Prolonged application time effects on universal adhesives in non-carious cervical lesions: An 18-month split mouth randomized clinical trial.

OBJECTIVE: This double-blind, split mouth randomized clinical trial aimed to assess the clinical performance of Clearfil Universal Bond Quick (CBUq) universal adhesive under different application times (no waiting and waiting) compared to Clearfil SE Bond adhesive in non-carious cervical lesions (NCCLs) over 18 months. METHODS: One hundred and eighty-three restorations were distributed randomly into three groups based on the adhesive system and waiting time: CUBq without waiting time (CUBq-NW), CUBq with a 20 s waiting time (CUBq-W), and CSE with a 20 s waiting time. After placement, restorations were evaluated after 18 months using the International Dental Federation (FDI) and United States Public Health Service (USPHS) criteria. Statistical analyses involved Friedman repeated measures analysis of variance and Wilcoxon tests, with a significance level set at 5 %. RESULTS: Over the 18-month period, no restorations were lost across the tested groups. Marginal adaptation evaluation indicated minor discrepancies in 21 restorations (8 CUBq-NW, 6 CUBq-W, and 7 CSE). There were no significant differences observed among the three groups following the 18-month clinical assessment (p > 0.05). Only two restorations showed marginal discoloration after 18 months (1 CUBq-NW and 1 CSE). CONCLUSIONS: The application of Clearfil Universal Bond Quick using either the "waiting" or "no-waiting" technique exhibited excellent clinical results in NCCLs during the 18-month follow-up period, demonstrating comparable performance to Clearfil SE Bond in all assessed outcomes. CLINICAL SIGNIFICANCE: The findings suggest that the new universal adhesive applied using the no-waiting technique demonstrates promising clinical performance when compared to conventional application methods. TRIAL REGISTRATION: ClinicalTrials.gov identifer RBR-69p7mpr.

Lesiones cervicales no cariosas: una revisión sistemática / Non carious cervical lesions: a systematic review

Introducción: las lesiones cervicales no cariosas (NCCL, por sus siglas en inglés) son un grupo de lesiones que afectan el área cervical del órgano dental causando hipersensibilidad dentinaria y defectos estéticos. Objetivo: analizar la literatura sobre las lesiones cervicales no cariosas, su etiología, consideraciones anatómicas, características morfológicas de la lesión y tratamientos no restaurativos. Material y métodos: se realizó una búsqueda en la base de datos PubMed, utilizando las palabras clave: non-carious cervical lesions OR noncarious cervical lesions OR tooth wear OR tooth erosion OR dental abfraction OR abfraction, recopilando un total de 78 artículos. Resultados: es necesario determinar la etiología antes de seleccionar las estrategias de tratamiento para las lesiones cervicales no cariosas. Conocer los distintos tipos de tejidos que componen al órgano dentario facilita la comprensión de los factores que participan en el desarrollo de las lesiones cervicales no cariosas. Esto permite que el tratamiento se enfoque más en la causa del problema que en los síntomas. Con esto podemos modificar diversos factores de manera interceptiva, los tratamientos de terapia con láser y compuestos tópicos son una estrategia mínimamente invasiva. Conclusiones: la mejor manera de describir a las lesiones cervicales no cariosas sería como una enfermedad multifactorial. Se debe prestar especial atención en los métodos de diagnóstico, identificando cofactores que propicien el avance de la lesión, como son la fricción y la biocorrosión. Esta revisión brinda datos que asocian a los factores oclusales como una de las principales causas de una enfermedad que afecta a más de la mitad de la población adulta (AU)

Introduction: non-carious cervical lesions (NCCL) are a group of lesions that affect the cervical area of the dental organ causing dentin hypersensitivity and cosmetic defects. Objective: to know, through a systematic review, the current state of non-carious cervical lesions. Material and methods: a search was conducted in the PubMed database, using the keywords: non-carious cervical lesions OR noncarious cervical lesions OR tooth wear OR tooth erosion OR dental abfraction OR abfraction, compiling a total of 78 articles. Results: determining etiology is necessary before selecting treatment strategies for non-carious cervical lesions (NCCL). Know the different types of tissues that make up the dentary organ, facilitate the understanding of the factors involved in the development of noncarious al cervical lesions. This allows treatment to focus more on the cause of the problem than on symptoms. With this we can modify various factors in an interceptive way, laser therapy treatments and topical compounds, are a minimally invasive strategy. Conclusions: the best way to describe non-carious al cervical lesions would be as a multifactorial disease to which special attention should be paid to both diagnostic methods, identifying cofactors that promote the progression of injury, such as friction and biocorrosion. This review provides data that associates occlusal factors as one of the main causes of a disease that affects more than half of the adult population (AU)

Five-year clinical evaluation of universal adhesive applied following different bonding techniques: A randomized multicenter clinical trial.

