The aetiology of non-carious cervical lesions (NCCLs) has not been fully clarified but they are characterised by a slow and gradual loss of mineralized dental tissue in the absence of dental caries. This results in a saucer or wedge-shaped defect that appears along the cementum–enamel Junction. The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in NCCLs.
Searches were conducted in The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Medline, and the Latin American and Caribbean Health Sciences Literature database (LILACS) for randomized, controlled trials (RCT) with a minimum of 3 years duration that evaluated the effectiveness of tooth-colored materials, adhesive systems, surface treatment, and preparation techniques for the restoration of NCCLs. Study quality was assessed. The primary outcome was the risk of loss of a NCCL restoration during the observation period of the clinical study using the restoration as the unit of observation. Adhesive systems were classified as; three-step etch-and-rinse, two-step etch-and-rinse, two-step self-etch, one-step self-etch, and glass ionomer materials
- 27 studies were included (14 were parallel design; 12 paired restorations,1 quadrant allocation). The observation period ranged from 3-13 years.
- After 3 years of follow-up, the survival rate ranged from 51 to 100 % with a mean retention rate of 85.4%.
- Mean retention at 4-8 years follow up was 82.9 %, with a range from59 to 100 %.
- For studies with follow up of 10 years or more mean retention rate was 56.5 %, with a range from 13.2 to 94.0 %.
- Meta-analysis were conducted on six of the ten possible pairwise adhesive group comparisons. However, four analyses involved 3 studies and two 4 studies.
The authors’ concluded
The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.
The authors highlight a number of issues with the quality of the included studies and only a small number of studies could be used in the meta-analyses undertaken so this should be taken into account when considering the findings.
Santos MJ, Ari N, Steele S, Costella J, Banting D. Retention of tooth-colored restorations in non-carious cervical lesions-a systematic review. Clin Oral Investig. 2014 Mar 27. [Epub ahead of print] PubMed PMID: 24671713.