depth (p < 0.001). Also, teeth with NCCL had a higher proportion of wear facets (66.8%; p < 0.001), intense occlusal contacts (39.8%; p = 0.008), and occlusal interferences (21.9%; p = 0.05). The regression model showed that teeth with wear facets were 1.50 times more likely to exhibit NCCL than teeth without wear facets (p < 0.001). Teeth with intense occlusal contact were 1.22 times more likely to exhibit NCCL than teeth without intense occlusal contact (p = 0.031). CONCLUSIONS: NCCL is a common dental condition in the older adults evaluated in this study. Wedge-shaped NCCL exhibited greater depth, while saucer NCCL had more expressive height. Occlusal risk factors may represent a crucial mechanism for the occurrence of NCCL in this population. CLINICAL RELEVANCE: Understanding the mechanisms involved in developing NCCL is helpful in diagnostic and preventive practices. The study showed the importance of dental occlusion and characteristics of different NCCL morphologies that help the clinician in decision-making.

Effects of lesion size on the 30-month clinical performance of restorations with bulk fill and a regular nanofilled resin composite in noncarious cervical lesions.

OBJECTIVE: The aim of this double-blind, randomized trial was to evaluate the influence of the occlusogingival distance (OGD) in noncarious cervical lesions (NCCLs) on the clinical performance of a regular bulk-fill resin composite and a regular nanofilled resin composite. MATERIALS AND METHODS: One hundred and forty NCCLs in 77 participants were randomly divided into four groups (n = 35), according to OGD (1.5 mm ± 10% or 3 mm ± 10%) and resin composites (Filtek Bulk Fill Posterior [B] or Filtek Z350 XT [C]), namely: 1.5 mm-B, 1.5 mm-C, 3 mm-B, and 3 mm-C. The restorations were bonded using a two-step self-etch adhesive (Clearfil SE Bond), applied following the manufacturer's instructions. Restorations were polished 1 week after placement. Two experienced and calibrated examiners evaluated the restorations using modified US Public Health Service criteria at baseline (7 days) and after 6, 12, 18, 24, and 30 months. Statistical analyses were carried out using Kruskal-Wallis, Friedman's repeated measures analysis of variance, and the Wilcoxon signed rank test (α = 0.05). RESULTS: After 30 months, the recall rate was 94.2%. Eight restorations were lost (3 for 1.5 mm-C, 2 for 1.5 mm-B, 1 for 3 mm-C, and 2 for 3 mm-B). All groups resulted in a significantly worse marginal discoloration and surface texture at 30 months in comparison with the baseline (1 week). No significant difference was found for the other parameters. CONCLUSION: The restorations performed with both resin composites produced clinically acceptable restorations. The OGD of NCCLs did not influence the clinical performance of restorations. CLINICAL SIGNIFICANCE: The OGD of NCCLs did not have a significant effect on the clinical performance of a regular bulk-fill and nanofilled restorations. Both materials showed a very good performance on 30-month evaluation.

Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration.

PURPOSE: To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated. MATERIAL AND METHODS: A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration. RESULTS: NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single-step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion. CONCLUSIONS: Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators.

Assessment of the Oral Health Impact Profile (OHIP-14) improvement of different treatments for dentin hypersensitivity in noncarious cervical lesions-a randomized clinical study.