OBJECTIVES: To evaluate the clinical performance of a universal adhesive system (Futurabond U, Voco) when applied following different adhesive strategies in non-carious cervical lesions (NCCLs) after 5 years. METHODS: Fifty participants were included. Futurabond U (Voco) was applied in NCCLs using four adhesive strategies (n = 50 each): only self-etch (SE); selective enamel etching + self-etch (SET + SE); etch-and-rinse with dry dentin (ERD); and etch-and-rinse with wet dentin (ERW). All cavities were restored with Admira Fusion composite resin (Voco). Restorations were evaluated after 1, 3, and 5 years using the World Federation criteria (FDI) and the modified United States Public Health Service (USPHS) criteria. RESULTS: After 5 years, retention rates were 81 % (65.8-90.5) for SE, 87 % (73.2-94.4) for SET + SE, 84 % (69.6-92.6) for ERD, and 78 % (63.6-88.9) for ERW (p > 0.05). Thirty-five restorations were considered to have minor discrepancies in marginal adaptation at the 5-year recall (14 for SE, 9 for SET + SE, 6 for ERD, and 6 for ERW; p > 0.05). Sixteen restorations were detected as a minor marginal discoloration (6 for SE, 4 for SET + SE, 1 for ERD, and 5 for ERW; p > 0.05) and one restoration showed a recurrence of caries (1 for ERW; p > 0.05) at the 5-year recall. No restorations showed postoperative sensitivity after 5 years. SIGNIFICANCE: NCCLs restorations using a universal adhesive showed satisfactory clinical performance after 5 years, regardless of the adhesive strategy.

Grado de microfiltración en ionómero de vidrio y resina compuesta nanoparticulada en lesiones cervicales no cariosas / Degree of microleakage in glass ionomer and nanoparticulate composite resin in non-carious cervical lesions

Introducción: El grado de microfiltración en el ionómero de vidrio y la resina compuesta nanoparticulada en lesiones cervicales no cariosas es de gran importancia para elegir el material restaurador más adecuado para cada caso clínico. Objetivo: Describir el grado de microfiltración en ionómero de vidrio y resina compuesta nanoparticulada en lesiones cervicales no cariosas. Métodos: Se realizó una revisión bibliográfica, correspondiente al nivel exploratorio, en busca de responder cinco preguntas científicas sobre el tema. Se identificaron 62 artículos de las bases de datos de Google Académico o Scopus entre 2015 y 2022. Resultados: Los estudios consultados sugieren que la resina compuesta nanoparticulada es una opción de restauración efectiva y estética en odontología, especialmente en casos de cavidades de alta carga mecánica y estética dental. Los estudios de casos que se revisan demuestran que el grado de microfiltración en las lesiones cervicales no cariosas puede ser significativamente mayor en las restauraciones con ionómero de vidrio en comparación con las resinas compuestas nanoparticuladas. Conclusiones: Se concluye que el elemento fundamental en el tratamiento es realizar un correcto diagnóstico, determinando las necesidades para mejorar la salud dental y realizar una correcta planificación, por lo que es necesario conocer los diferentes tipos de tratamientos con la finalidad de seleccionar el más adecuado, que cumpla con las características biológicas, mecánicas y estéticas, ya que uno de los objetivos fundamentales de cualquier tratamiento es devolver la función y la estética de modo satisfactorio y con la mayor durabilidad posible.

Introduction: The degree of microleakage in glass ionomer and nanoparticulated composite resin in non-carious cervical lesions is of great importance for choosing the most suitable restorative material for each clinical case. Objective: To describe the degree of microleakage in glass ionomer and nanoparticulated composite resin in non-carious cervical lesions. Methods: A literature review, corresponding to the exploratory level, was carried out to answer five scientific questions on the subject. Sixty-two articles were identified from Academic Google or Scopus databases between 2015 and 2022. Results: The studies consulted suggest that nanoparticulated composite resin is an effective and esthetic restorative option in dentistry, especially in cases of cavities with high mechanical load and dental esthetics. The case studies reviewed demonstrate that the degree of microleakage in non-carious cervical lesions can be significantly higher in glass ionomer restorations compared to nanoparticulated composite resins. Conclusions: It is concluded that the fundamental element in treatment is to carry out a correct diagnosis, determining the needs to improve dental health and to carry out correct planning, so it is necessary to know the different types of treatments with the aim of selecting the most suitable one, which complies with the biological, mechanical and esthetic characteristics, since one of the fundamental objectives of any treatment is to restore function and esthetics in a satisfactory way and with the greatest possible durability.

