Two-year clinical evaluation of self-etching adhesives in posterior restorations.

PURPOSE: To evaluate the 2-year clinical performance of three self-etching adhesives and one etch-and-rinse adhesive (control) in posterior composite restorations. MATERIALS AND METHODS: Upon approval by the Institutional Review Board, 121 restorations were inserted in 38 subjects. The adhesives were applied as per manufacturers' instructions. Preparations were restored with a nanofilled composite resin (Filtek Supreme, 3M ESPE) and evaluated at baseline, 6 months, 1 year, and 2 years. Statistical analyses included the McNemar and the Mann-Whitney non-parametric tests (p < 0.05). RESULTS: At 2 years, 91 out of 121 restorations were evaluated using the USPHS modified criteria. The number of alpha ratings decreased significantly from baseline to 2 years for Adper Prompt L-Pop, Clearfil S3 Bond, and iBond in the categories color match, marginal staining, and marginal adaptation. For One-Step Plus, only marginal staining was significantly worse at 2 years than at baseline. Postoperative sensitivity to air improved significantly for One-Step Plus at 2 years, but this improvement was already detected at 1 year. When the 2-year evaluation criteria were pooled by pairs of adhesives, One-Step Plus resulted in a significantly greater number of alfa ratings for marginal adaptation than the other three adhesives. On the other hand, iBond resulted in a significantly lower number of alfa ratings than any of the other 3 adhesives for color match and marginal staining. Adper Prompt L-Pop, Clearfil S3 Bond, and One-Step Plus resulted in a statistically similar number of alfa ratings for marginal staining and color match. There were no significant differences in any of the evaluation criteria between Clearfil S3 Bond and Adper Prompt L-Pop. CONCLUSION: Only One-Step Plus, the etch-and-rinse adhesive, resulted in good marginal adaptation at 2 years. One of the self-etching adhesives, iBond, resulted in unacceptable clinical performance.

One-year clinical performance of self-etch adhesives in posterior restorations.

PURPOSE: To evaluate the 1-year clinical performance of three self-etching adhesives (Adper Prompt L-Pop, Clearfil S3 Bond, iBond) in posterior composite restorations using one etch&rinse adhesive (One-Step Plus) as control. METHODS: Upon approval by the Institutional Review Board, 121 restorations were inserted in 38 subjects. The adhesives were applied as per manufacturers' instructions. Preparations were restored with a nanofilled resin composite (Filtek Supreme) and evaluated at baseline, 6 months, and 1 year. Statistical analyses included the Chi-square distribution with the McNemar non-parametric test (P < 0.05). RESULTS: At 1 year, 111 restorations in 35 subjects were evaluated using the USPHS modified criteria. No significant changes were observed for the etch&rinse adhesive One-Step Plus. At 1 year the number of Alfa ratings decreased significantly for Clearfil S3 Bond and for iBond in the categories color match, marginal staining, and marginal adaptation. For Adper Prompt L-Pop, marginal adaptation at 1 year was significantly worse than at baseline. Postoperative sensitivity to air improved significantly for Adper Prompt L-Pop, Clearfil S3 Bond, and iBond. When the evaluation criteria were paired at 1 year, iBond resulted in a significantly lower number of Alfa ratings than any of the other adhesives for color match, marginal staining, and marginal adaptation. One-Step Plus resulted in a greater number of Alfa ratings for marginal adaptation than either Adper Prompt L-Pop or Clearfil S3 Bond. Marginal adaptation was significantly better for Clearfil S3 Bond than for Adper Prompt L-Pop. The post-operative sensitivity measured at 1 year for Adper Prompt L-Pop was statistically better than that for One-Step Plus.

Eighteen-month clinical evaluation of two dentin adhesives applied on dry vs moist dentin.