OBJECTIVES: To assess the improvement on oral health-related quality of life (OHRQoL) of individuals with cervical dentin hypersensitivity (CDH) with the noncarious cervical lesion (NCCLs) subjected to different treatments. MATERIAL AND METHODS: A single-blind randomized clinical trial was conducted with patients (n = 74) randomly allocated into three groups according to the treatment performed: PO, potassium oxalate (Oxa-Gel BF); LL, low-power laser irradiation; and POLL, potassium oxalate (Oxa-Gel BF) associated with low-power laser irradiation. The treatments were applied in four steps, weekly. The questionnaire Oral Health Impact Profile (OHIP-14) was applied before initiating and immediately after the fourth session. The greater the sum of the score, the smaller the measurement of OHRQoL. RESULTS: The total mean values of the variables at the final moment were significantly lower than the initial one for all dimensions (p value ranging from < 0.001 to 0.006). Furthermore, the OHIP-14 scores final analysis between the groups indicated that the POLL group compared to LL had a significantly lower final score for the functional limitation (p = 0.009), physical pain (p = 0.049), and psychological discomfort (p = 0.035) dimensions and that group PO compared to group LL had a significantly lower final score for the functional limitation dimension (p = 0.024). CONCLUSIONS: There was a reduction in the OHIP-14 score for all dimensions, indicating an improvement in patients' quality of life after the use of desensitizing therapies. Patients in group LL had a higher functional limitation, physical pain, and psychological discomfort. CLINICAL RELEVANCE: This study indicated improvement of desensitizing therapies for CDH to improve patients' OHRQoL. TRIAL REGISTRATION: This trial was registered in the Brazilian Clinical Trials Registry Platform (REBEC protocol number RBR-4ybjmt).

A Randomized, Controlled, Split-mouth Trial Evaluating the Clinical Performance of High-viscosity Glass-ionomer Restorations in Noncarious Cervical Lesions: Two-year Results.

PURPOSE: To compare the two-year clinical performance of high-viscosity glass ionomer (Hv-GIC) restorations in noncarious cervical lesions with nanohybrid composite restorations applied with a three-step etch-and-rinse adhesive (E&Ra/nanoC). MATERIALS AND METHODS: One hundred thirty-four noncarious cervical lesions were included and assigned to two groups according to the split-mouth design. The cervical lesions in the experimental group were restored with an Hv-GIC (Equia, GC), while a nanohybrid composite (G-aenial, GC) with a three-step etch-and-rinse adhesive (Optibond FL, Kerr) was applied as the control. All tested restorative materials were used according to the manufacturers' instructions. Clinical evaluation was performed after one week, six months, one year, and two years using World Dental Federation criteria. Data were analyzed using Friedman's ANOVA and Mann-Whitney U-tests (α = 0.05). RESULTS: After two years, Hv-GIC restorations had a retention rate of 91% in comparison to 100% for E&Ra/nanoC restorations. Significant differences existed between the two restorative materials solely with respect to the retention parameter after two years (p = 0.008). CONCLUSIONS: The two-year clinical performance of Hv-GIC was clinically acceptable. However, the retention of E&Ra/nanoC restorations was significantly better than that of Hv-GIC restorations after two years.

Are Glass-Ionomer Cement Restorations in Cervical Lesions More Long-Lasting than Resin-based Composite Resins? A Systematic Review and Meta-Analysis.

PURPOSE: To compare the the loss of retention and color match of glass-ionomer cements (GIC) and resin-based composites (RC) in noncarious cervical lesions. Other secondary outcomes (surface texture, marginal adaptation, marginal discoloration, and secondary caries) were evaluated in a systematic review and meta-analysis. MATERIALS AND METHODS: A comprehensive search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, and Cochrane. We included only randomized clinical trials. The quality of the evidence for each outcome was assessed using the GRADE tool. RESULTS: A total of 1530 articles were identified, but only 19 reports remained for analysis, all of which were judged to possess "unclear" risk of bias. GIC showed higher retention rates in all follow-ups (1 to 3 years, p < 0.0001; at 5 years, p < 0.00001). No difference was observed for marginal discoloration, marginal adaptation and secondary caries in all follow-ups (p > 0.05). RC showed better color match than GIC only at 2 years (p = 0.03). Higher roughness was observed in GIC in all follow-ups (at 1 year p = 0.0003; at 3 years p = 0.0004). Quality of evidence was graded as moderate or low due to unclear risk of bias and imprecision in some outcomes. CONCLUSION: The loss of retention of RMGIC/GIC was inferior to that of RC, but a higher roughness was observed in the RMGIC/GIC when compared to RC in all follow-ups of the clinical studies evaluated. In addition, the color match was better with RC only in the 2-year follow-up when compared to GIC. The quality of evidence was judged as moderate to low in these two outcomes.