X-ray microtomography analysis of gaps and voids in the restoration of non-carious cervical lesions with different composite resins.

Context (Background): Resin composites are the most widely used material for restoring cervical defects. However, the high failure rate of these restorations is still a concern. Aims: The aim of this in vitro study was to evaluate, using microtomography (µCT), the interfacial gap and voids formation in Class V cavities in premolars restored with materials with lower polymerization shrinkage combined with different restorative techniques. Settings and Design: Cervical defects were created in 30 intact premolar and were randomly distributed to be restored by one of the following techniques (n = 6): Composite resin with two increments (CR), organic modified polymer (ORMOCER) with single (OR1) or two increments (OR2, or low viscosity bulk-fill composite resin with single (BF1) or two increments (BF2). Methods and Material: Each tooth was scanned before filling to determine the volume of interest (VOI) to be applied in the second µCT after restoration and to control the cavity volume among the groups. In the µCT after filling, the volume of interfacial gaps and voids was calculated for each group. Statistical Analysis: The groups were compared using one-way and Tukey HSD post hoc test (α = 0.05). Results: It was possible to identify higher gap formation in the OR1 group and higher void formation in CR group (P < 0.05). OR2 group showed better results than the group with one increment. BF2 showed the best filling capacity. Conclusions: It was possible to conclude that the material and the number of increments directly influenced the internal adaptation and voids formation of Class V restorations.

Prevalence of non-carious cervical lesions and orthodontic treatment: a retrospective study.

BACKGROUND: This study aimed to assess the distribution of non-carious cervical lesions (NCCLs) by tooth type, investigate the prevalence of NCCLs in patients undergoing orthodontic treatment, and identify the possible associated factors. MATERIAL AND METHODS: A total of 160 patients were enrolled in this retrospective study. Data on the following variables were collected from pre-and post-orthodontic treatment records: age, sex, Angle's malocclusion, facial pattern, number of activation sessions, compensatory treatment, and retreatment. Frontal, right and left lateral intraoral photographs of each patient were evaluated to identify the presence or absence of NCCLs in each tooth and assess the distribution of NCCLs in the 3840 teeth from the enrolled patients. Furthermore, patients were classified as NCCLs present, irrespective of the number of NCCLs on the teeth or NCCL absent. Bivariate and multivariate Poisson regression analyses with robust variance were used to assess the association between the NCCLs and each independent variable. Prevalence ratio and 95% confidence intervals were calculated and p < 0.05 was considered statistically significant. RESULTS: The prevalence of NCCLs before and after orthodontic treatment was 22.71% and 30.91%, respectively. Premolars were the most affected teeth, followed by the first molars, canines, and incisors. After statistical analysis, age was found to be the variable factor that influenced the prevalence ratio, with NCCL being the most prevalent when orthodontic treatment was performed in adulthood. CONCLUSIONS: Premolars were most commonly affected by NCCLs. Furthermore, age seemed to contribute to the increased prevalence of NCCLs in adults undergoing orthodontic treatment.

Thirty-six-month follow-up of cervical composite restorations placed with an MDP-free universal adhesive system using different adhesive protocols: a randomized clinical trial.