PURPOSE: To evaluate the influence of substrate moisture on the clinical behavior of two dentin adhesives after 18 months. The null hypothesis tested was that drying dentin with air upon rinsing off the acid would not influence the clinical performance of two dentin adhesives as compared to leaving the preparation visibly moist. MATERIALS AND METHODS: Thirty-five patients were enrolled in this study. One hundred twenty-eight restorations divided into 4 groups were inserted and evaluated at baseline: (1) NT/Moist - Prime & Bond NT, an acetone-based adhesive, applied on moist dentin; (2) NT/Dried - Prime & Bond NT applied on dentin dried with air for 3 to 4 s; (3) SB/Moist - Single Bond, an ethanol- and water-based adhesive, applied on moist dentin; (4) SB/Dried - Single Bond applied on dentin dried with air for 3 to 4 s. A microfilled composite resin was used for all restorations. Patients were recalled at 6 and 18 months. RESULTS: At 18 months after initial placement, 110 restorations (86% recall rate) were re-evaluated. Retention rates at 18 months were 92% for NT/Moist, 93% for NT/Dried, 100% for SB/Moist, and 89% for SB/Dried. No statistically significant differences were found among groups for retention rate. Both NT/Moist and SB/Moist resulted in a significant decrease in sensitivity to air from baseline to 18 months. When data were pooled for the variable "substrate moisture", SB resulted in an overall retention rate of 95%, while NT resulted in a retention rate of 92% (statistically similar). The marginal adaptation with SB was significantly worse at 18 months than at baseline. CONCLUSION: The moisture level of the dentin substrate in noncarious cervical lesions does not influence retention of composite restorations, but moist conditions caused less sensitivity to air. When applied as per manufacturers' instructions (moist dentin), both adhesives resulted in Class V retention rates exceeding the ADA 18-month full acceptance guidelines.

Clinical performance of a self-etching adhesive at 18 months.

PURPOSE: To test the null hypothesis that beveling and/or etching enamel would not affect the 18-month clinical performance of the self-etching adhesive Clearfil SE Bond (CSEB) in noncarious cervical lesions (NCCL). METHODS: With Institutional Review Board approval, 34 patients were enrolled in this study. A total of 120 NCCL was selected and assigned to four groups: (1) CSEB was applied without any cavity preparation; (2) CSEB was applied after beveling enamel; (3) CSEB was applied after etching enamel for 15 seconds with 35% phosphoric acid; (4) CSEB was applied after beveling and etching enamel. A microfilled composite resin was used for all restorations. RESULTS: At 6 months after initial placement, 120 restorations (a 100% recall rate) were evaluated. At 18 months, 87 restorations (a 72.5% recall rate) were available for evaluation. A survival rate of 100% was measured for all groups at both 6 and 18 months. Sensitivity to air decreased significantly only for Group 3 (no bevel+acid etch) from baseline to 18 months without statistical changes from 6 months to 18 months. None of the other parameters resulted in significant differences for any of the four groups. However, when data were pooled, both the overall marginal discoloration and the overall marginal adaptation were significantly worse at 18 months than at baseline, while sensitivity to air decreased significantly from baseline to 18 months. The 18-month survival rate of the self-etching adhesive Clearfil SE Bond was not improved by enamel bevel or by enamel etching. Both overall marginal adaptation and overall marginal discoloration were worse at 18 months than at baseline. .

The effect of adhesive and flowable composite on postoperative sensitivity: 2-week results.

