الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Dental manufacturers have recently developed a new class of more versatile multi-mode adhesive systems that can be applied as 1-step SE, 2-step ER, or 2-step SEE bonding agents. Most universal adhesives include acidic functional monomers like 10-MDP, which has a polymerizable methacrylate group as well as a phosphate group that can create stable salts with the calcium in hydroxyapatite. The high bond strength of MDP to enamel and dentin has been related to the stability of the formed calcium salt and its high enamel etching ability.
Non-carious cervical lesions (NCCLs) occur when there is no bacterial involvement in the cervical loss of tooth structure. This can be caused by abfraction, erosion, abrasion, or a combination of several factors. Adhesive systems are frequently clinically evaluated using these lesions because bonding to them is challenging due to the overall lack of macro-mechanical retention and the inclusion of both enamel and dentin margins, which demand different adhesive strategies. The present study was performed to evaluate the clinical performance of multi-mode adhesive with three application modes (ER, SE, or SEE modes) in comparison to SE adhesive and ER adhesive as control methods in NCCLs restorations. The evaluation was performed regarding fractures/retention, marginal staining, marginal adaptation, postoperative sensitivity, and the recurrence of caries using the FDI criteria. Before starting the restorative processes, the subject’s demographics (gender and age) and tooth type (canine/premolar) were recorded, and the dimensions of NCCLs were measured in millimeters. All restored teeth were isolated with rubber dam isolation and a 212 clamp. The incisal/occlusal margin of enamel was beveled with a 0.5 mm with a medium-grit diamond stone in high-speed handpiece.
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All subjects received five composite restorations, one for each group, on five lesions in canines and premolars bonded with Gluma bond 5, Gluma self-etch, and Gluma bond universal system applied in three modes (SE, SEE, and ER modes). After the adhesive application, the charisma Diamond restorative material was applied in increments with a plastic filling instrument. All adhesives and composite restorations are applied and light-cured following the manufacturer’s recommendations. The composite restorations were then finished and polished. The clinical performance of the adhesives was evaluated one week after the restoration procedure (baseline), 3, 6, and 12 months according to the FDI assessment criteria. The evaluation was achieved by two calibrated evaluators through a visual and tactile examination using a mouth mirror and probe. To keep evaluators blind to evaluations during follow-up recalls, a standard case sheet was used for each evaluator in the four recall periods.
The scores of the present study were statistically analyzed following the CONSORT-recommended intention-to-treat protocol for the five tested criteria and for each overall criteria. The distributions of the evaluated lesions were described using the Pearson chi-square test. Data was presented using frequency and percentage. Groups were compared at each time point regarding all criteria by the Kruskal-Wallis test. Within each group, comparisons were completed using the Friedman test.
There were no dropouts in this trial. Using the Pearson Chi-square test, none of the cavity’s features influenced the retention of composite restorations. After 12 months, there were no statistically significant difference in aesthetic (marginal staining), functional (fractures/retention, and marginal adaptation), or biological (post-operative sensitivity and caries recurrence) evaluation criteria between adhesive systems and strategies by the Kruskal-Wallis test. Also, when the baseline and 12-month outcomes were compared using the Friedman test, no significant difference was found for all groups.
Based on the outcomes of the present study, phosphoric acid etching (SEE or ER modes) was recommended before the application of universal adhesive.