OBJECTIVES: To evaluate the influence of different application strategies on the clinical behavior of an MDP-free universal adhesive placed in non-carious cervical lesions (NCCLs) over the course of 36 months. MATERIALS AND METHODS: Thirty-one patients participated in this study (N = 31). One hundred twenty-four restorations were assigned to four groups: We used the self-etch strategy on groups with (SE-et) and without (SET) selective enamel etching, and the etch-and-rinse strategy on groups with dry (ER-D) and moist (ER-M) dentin. After applying the MDP-free universal adhesive (Xeno Select universal adhesive, Dentsply Sirona), cavities were filled using EvoluX composite resin (Dentsply Sirona). The restorations were evaluated at baseline and after 36 months according to World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. Friedman's repeated-measures analysis of variance rank (α = 0.05) was used for statistical analysis. RESULTS: We evaluated the 31 patients after 36 months. Forty-two restorations were lost (ER-D = 5, ER-M = 7, SE-et = 14, SET = 16). The 36-month retention/fracture rates (95% confidence interval) were 83.9% for ER-D, 77.4% for ER-M, 54.9% for SE-et, and 48.4% for SET. ER strategy showed better retention rate than SE strategy (p < 0.05). Thirty-four restorations (ER-D = 6, ER-M = 10, SE-et = 10, SET = 8) showed marginal staining per FDI criteria and 15 restorations (ER-D = 1, ER-M = 2, SE-et = 6, SET = 6) showed marginal staining per USPHS criteria. No restorations showed postoperative sensitivity or recurrence of caries. CONCLUSION: The retention rate of Xeno Select universal adhesive was poor, mainly in the self-etch strategy. TRIAL REGISTRATION: REBEC clinical registry under protocol RBR-4wh4sh. CLINICAL RELEVANCE: MDP-free universal adhesive behavior depends on the bonding strategy used.

Non-carious cervical lesions (NCCLs) and associated factors: A multilevel analysis in a cohort study in southern Brazil.

AIM: To investigate the prevalence of non-carious cervical lesions (NCCLs) and their association with individual and tooth-related factors in adults from the 1982 Pelotas Birth Cohort. MATERIALS AND METHODS: Participants were interviewed and clinically examined at the age of 31. NCCL was defined as loss of dental tissue without bacterial involvement in the cervical region. Independent variables were the socioeconomic, demographic, behavioural, and clinical characteristics. Associations were tested using a multilevel Poisson regression model. RESULTS: Five-hundred and thirty-nine participants were clinically examined, with a 26% prevalence of NCCLs, which were more prevalent in the maxilla (56.5%) and in premolars (72.9%). In the multilevel analysis, women presented lower prevalence than men [prevalence ratio (PR) 0.59 (0.48-0.73)]; those who reported smoking at both 22 and 30 years of age had more NCCLs than those who never smoked [PR 1.65 (1.31-2.07)]; and high-frequency brushers presented higher prevalence than low-frequency brushers [PR 1.26 (1.03-1.55)]. Gingival recession increased 10 times the prevalence of NCCLs [PR 10.03 (8.15-12.35)], while the presence of periodontal pockets (≥4 mm) reduced the prevalence of NCCLs [PR 0.43 (0.28-0.66)]. CONCLUSIONS: NCCLs were more prevalent in males, smokers, and those with higher frequency of toothbrushing. While the presence of periodontal pockets was associated with a lower prevalence of NCCLs, gingival recession was a strong clinical indicator for the presence of NCCLs.

Two-year randomized clinical trial of different restorative techniques in non-carious cervical lesions and MMP activity in gingival crevicular fluid.

OBJECTIVES: To evaluate different restorative techniques for non-carious cervical lesions (NCCLs) and the activity of matrix metalloproteinases (MMPs) in gingival crevicular fluid. MATERIALS AND METHODS: Two hundred restorations were performed in 50 patients using resin composite restorative system without (I) and with selective enamel conditioning (II) and resin-modified glass-ionomer cement without (III) and with EDTA pretreatment (IV). Gingival crevicular fluid samples were collected in 15 patients. Restorations were evaluated using USPHS criteria at baseline and after 2 years. Percentages of MMP activity were assessed by zymography as a surrogate outcome. Equality tests of two proportions, logistic regression analysis, survival analysis, ANOVA repeated measures, and Fisher tests were used. RESULTS: No differences in clinical performance were found among groups. Group I had lower retention at 2 years than at baseline. Decreased alpha scores for marginal integrity and marginal discoloration were observed for all groups after 2 years. MMP-2 decreased after 1 year, and its activity increased back to the initial level after 2 years, mainly for groups I, II, and III. MMP-9 increased after 1 year, and it was reduced to the initial level after 2 years, mainly for group I. CONCLUSIONS: All restorative techniques performed similarly in NCCLs after 2 years with initial marginal defect alterations. MMP-2 reestablished its initial levels after 2 years, and MMP-9 had few alterations over time in crevicular fluid. Clinical relevance The different restorative techniques are equally successful in NCCLs after 2 years of clinical functioning and have similar effects on MMPs present in crevicular fluid.