Although HEMA-Containing Dental Adhesive Systems Have High Hydrophilic Characteristics, Their Clinical Performance Is Similar to HEMA-Free Dental Adhesive Systems for Noncarious Cervical Lesions.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Do HEMA-free adhesive systems have better clinical performance than HEMA-containing systems in noncarious cervical lesions? A systematic review and meta-analysis. da Silva TSP, de Castro RF, Magno MB, Maia LC, da Silva 3 Souza Júnior. J Dent 2018; 74: 1-14. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Does Evidence Support a Combined Restorative Surgical Approach for the Treatment of Gingival Recessions Associated With Noncarious Cervical Lesions?

OBJECTIVES: Gingival recessions are frequently associated with noncarious cervical lesions. Combined restorative surgical approaches have been suggested for the management of these combined defects. The aim of this review was to analyze the current evidence on the effectiveness of these combined restorative surgical approaches. METHODS: A systematic review of randomized controlled studies published from January 2006 to June 2016 was performed. RESULTS: Ten articles comparing combined restorative surgical approaches to surgery alone were included. Both the procedures showed similar outcomes in term of root coverage but the combined restorative surgical approach achieved better result in the reduction of dentin hypersensitivity. In combined restorative surgical treatments, resin-modified glass ionomers showed better antimicrobial properties but poorer esthetic outcome than resin composites. CONCLUSION: Data to support or refute definitely the interest of combined approaches for the treatment of gingival recessions associated with noncarious cervical lesions are limited.

Salivary factors associated with noncarious cervical lesions: A systematic review.

OBJECTIVE: This study aimed to carry out a systematic review of observational studies searching the association between salivary factors (amount and quality of saliva) and noncarious cervical lesions (NCCL) in individuals with permanent dentition. DESIGN: Cross-sectional, case-control, and cohort studies performed in humans with permanent dentition (population) and considering noncarious cervical lesions (outcome) in association with salivary characteristics (exposure) were included. PubMed, Web of Science, Cochrane, LILACS/BBO, Scopus, Embase, IBCT, NICE, OpenGrey, and Google Scholar were searched, with no language or date restrictions. Of 6561 potentially eligible studies, 142 were selected for full-text analysis. Three reviewers independently selected the studies, performed data extraction, and quality analysis through the Newcastle-Ottawa Scale. RESULTS: Finally, ten references were included in the review, four case-control and six cross-sectional studies. Several salivary parameters were evaluated. Some parameters were considered associated with the presence of noncarious cervical lesions: salivary buffering capacity, salivary pH, citric acid, and calcium and potassium levels. The methodological quality varied across studies, with high heterogeneity among them. CONCLUSIONS: Some associations between saliva and NCCL suggesting protective factors and others risk factors were found. However, the evidence is sparse and comes from a few studies with great heterogeneity. New scientific evidence, with standardized methods, should be encouraged. Understanding salivary parameters that influence the occurrence of NCCL is important to guide dentists in relation to etiological factors that could potentially be neglected. The results may help in the development of new and early diagnostic methods and treatments for noncarious cervical lesions.

A 24-month clinical evaluation of composite resins with different viscosity and chemical compositions: a randomized clinical trial.

