Effect of selective enamel etching on clinical performance of CAD/CAM partial ceramic crowns luted with a self-adhesive resin cement

Abstract

Objectives: This study was conducted to evaluate a self-adhesive resin luting cement [RelyX Unicem 3MESPE-RXU] for luting partial ceramic crowns (PCCs) with and without selective enamel etching in a prospective, randomized clinical trial.

Materials and methods: Thirty-four patients had received the intended treatment. Two PCCs (Vita Mark II; Cerec 3D; Sirona) had been placed in a split-mouth design: one with RXU without enamel etching (RXU), the other with RXU with selective enamel etching (RXU + E). Restorations were evaluated at baseline (BL) and after 12, 24, and 36 months (USPHS criteria). For statistical analysis, the Chi-square test was applied (α = 0.05). Clinical survival of all restorations (n = 68) after 3 years was determined using Kaplan-Meier analysis.

Results: Twenty three patients (12 male/11 female) were available for clinical evaluation after 3 years. 19 RXU-PCCs were placed in molars, four in premolars, 18 RXU + E-PCCs in molars, five in premolars. Concerning clinical changes, no significant differences were found between luting strategies RXU/RXU + E at all recalls. Statistically significant changes over time were observed for marginal adaptation and marginal discoloration between BL and 36 m for RXU and RXU + E. For RXU + E, postoperative hypersensitivities decreased significantly from BL (n = 6) to 36 m (n = 0). Of the 68 restorations originally included, eight RXU and four RXU + E restorations failed. At 3 years, Kaplan-Meier survival of RXU was 72.9 %, that of RXU + E 87.6 %. Survival rates were not statistically significant different.

Conclusions: Although clinical survival of RXU + E is slightly better at 3 years, restorations of both groups perform similar with respect to clinical changes over time as evaluated by modified USPHS criteria.

Clinical relevance: The self-adhesive resin cement RXU can be used in conjunction with selective enamel etching, because survival rates of PCCs in the RXU + E group were not lower but, as a trend, even better than without enamel etching.