Restorative materials for restorations of non-carious cervical lesions: an overview

Objective: To review the available scientific literature on the restorative treatment of non-carious cervical lesions; in particular, the restorative materials that present optimal performance in this type of clinical situation. Methods: A literature review was performed using Pubmed search engine with the aim of determining the ideal restorative material for restorations of non-carious cervical lesions. Results: Beautifil II (Shofu INC.) restorative material showed satisfactory results in terms of fracture resistance, flexural strength and excellent aesthetics, in addition to components that act as anti-cariogenic, anti-plaque and oral pH balance. The Clearfil SE Bond adhesive (Kuraray NORITAKE) showed in clinical research the highest bond strength rate compared to other adhesive systems available in the dental market. Conclusion: Non-carious cervical lesions are multifactorial lesions that require the professional knowledge to conduct the treatment effectively. The Shofu Beautifil II showed the best results in fracture resistance, flexural strength and excellent aesthetics, it has anticariogenic potential, anti-plaque bacteria and contributes to the oral pH balance. The Clearfil SE Bond adhesive showed the highest retention rate among its competitors.

Relationship between presence of abfractions and premature contacts

ABSTRACT: Abfractions (AFs) are non-carious cervical lesions considered of multifactorial etiology by several authors. Objective: Relate the presence of premature contacts and AFs. Materials & Methods: The original number of students to be analyzed were 117, 36 of whom (equal amount of women and men) were finally chosen for presenting premature contacts. 19 of them presented abfractions. A survey was conducted with questions on issues like toothbrushing habits, diet and some gastric disorders; besides the participants had to take the Hamilton Anxiety Rating Scale. Then, stone models were obtained and mounted for further occlusal analysis with WCM ® semi-adjustable articulator searching the abfractions and their coincidence with premature contacts. Fisher's exact test (p<0,05) was used to associate AF with toothbrushing habits, diet, burning symptoms and gastroesophageal reflux. Chi-square test (p<0,05) was used to associate AFs and premature contacts. Student's t-distribution was used to associate AFs with anxiety. Results: There was a significant relationship between AFs presence and premature contacts (p=0,00). There was not a significant relationship between presence of AFs and toothbrushing habits and diet. There was not a significant relationship between presence of AFs and anxiety. Conclusions: AF presence do associate with premature contacts in the same affected tooth.

Clinical behavior of universal adhesives in non-carious cervical lesions: A randomized clinical trial.

OBJECTIVES: This randomized, double-blind clinical trial, , evaluated the behavior of two universal adhesives used in etch-and-rinse (ER) or self-etch (SE) approach in non-carious cervical lesions (NCCLs). METHODS: Two hundred and eleven NCCLs were selected in 54 participants and randomly allocated into four experimental groups: Scotchbond Universal Adhesive - SBU (3M Oral Care) and Prime & Bond Elect - PB (Dentsply Sirona) used in ER and SE modes. Two trained operators placed all resin composite restorations (Filtek Z250, 3M Oral Care). Restorations were evaluated at baseline and after 6 months using both FDI and USPHS modified criteria by a blinded calibrated examiner. Kruskal-Wallis and Mann-Whitney U non-parametric tests were used to compare the restoration failures among experimental groups. RESULTS: Statistically significant differences were found among groups regarding failures (p=0.000 for both FDI and USPHS criteria). PB-SE presented more failures (p<0.05) than other experimental groups. No significant difference was found between any other pair of groups (p>0.05). CONCLUSIONS: The etch and rinse approach affected the clinical performance of Prime and Bond Elect. For this material, the self-etch approach generated lower criteria scores after a six-month follow-up. The bonding strategy did not influence Scotchbond Universal Adhesive clinical performance. (RBR-2GQMVF) CLINICAL SIGNIFICANCE: The clinical behavior of mild universal adhesive Prime & Bond Elect depends on the bonding strategy. The etch-and-rinse approach is recommended for this adhesive system. Scotchbond Universal Adhesive can be used in both bonding strategies without impairing clinical performance.

Prevalence and severity of non-carious cervical lesions and dentin hypersensitivity: association with oral-health related quality of life among Brazilian adults.