OBJECTIVES: To evaluate the clinical performance of two methacrylate-based flowable composites and an ormocer-based flowable composite in noncarious cervical lesions (NCCLs) in adult participants. METHOD AND MATERIALS: In total, 183 restorations were performed on NCCLs. All cavities were restored using a universal adhesive system (Futurabond U, Voco) with selective enamel etching and with one of the three evaluated flowable composites (n = 61): low-viscosity methacrylate-based composite (GrandioSO Flow, LV), high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV), and an ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 24 months. Kruskall-Wallis analysis of variance rank (α = .05) was used for statistical analysis. RESULTS: After 24 months of clinical evaluation, 16 restorations were lost (LV = 3, HV = 10, ORM = 3) and the retention rates (95% confidence interval) were 95.0% for LV, 82.2% for HV, and 95.0% for ORM, with statistical differences observed between HV and LV as well as HV and ORM (P < .05). When secondary parameters were evaluated, no significant differences between groups were observed (P > .05). Thirty-three restorations (LV = 8, HV = 13, ORM = 12) showed minor marginal staining, 71 restorations (LV = 26, HV = 20, ORM = 25) presented small marginal adaptation defects, and one restoration for HV presented recurrence of caries. CONCLUSION: The universal adhesive associated with the ormocer-based and methacrylate-based flowable composite showed promising clinical performance after 24 months. However, the heavy-flow restorations showed significantly more failures. (Quintessence Int 2023;54:186-199; doi: 10.3290/j.qi.b3631841).

The Effect of Toothpastes Containing Hydroxyapatite, Fluoroapatite, and Zn-Mg-hydroxyapatite Nanocrystals on Dentin Hypersensitivity: A Randomized Clinical Trial.

Aims: The aim of this study was to compare the effect of toothpastes containing hydroxyapatite (nHAP), Zn-Mg-hydroxyapatite (nZnMgHAP), and fluorapatite (nFAP) nanocrystals on dentin hypersensitivity (DH) associated with noncarious cervical lesions. Materials and Methods: Thirty consenting volunteers aged 35-45 years with DH were enrolled in a double-blind, parallel study, randomly assigned to the nHAP group (n = 10), the nZnMgHAP group (n = 10), or the nFAP group (n = 10), and instructed to use the toothpaste twice daily for one month. The primary outcome was Schiff scores at baseline and after 2 and 4 weeks. Results: All patients fulfilled the study requirements, and no adverse effects were registered. A reduction in DH was registered in 90%, 100%, and 50% of patients using nHAP, nZnMgHAP, and nFAP-containing toothpastes with effect sizes 2.52 (confidence interval [CI] 95%: 0.82, 4.14), 3.30 (CI 95%: 1.33, 5.20), and 1.44 (CI 95%: 0.09, 2.72), respectively. At 4 weeks, Schiff index scores decreased significantly in all groups compared to baseline. Conclusions: nZnMgHAP may be considered a promising agent for DH management.

Cervical Abrasion, Sexual Dimorphism, and Anthropometric Tooth Dimension.

Introduction: The aim of this study was to analyze the anatomic crowns of the maxillary and mandibular dentition concerning the mesiodistal, buccolingual measurements which will be used to establish normative data as a part of comprehensive study being carried out to determine the depth of the cervical abrasion (CA) of the individuals by predicting the CA Index of Treatment Needs (CAITN) score. Materials and Methods: A newly developed instrument termed as CAITN probe was used to measure CA of the tooth more quantitatively. The mesiodistal and buccolingual width of all the 14 maxillary and mandibular teeth from the right second permanent molar to the left second permanent molar of the study sample was measured. The ratio between buccolingual and mesiodistal measurements of each tooth of the maxillary and mandibular arch of the study sample (n=100) was also determined. Statistical analysis was performed using the SPSS 26.0 software. Results: Descriptive statistics were calculated for each group independently. The statistical significance of the difference in mean in mesiodistal and buccolingual diameters between males and females was calculated using the t-test for independent samples with p < 0.05. The ratio was highest in the left second premolar (1.752) and least in the right central incisor (0.980) of the maxillary arch. Similarly, the ratio was highest in the left central incisor (1.723) and least in the left second molar (0.910) of the mandibular arch. Conclusion: The present study was conducted as an initial step in the process of development of the novel tool or index enabling the dentists to organize the health-care needs of their patients by facilitating standardized identification of CA with objective measurements used for epidemiological or community purpose.