OBJECTIVE: To measure 2-week postoperative sensitivity in Class II composite restorations placed with a self-etching adhesive (Clearfil SE Bond) or a total-etch adhesive (Prime&Bond NT) with or without a flowable composite as cervical increment. METHOD AND MATERIALS: Upon approval by the University of Guarulhos Committee on Human Subjects, 100 restorations were inserted in 46 patients who required Class II restorations in their molars and premolars. Enamel and dentin walls were conditioned with a self-etching primer (for Clearfil SE Bond) or etched with 34% phosphoric acid (for Prime&Bond NT). A 1- to 2-mm-thick increment of a flowable composite (Filtek Flow) was used in the proximal box in 50% of the restorations of each adhesive. Preparations were restored with a packable composite (Surefil). The restorations were evaluated preoperatively and 2 weeks postoperatively for sensitivity to cold, air, and masticatory forces using a visual analog scale. Marginal integrity of the accessible margins was also evaluated. Statistical analysis used a mixed linear model with subject as a random effect. RESULTS: Ninety-eight teeth from 44 subjects were observed at 2 weeks. The type of adhesive and use of flowable composite had no significant effects or interaction for any of the four outcomes of interest, ie, change from baseline to 2 weeks in sensitivity and response time for the cold or air stimulus. For the air stimulus, the overall average change from baseline was not significant for either sensitivity or response time. For the cold stimulus, the overall average change from baseline was significant for both sensitivity and response time. No case of sensitivity to masticatory forces was observed. CONCLUSION: No differences in postoperative sensitivity were observed between a self-etch adhesive and a total-etch adhesive at 2 weeks. The use of flowable composite did not decrease postoperative sensitivity.

Influence of acid etching and enamel beveling on the 6-month clinical performance of a self-etch dentin adhesive.

This study tested the hypothesis that beveling and/or etching enamel does not affect the 6-month clinical performance of the self-etch adhesive Clearfil SE Bond in class V noncarious lesions. With Institutional Review Board approval, 34 patients were enrolled in this study. A total of 120 noncarious cervical lesions were selected and assigned to 4 groups: (1) Clearfil SE Bond was applied without any cavity preparation; (2) After the enamel was beveled, Clearfil SE Bond was applied; (3) After the enamel was etched for 15 seconds with 35% phosphoric acid, Clearfil SE Bond was applied; (4) After the enamel was beveled and etched with 35% phosphoric acid for 15 seconds, Clearfil SE Bond was applied. A microfilled composite resin was used for all restorations. Six months after initial placement, 120 restorations (a 100% recall rate) were re-evaluated. Retention rates at 6 months were 100% for all groups. Sensitivity to air improved from baseline to 6 months, but the overall difference was not statistically significant. The 6-month retention rate of the self etch dentin adhesive system Clearfil SE Bond was not improved by enamel beveling or by enamel etching. For the self-etch material Clearfil SE Bond, instrumentation or etching of enamel may not be critical for its clinical performance at 6 months.

In vivo influence of residual moisture on microtensile bond strengths of one-bottle adhesives.

PURPOSE: This study evaluated the microtensile bond strengths of three dentin adhesives applied on clinically moist dentin or on dentin that was dried with air for 5 seconds. The null hypothesis to test was that the level of residual moisture does not influence bond strengths when restorations are placed in vivo. MATERIALS AND METHODS: Twenty-four premolars scheduled to be extracted for orthodontic reasons from patients between the ages of 15 and 23 years were restored with one of the following adhesive systems followed by a mini hybrid composite resin: Excite (Ivoclar/Vivadent), an ethanol-based dentin adhesive; Prime & Bond NT (Dentsply/Caulk), an acetone-based dentin adhesive; and Single Bond (3M ESPE), an ethanol and water-based dentin adhesive. After extraction, the specimens were sectioned with a slow-speed diamond saw in two perpendicular directions to obtain sticks with a cross-section of 0.7 +/- 0.2 mm2. The specimens were attached to a Geraldeli device and fractured using a universal testing machine at a crosshead speed of 1 mm per minute. RESULTS: For each dentin adhesive, there were no statistical differences between means for dry dentin versus moist dentin. Single Bond and Prime & Bond NT ranked in the same statistical subset regardless of the moisture condition of the substrate. Both Excite, dry, and Excite, moist, resulted in statistically lower bond strengths than Single Bond, moist, but similar to those of Single Bond, dry, Prime & Bond NT, moist, and Prime & Bond NT, dry. CLINICAL SIGNIFICANCE: In this study, the level of residual moisture did not influence microtensile bond strengths. Clinically, the degree of moisture left on the dentin surface upon rinsing off the etching gel may not be as relevant as previously reported in laboratory studies.