OBJECTIVES: To assess the association between dentin hypersensitivity (DH) (with or without non-carious cervical lesions (NCCL)) and physical and psychosocial oral health impact. METHODS: A cross-sectional population-based study with one-stage random sample of adults living in a Brazilian municipally was conducted between 2018 and 2019. Interviews and oral examinations were performed by calibrated examiners (Kappa ≥0.7). The participant was considered as having physical and psychosocial impact if at least one item of the Oral Health Impact Profile (OHIP-14) was experienced fairly often or very often. NCCL was assessed by the Tooth Wear Index (codes 2 to 4) and DH was evaluated by a tactile test with a probe in the cervical area of teeth. The combination of these clinical variables resulted in categories of the independent variable: without DH or NCCL, NCCL without DH, DH without NCCL, and both DH with NCCL. The covariables were sociodemographic and economic factors, health habits, and oral conditions. Associations were investigated by Poisson Regression models using Direct Acyclic Graph (Stata 17). RESULTS: Of 197 adults, 59.3% had oral health impact and 31.3% had DH with NCCL. Higher frequency of oral health impact was observed in adults with DH alone. A higher impact on the physical pain dimension of the OHIP-14 was observed in adults with DH and NCCL (PR: 2.46; 95% CI: 1.21-5.00) and with DH alone (PR: 2.03; 95% CI: 1.21-3.41). CONCLUSION: NCCL and DH are common conditions in adults and the presence of DH is associated with higher oral health impact. Regardless the presence of NCCL, DH is associated with the physical pain dimension of OHRQoL.

Adhesive strategies in cervical lesions: systematic review and a network meta-analysis of randomized controlled trials.

OBJECTIVES: A network meta-analysis (NMA) was performed to assess which adhesive strategy is most clinically effective in treating non-carious cervical lesions (NCCLs). MATERIAL AND METHODS: Studies were identified by a systematic search of electronic databases including MEDLINE via PubMed, Brazilian Library in Dentistry (BBO), Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), Scopus, and Web of Science without restrictions on publication year or language. The grey literature was also consulted. Only randomized clinical trials that compared different adhesive strategies in NCCLs in adult patients were included. The risk of bias was evaluated by using the Cochrane Collaboration tool. A random-effects Bayesian mixed treatment comparison model was used to compare adhesive strategies (3ER, 2ER, 2SE, and 1SE) at different follow-up times. The surface under cumulative ranking curve (SUCRA) was estimated for each strategy. Heterogeneity was assessed by using the Cochran Q test and I2 statistics. The quality of evidence was evaluated using the GRADE approach. RESULTS: A total of 5058 studies were identified, 66 of which met the eligibility criteria and of these 5 were judged "low" risk of bias and 57 were meta-analyzed. We did not observe significant differences in the NMA analysis for any two pairs of adhesives, except for the shortest follow-up for 2ER vs 3ER. The material 2SE ranked highest, although it differed only slightly from the other bonding strategies. CONCLUSIONS: No bonding strategy is better than the others. CLINICAL RELEVANCE: Adhesive efficacy cannot be characterized by its bonding strategy.

Effects of cervical restorations on the periodontal tissues: 5-year follow-up results of a randomized clinical trial.

OBJECTIVE: This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCLs) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques. METHODS: A randomized controlled split-mouth and blinded trial was carried out. Patients (n = 38) with at least two NCCLs were included. Before the cervical restoration placement, the NCCLs (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5 years. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95 % confidence interval (95 %CI) were calculated by Poisson regression (α < 0.05). RESULTS: After 5 year, 31 teeth (13.6 %) presented occurrence/progression of GR. In the multivariate analyses, the occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95 %CI: 2.65; 1.01-7.00) and a lack of marginal adaptation of the restoration (RR; 95 %CI: 10.98; 2.31-52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, and the presence of biofilm or gingivitis did not present a statistically significant higher risk for occurrence/progression of GR. CONCLUSION: The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals who received a restoration for an NCCL. CLINICAL SIGNIFICANCE: Isolation with a rubber dam and dental clamps may promote GR in sites with restored NCCLs. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.

Objective assessment of simulated non-carious cervical lesion by tridimensional digital scanning.

OBJECTIVE: To explore the use of 3D intraoral scanner/image analysis for the detection and monitoring of simulated non-carious cervical lesions (NCCLs) in vitro. MATERIALS AND METHODS: A total of 288 NCCLs of different severities and simulated using a laboratorial model associating toothbrush stiffness (soft, medium, and hard) and toothpaste abrasivity (low, medium, high, and negative control) were analyzed. Dental impressions were taken from specimens before and after 35K and 65K brushing strokes, and then scanned with a CEREC Omnicam scanner. 3D models were analyzed for volumetric tooth loss. 3D optical profilometry was considered as the gold standard. Data were analyzed using ANOVA and Fisher's PLSD tests (alpha = 0.05), and agreement between methods by using intraclass correlation coefficient. RESULTS: Toothbrushes of hard and mid stiffness caused higher tooth loss than soft when associated with the highest abrasive, at 35K and 65K strokes (p < 0.001). Variation in slurry abrasivity led to differences in tooth loss (with control < low < medium < high, p < 0.0001) after both 35K and 65K strokes, regardless of the type of toothbrush used, except at 35K, wherein control = low (p = 0.55). 35K strokes caused less tooth loss than 65K for all abrasive slurries (p < 0.0001) except controls. The intraclass correlation coefficient for agreement between the test and gold standard methods was 0.85. CONCLUSIONS: Analysis of 3D images from intraoral scanner could detect and monitor NCCL progression, although this ability was limited on incipient lesions. Overall good agreement was found between the test method and optical profilometry. CLINICAL RELEVANCE: The suggested method may be applicable to detect and monitor NCCLs clinically.