[Efficacy of tunnel technique for treatment of gingival recession of upper adjacent teeth with noncarious cervical defect].

OBJECTIVE: To evaluate the efficacy of tunnel technique (TUN) in treatment of teeth with adjacent gingival regression (GR) combined with noncarious cervical lesions (NCCL). METHODS: We collected data from 21 patients (79 teeth) undergoing TUN surgery for GR combined with NCCL. According to GR depth (GRD) and lesion depth (LD) of NCCL, the teeth were divided into group 1 with GRD≤3 mm and LD≤1 mm; group 2 with GRD≤3 mm and LD>1mm; group 3 with GRD>3 mm and LD≤1 mm; and group 4 with GRD>3 mm and LD>1 mm. The mean root coverage (MRC) rate, complete root coverage (CRC) rate, keratinized gingival width, and keratinized gingival thickness were compared among the 4 groups after TUN surgery. RESULTS: The keratinized gingival width and thickness were significantly improved after the surgery in the 4 groups. When the GRD was below 3 mm, the MRC was not significantly different between group 1 and group 2 (8.55% vs 95.45%, P>0.05); When the GRD was beyond 3 mm, the MRC and CRC rates were both decreased in group 3 and group 4, especially in group 4, where the CRC rate (25%) was significantly lower than those in the other 3 groups (P < 0.01). CONCLUSION: In patients with GR combined with NCCL, TUN surgery can obviously improve keratinized gingival width and thickness. GRD has a greater effect on the outcome of root coverage than LD, suggesting that NCCL restoration before TUN surgery may not be necessary. Both GRD and LD should be considered in the evaluation of the clinical efficacy of TUN surgery.

Clinical efficacy of universal adhesives for the restoration of noncarious cervical lesions: A randomized clinical trial.

INTRODUCTION: The efficacy of an adhesive agent is an important aspect in restoring noncarious cervical lesion (NCCL) as studies have proved that compromise in adhesive agent results in reduced bond strength. The purpose of this prospective randomized double-blind clinical trial was to evaluate the efficacy of the newly formulated "universal" dental adhesive in the restoration of NCCLs in permanent dentition using either a self-etch or a selective-etch approach. MATERIALS AND METHODS: The study was done following the consolidated standards of reporting trials. 100 NCCLs randomly divided into 2 groups were restored using G-Premio Bond adhesive and Genial flowable composite in selective etch mode and self-etch mode. Restorations were evaluated at 1 week, 6 months, and 12 months using modified US Public Health Service criteria for marginal staining, fracture, and postoperative sensitivity. Statistical analysis was performed using appropriate tests. RESULTS: Recall rates were 100%, 98%, and 78% at the evaluation time. The result showed that neither the self-etch nor the selective etch mode had significant difference in ALPHA/BRAVO/CHARLIE scores (P > 0.05). Percentage-wise comparison showed less changes reported in the selective etch group compared to self-etch group. CONCLUSION: It was concluded that there was no statistical significance between the groups for the parameters evaluated, but selective etch performed better than self-etch group.

Influence of desensitizing agents in management of noncarious cervical lesion and bonded restorations: A preliminary 12-week report.

OBJECTIVES: The primary objective of this study was to investigate the effectiveness in reducing dentin hypersensitivity in noncarious cervical lesions (NCCLs) by home-based desensitizing toothpaste (TP), in-office Gluma desensitizer application, and resin-modified glass-ionomer cement (RMGIC) restoration. The secondary objective was to evaluate the long-term outcome of the glass-ionomer cement restoration following the application of bioactive glass-containing desensitizer TP. MATERIALS AND METHODS: A total of 73 patients or 151 teeth were included in the study and randomly allotted to one of the four different treatment groups. Pre- and postoperative symptom and air-blast/tactile sensitivity scores were recorded for statistical analysis. Postoperative sensitivity was analyzed at 1, 4, and 12 weeks after treatment. Nonparametric statistical tests were employed. RESULTS: Kruskal-Wallis test noted a significant reduction in postoperative sensitivity at all time periods with the RMGIC group compared to other treatment options. Significantly higher patient dropout was observed in desensitizing TP regimen. CONCLUSIONS: This interim 12-week report on dentin hypersensitivity management of NCCLs concludes that resin-modified glass-ionomer restoration was able to achieve a significant instant reduction in sensitivity and patient satisfaction compared to other noninvasive at-home and in-office procedures. CLINICAL RELEVANCE: This interim 12-week report on dentin hypersensitivity management of noncarious cervical lesions concludes that resin-modified glass-ionomer restoration was able to achieve a significant reduction in sensitivity, and patient satisfaction was higher compared to other noninvasive at-home and in-office procedures.

