Clinical Performance of Non-Carious Cervical Restorations Restored with the "Sandwich Technique" and Composite Resin: A Systematic Review and Meta-analysis.

PURPOSE: To compare the retention rates of non-carious cervical restorations (NCCLs) constructed using the sandwich technique (a lining of glass-ionomer cement [GIC] or resin-modified glass-ionomer cement [RMGIC] and composite resin [CR]) with CR-only restorations. MATERIALS AND METHODS: The search was performed in various databases, including the Cochrane Library, PubMed, Scopus, and Web of Science. Gray literature was inspected, as were ongoing and unpublished abstracts from the IADR (1990-2017). Study quality was evaluated using the Cochrane Collaboration bias risk tool. Data from primary and secondary outcomes were meta-analyzed at 1-, 2- and 3-year follow-ups using the random effects model. The quality of the body of evidence was assessed using the GRADE approach. RESULTS: Initially, a total of 3645 articles were selected. After selection by titles, abstracts, and full texts, 6 articles were retrieved, but three were follow-ups of the same RCT. Therefore, a total of four studies remained for analysis. All studies were at unclear risk for bias. Among all outcomes, only loss of retention was lower for the sandwich technique at the 3-year follow-up (risk ratio [RR]: 7.5; 95% CI: 2.1 to 27.2; p = 0.002). CONCLUSIONS: Based on the limited number of available studies, higher retention rates in NCCL restorations were observed with the sandwich technique compared to CR-only restorations at the 3-year follow-up. Secondary outcomes were not influenced by the restorative technique. Except for retention rates, which were of moderate quality, the evidence quality of all secondary outcomes was low.

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.

A Randomized Clinical Trial Evaluating Rubber Dam Clamp Pain Reduction from a New Topical Liposomal Anesthetic Gel.

PURPOSE: Discomfort during rubber dam clamp often occurs in pediatric dentistry. The purpose of this randomized, triple-blind, clinical trial was to evaluate the effect of pain reduction using a new topical liposomal thermo-sensitive gel (TLTG) or a placebo gel during rubber dam clamp isolation for sealants in children. METHODS: Eighty-one children (eight to 12 years old) had LTSG or the placebo gel with random assignment placed around the gingival tissue of their permanent mandibular first molars. A clamp was placed after two minutes on the teeth, and intensity of pain was registered using a Wong-Baker FACES scale and an 11-point numerical scale. The data were evaluated using McNemar's test and Wilcoxon signed rank test. RESULTS: The odds ratio for pain (OR equals 0.7; 95 percent confidence interval equals 0.3 to 1.8) was not statistically significant (P=0.52). However, there was a small difference in the pain intensity between liposomal and placebo groups for both scales (P<0.05). CONCLUSION: The liposomal thermo-sensitive anesthetic gel may reduce, to a small extent, the pain intensity in children submitted to rubber dam isolation before resin sealant placement.

Intrapocket topical anesthetic versus injected anesthetic for pain control during scaling and root planing in adult patients: Systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, the authors evaluated the pain during scaling and root planing with use of topical anesthetic versus that with the use of injected anesthetic in adult patients. TYPES OF STUDIES REVIEWED: The authors searched 6 databases for randomized clinical trials in which the investigators compared the clinical effectiveness of intrapocket and injectable anesthetics. The primary outcome was the risk of developing pain or intensity of pain. Quality assessment followed the guidelines from the Cochrane Collaboration's risk-of-bias tool. The authors performed meta-analyses on studies considered at low and unclear risk of bias. RESULTS: From 976 articles identified, 6 remained in the qualitative synthesis (4 at low and 2 at unclear risk of bias). Injected anesthetic produced lower pain intensity than did anesthetic gel (P = .03) and required less rescue anesthetic than did topical anesthetic (P < .0001). There was no difference in patient preference (P = .09). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Injected anesthetic decreased the intensity of pain and the need for rescue anesthetic during scaling and root planing, but the risk of developing pain yielded similar results for injected and topical anesthetics.

Is the bonding of self-adhesive cement sensitive to root region and curing mode?

OBJECTIVES: To evaluate the influence of two curing techniques on the degree of conversion (DC) of resin cements and on bond strength (BS) of fiber posts in different regions of root dentin. MATERIAL AND METHODS: Twenty single-rooted premolars were endodontically treated, and the post spaces were prepared. The roots were randomly divided into two groups (n=10), according to the activation mode of the resin cement RelyX™ U200 (3M ESPE Saint Paul, MN, USA): conventional (continuous activation mode) and soft-start activation mode (Ramp). The posts (WhitePost DC/FGM) were cemented according to the manufacturer's recommendations and, after one week, the roots were cross-sectioned into six discs each of 1-mm thickness, and the cervical, medium, and apical thirds of the root canals were identified. The DC was evaluated under micro-Raman spectroscopy and the BS was evaluated by the push-out test. The data were analyzed by two-way ANOVA and Tukey's test (α=0.05). RESULTS: Neither the activation mode nor the root regions affected the DC of the resin cement. Higher BS was achieved in the soft-start group (p=0.036); lower BS was observed in the apical third compared to the other root regions (p<0.001). Irrespective of the activation mode and root region, the mixed failure mode was the most prevalent. CONCLUSION: The BS of fiber posts to root canals can be improved by soft-started polymerization. The DC was not affected by the curing mode.

Is the bonding of self-adhesive cement sensitive to root region and curing mode?

Abstract Objectives To evaluate the influence of two curing techniques on the degree of conversion (DC) of resin cements and on bond strength (BS) of fiber posts in different regions of root dentin. Material and Methods Twenty single-rooted premolars were endodontically treated, and the post spaces were prepared. The roots were randomly divided into two groups (n=10), according to the activation mode of the resin cement RelyX™ U200 (3M ESPE Saint Paul, MN, USA): conventional (continuous activation mode) and soft-start activation mode (Ramp). The posts (WhitePost DC/FGM) were cemented according to the manufacturer’s recommendations and, after one week, the roots were cross-sectioned into six discs each of 1-mm thickness, and the cervical, medium, and apical thirds of the root canals were identified. The DC was evaluated under micro-Raman spectroscopy and the BS was evaluated by the push-out test. The data were analyzed by two-way ANOVA and Tukey’s test (α=0.05). Results Neither the activation mode nor the root regions affected the DC of the resin cement. Higher BS was achieved in the soft-start group (p=0.036); lower BS was observed in the apical third compared to the other root regions (p<0.001). Irrespective of the activation mode and root region, the mixed failure mode was the most prevalent. Conclusion The BS of fiber posts to root canals can be improved by soft-started polymerization. The DC was not affected by the curing mode.