Prevalence and risk indicators of non-carious cervical lesions in male footballers.

BACKGROUND: Non-carious cervical lesions (NCCLs) have shown a significant incidence and prevalence and have been increasingly associated with people's lifestyles and youths. This cross-sectional study aimed to determine the prevalence of NCCLs in footballers and to address potential risk indicators. METHODS: Fourty-three male semi-professional footballers with an average of 27 years old completed a questionnaire and were subjected to intraoral examination in terms of cervical tooth wear, morphological characteristics of NCCLs, tooth sensitivity, occlusal/incisal wear, and malocclusion classification. Also, laboratory assays were performed to determine salivary parameters: flow rate, pH, buffer capacity, level of Ca (calcium), Na (sodium), and K (potassium) ions, and level of cortisol. The data obtained from the questionnaire and intraoral examinations were subjected to Chi-square and Poisson regression models while the data obtained from the laboratory assays were analyzed by using analysis of variance (p <  0.05). RESULTS: The prevalence of NCCLs was 39.5%. The participants presented predominantly initial lesions with signs of mechanical stress. The daily training time was found as a significant risk indicator (p = 0.028). The multivariate analysis showed a significant difference in the variables daily training time (p = 0.023), lemon water intake while fasting (p = 0.002), toothpaste type (p = 0.004), tooth sensitivity (p = 0.006); previous orthodontic treatment (p = 0.003), and occlusion type (p = 0.008). All participants presented normal salivary parameters and levels of cortisol. CONCLUSION: The prevalence of NCCLs among footballers was remarkable. The premolars were the most affected teeth and presented symptoms/signs of initial lesions. The daily training time was a dominant risk indicator of NCCLs development. Footballers presented adequate salivary parameters and cortisol levels.

Correlação de Ansiedade com a Presença de Lesões Cervicais Dentárias não Cariosas / Association between anxiety and the presence of non-carious dental cervical lesions

Objetivo: este estudo tem como objetivo avaliar a associação entre ansiedade, hábitos alimentares, parafuncionais, condições sistêmicas, hábitos de higiene oral em associação com a ansiedade de pacientes com lesões cervicais dentárias não cariosas (LCNCs) em uma população. Material e Métodos: por meio de um estudo quantitativo, observacional, 100 pacientes, obtidos por cálculo do tamanho da amostra, com presença de LCNCs, foram avaliados por exame clínico e cálculo amostral; entre 20 e 58 anos, com idade média de 37 anos. Os dados foram coletados por meio de um questionário elaborado por um pesquisador previamente calibrado, referente à avaliação médica, odontológica, de histórico social e de ansiedade. Após a obtenção dos dados, eles foram tabulados e submetidos à análise estatística pelo teste binomial exato de Fisher de duas proporções, adotando um nível de significância de 5%. Resultados: o consumo de bebida gaseificada (81,6%), frutas cítricas (76,3%), frequência de escovação dentária igual ou superior a três vezes ao dia (100%) e abrasividade do creme dental (100%) foram significativamente associados à presença de NCCL (p = 0,0001). Doença do refluxo gastrointestinal, xerostomia, bulimia e anorexia demonstraram associação negativa com o NCCL (p=1,000). A ansiedade não mostrou relação direta com a NCCL na população estudada (36,8%). Conclusão: assim, pode-se concluir que não houve associação direta entre a presença de lesões cervicais não cariosas e a ansiedade