Comparative evaluation of clinical performance of two self-etch adhesive systems with total-etch adhesive system in noncarious cervical lesions: An in vivo study.

BACKGROUND: The growing demands for esthetic restorations have stimulated intensive research in the field of adhesive dentistry. Dental adhesive systems are used to promote adhesion between composite resins and dental structure. In the fundamental principles of adhesion, the primary mechanism contributing to the formation of adhesion is micromechanical bonding between the restoration and the tooth. The bond strength of self-etching adhesives to dentin was found to be almost equal to that of total-etch adhesives. The aim of the present prospective, double-blind, randomized controlled clinical trial was to evaluate and compare the clinical performance of two self-etch adhesive systems with total-etch adhesive system in noncarious cervical lesions (NCCLs). MATERIALS AND METHODS: In each patient, three teeth were randomly assigned according to the adhesive system used to Group A (total-etch adhesive system), Group B (two-bottle self-etch adhesive system), and Group C (one-bottle self-etch adhesive system). The clinical efficacy of these adhesive systems was determined by evaluating the retention rate, marginal integrity, and postoperative sensitivity at the following three levels: baseline, 6 months, and 18 months by following the Modified USPHS criteria introduced by Vanherle et al. RESULTS: In the present study, the retention rate at 18 month in Group A, Group B, and Group C of 96%, 92%, and 92% was observed, respectively. A marginal integrity at 18 months was 88%, 80%, and 84% for Group A, Group B, and Group C, respectively. Postoperative sensitivity at 18 months was 16%, 12%, and 12% for Group A, Group B, and Group C, respectively. CONCLUSION: The clinical performance of total-etch and self-etch adhesive systems in NCCLs did not differ significantly with regard to the evaluated parameters - retention, marginal integrity, and postoperative sensitivity.

Do HEMA-free adhesive systems have better clinical performance than HEMA-containing systems in noncarious cervical lesions? A systematic review and meta-analysis.

OBJECTIVES: To determine through a systematic review whether HEMA-free adhesive systems have better clinical performance than HEMA-containing systems in noncarious cervical lesion (NCCL) restorations. SOURCES: We systematically searched PubMed, The Cochrane Library, Scopus, Web of Science, and Open Grey databases using MeSH terms, synonyms, and keywords, with no language or date restriction. The reference lists of included articles were manually searched. STUDY SELECTION: Randomized controlled clinical trials comparing the effectiveness of HEMA-free and HEMA-containing adhesive systems in NCCL restorations were included. The risk of bias in the included studies was assessed and classified through the Cochrane Collaboration's common scheme for bias. Quantitative data were subgrouped according to the main clinical parameters evaluated, and heterogeneity was tested using I2 index. DATA: A total of 2889 potentially relevant studies were identified. After title and abstract examination, 51 studies remained. Finally, 22 studies were included in the systematic review, totaling to 997 participants. Thus, 13 studies were classified as "low" risk of bias and nine as "unclear". These 22 studies were also included in the meta-analysis, and no significant statistical difference was found between the clinical performances of HEMA-free and HEMA-containing adhesive systems for all parameters analyzed: retention risk difference (RD) 0.03 [-0.01, 0.07] (p = 0.13); marginal discoloration RD 0.02 [-0.01, 0.04] (p = 0.19); marginal adaptation RD -0.01 [-0.04, 0.01] (p = 0.34); caries RD 0.00 [-0.01, 0.01] (p = 0.92); or postoperative sensitivity RD -0.00 [-0.02, 0.01] (p = 0.72) and for overall effect RD 0.00 [-0.01, 0.01] (p = 0.65). CONCLUSIONS: HEMA-free and HEMA-containing adhesive systems showed a similar clinical performance in NCCL restorations. CLINICAL SIGNIFICANCE: Only the presence of HEMA does not indicate better clinical performance of adhesive systems.

