Composite restorations placed in non-carious cervical lesions-Which cavity preparation is clinically reliable?

Abstract

The purpose of this in-vivo study was to evaluate the clinical performance of restorations placed in non-carious cervical lesions (NCCLs), using different cavity preparation designs, after 7.7 years. A total of 85 NCCLs with coronal margins in enamel and cervical margins in dentin were randomly assigned to the following treatment protocols: dentin surface cleaning, dentin surface roughening with round bur plus flowable composite, dentin surface roughening/cervical groove preparation with round bur, dentin surface roughening/cervical groove preparation with round bur plus flowable composite. After enamel beveling and selective enamel etching, the defects were restored with composite. The restorations were assessed by two independent, calibrated and blinded investigators, using modified USPHS criteria. At 7 years (7.7 (± 0.35)), a total of 64 restorations (75.3%) were available for follow-up examination. The total retention rate, irrespective of the test groups, was 82.8%. Restorations placed without any preparation showed the highest loss rate (27.8%). Esthetic appearance, marginal adaptation, anatomic form and marginal discoloration did not differ significantly between the groups. Composites are long-term stable materials for restoring NCCLs. Restorations placed without any dentin preparation (cavity cleaning only) showed the highest loss rate.

Keywords: NCCL; USPHS criteria; cavity preparation design; class V-lesions; in-vivo study; non-carious cervical lesions.

FIGURE 1

(a) Clinical situation before treatment, NCCLs located at teeth 22 and 23, no gingival inflammation present. (b) Clinical situation after surface roughening/groove preparation with retraction cord in place. Cavity preparation design is illustrated at tooth 23. Grey = small cervical groove (groups 3 and 4 only, depth max. 0.5 mm), dotted area: roughened dentin (groups 2,3 and 4; in group 1, this area was cleaned only), striped area: beveled enamel (all groups)

FIGURE 2

Comparison of the loss rates (in %) of the four treatment groups after 7.7 years, the loss rate of the group CLEAN was significantly different from all the other groups with surface preparation (PREP_FLOW + GROOVE + GROOVE_FLOW; p = 0.041)

FIGURE 3

(a) Cervical defects on teeth 32, 33 and 34, pre‐operative situation, male patient aged 64. The defects on teeth 33 and 34 were included into the study. (b) Restorations 33 and 34 during the first postoperative examination after one week. (c) Restoration during follow‐up after >7 years. The restoration on tooth 33 was rated “Bravo” for marginal adaptation and marginal discoloration, and “Alpha” for all the other criteria. The restoration on tooth 34 was rated “Alpha” for all criteria