Objective: This study evaluated the association between parafunctional anxiety, eating habits, systemic conditions and assessment of oral hygiene habits with dental non-carious cervical lesions (NCCL). Material and Methods: this quantitative, observational study included 100 patients between 20 and 58 years old (mean of 37 years) with NCCL evaluated by clinical examination and sample calculation. The data were collected with use of a questionnaire made by a previously calibrated researcher, which referred to medical, dental, social history and anxiety assessments. After obtaining the data they were tabulated and subjected to statistical analysis using Fisher's exact two-proportion binomial test, adopting a 5% significance level. Results: consumption of carbonated drinks (81.6%), citrus fruits (76.3%), tooth brushing frequency equal or higher than three times a day (100%) and abrasiveness of toothpaste (100%) were significantly associated with presence of NCCL (p=0.0001). Gastrointestinal reflux, xerostomia, bulimia and anorexia showed negative association with NCCL (p=1.000). Anxiety was not directly associated with NCCL in the study population (36.8%). Conclusion: there was no direct association between the presence of non-carious cervical lesions and anxiety

A 2-year clinical evaluation of direct and semi-direct resin composite restorations in non-carious cervical lesions: a randomized clinical study.

OBJECTIVES: The purpose of this study was to evaluate the 2-year success of resin composite restorations in non-carious cervical lesions (NCCLs) using the direct or semi-direct techniques. MATERIALS AND METHODS: Thirty volunteers presenting with at least two NCCLs were included. Each participant received one restoration using the direct technique and the other using the semi-direct technique, totaling 60 restorations. Time for completing the treatment was computed. Assessments at baseline, 7 days, and 6, 12, and 24 months were performed using the modified United States Public Health Service criteria. Descriptive analysis was reported as a percentage of successful treatments. For inferential analysis, the Student t test was used to evaluate the differences between extension, depth, and time. The chi-square/Fisher tests were used to compare treatment success after each period (α = 0.05). The results were evaluated by using the Kaplan-Meier survival analysis. RESULTS: Differences were detected regarding mean ± standard deviation time, in which direct and semi-direct procedures were accomplished in 21.8 (± 14.5) and 35.3 (± 19.9) min, respectively. Of the 60 restorations placed, 7 failed in the direct group while 8 failed in the semi-direct group up to 2 years. No differences were detected between restorative protocols. The cumulative survival was 88.5% and 88.4% for the direct technique and semi-direct techniques after 24 months, respectively. CONCLUSION: The tested restorative protocols present similar results for NCCLs within the studied periods. CLINICAL RELEVANCE: The semi-direct technique exhibited clinical performance similar to direct technique for NCCL, demonstrating an alternative for restorations of these lesions.

One-year evaluation of a new restorative glass ionomer cement for the restoration of non-carious cervical lesions in patients with systemic diseases: a randomized, clinical trial

Abstract Objective This randomized and clinical trial aimed to evaluate the performance of a new restorative Glass Ionomer Cement (GIC) for the restoration of non-carious cervical lesions (NCCLs) of patients with systemic diseases compared with a posterior resin composite after 12 months. Methodology 134 restorations were placed at 30 patients presenting systemic diseases by a single clinician. NCCLs were allocated to two groups according to restorative system used: a conventional restorative GIC [Fuji Bulk (GC, Tokyo Japan) (FB)] and a posterior resin composite [G-ænial Posterior (GC, Tokyo Japan) (GP)] used with a universal adhesive using etch&rinse mode. All restorative procedures were conducted according to manufacturer's instructions. Restorations were scored regarding retention, marginal discoloration, marginal adaptation, secondary caries, surface texture, and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after 1 week (baseline), 6, and 12 months. Descriptive statistics were performed using chi-square tests. Cochran Q and Mc Nemar's tests were used to detect differences over time. Results After 12 months, recall rate was 93% and the rates of cumulative retention failure for FB and GP were 4.9% and 1.6% respectively. Both groups presented similar alpha rates for marginal adaptation (FB 86.2%, GP 95.5%) and marginal discoloration (FB 93.8%, GP 97%) at 6-month recall, but FB restorations showed higher bravo scores than GP restorations for marginal adaptation and marginal discoloration after 12 months (p<0.05). Regarding surface texture, 2 FB restorations (3.1%) were scored as bravo after 6 months. All restorations were scored as alpha for secondary caries and postoperative sensitivity after 12 months. Conclusion Although the posterior resin composite demonstrated clinically higher alpha scores than the conventional GIC for marginal adaptation and discoloration, both materials successfully restored NCCLs at patients with systematic disease after a year. Clinical relevance Due to its acceptable clinical results, the tested conventional restorative GIC can be used for the restoration of NCCLs of patients with systemic diseases.