Stress distribution in endodontically treated abfracted mandibular premolar restored with different cements and crowns: A three-dimensional finite element analysis.

CONTEXT: Noncarious cervical lesions may penetrate the pulp and require root canal treatment followed by crown placement. Such teeth may be susceptible to fracture, especially at the cervical area. AIMS: To estimate which combination of restorative material and crown resulted in homogenous stress-strain distribution of endodontically treated abfracted mandibular premolar using three-dimensional finite element model (FEM). SETTINGS AND DESIGN: A three-dimensional model of mandibular single-rooted premolar along with alveolar bone was created in finite element analysis (FEA) software preprocessor ANSYS rel 14.5 FEM software (ANSYS Inc., Houston, USA, 1994). Cervical lesion was created in the model with specific dimensions, 3 mm mesiodistally and 2 mm gingivoocclusally with enamel occlusal margin and dentin gingival margin. MATERIALS AND METHODS: Tooth was simulated to be root canal treated and restored with different types of cements and crowns followed by placing a static load of 300 N at an angle of 135°. Analysis was run and stress distribution pattern was studied. RESULTS: Cervical region of an endodontically treated tooth is subjected to stresses, irrespective of restorative material used. Porcelain fused to metal (PFM) crowns showed least strain values with different postendodontic, restorative materials. CONCLUSIONS: FEA is a predictable and reproducible model to predict stress-strain behavior. PFM crowns with different postendodontic restorative materials showed least strain values in the cervical area of abfracted, endodontically treated premolars.

Clinical performance of resin-modified glass ionomer cement, flowable composite, and polyacid-modified resin composite in noncarious cervical lesions: One-year follow-up.

BACKGROUND: The restoration of noncarious cervical lesions (NCCLs) often poses a challenge to the clinician. Various restorative materials are available in the market for the restoration of the same. Each material has various advantages and shortcomings. AIM: The aim of this study was to compare and to evaluate the clinical performance of capsulated resin-modified glass ionomer cement (RMGIC), flowable composite, and polyacid-modified composite resin (PMCR) in NCCLs. MATERIALS AND METHODS: A total of 101 restorations were placed among healthy controls in this clinical trial. A total of 101 restorations were divided into three groups with n = minimum 32 per group (Group 1: 33 restorations, Group 2: 34 restorations, and Group 3: 34 restorations). The restorative materials used were capsulated RMGIC, flowable composite and PMCR. After the placement, the restorations were evaluated for the United States Public Health Services criteria for six parameters, namely retention, marginal adaptation, marginal discoloration, color stability, surface roughness, and sensitivity. The restorations were evaluated at baseline, 6 and 12 months. STATISTICAL ANALYSIS: Statistics was performed using SPSS 21.0 version. Chi-square test was done to compare the proportions between groups. Fisher's exact test was used to compare proportion change between time points. RESULTS: There was no statistically significant difference seen among the three groups for retention, color stability, surface roughness, and hypersensitivity. RMGIC had shown superior characteristics in marginal adaptation and marginal discoloration compared to flowable composite and PMCR, and the difference was statistically significant. CONCLUSION: Within the limitations of this study, all the three restorative materials are clinically acceptable for the restoration of NCCLs. RMGIC is superior regarding marginal adaptation and esthetics for restoring NCCLs.