Insufficient evidence for recommendations on best adhesive system or bonding strategy for non-carious cervical lesions

shutterstock_15351199- light activated restoration

Tooth coloured adhesive filling materials are in common use in dentistry providing good results. However, their success relies on the adhesive systems that provide this bond which has allowed a more conservative approach to cavity preparation.  The aim of this review was to assess the effectiveness of these systems in non-carious cervical lesions (NCCLs).   The review considered four bonding strategies


  1. Three-step etch-and-rinse
  2. Two-step etch-and-rinse
  3. Two-step self-etch
  4. One-step self-etch

The authors conducted searches is a range of electronic databases;  Cochrane Oral Health Group Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE as well as a range of dental journals and the reference lists of identified studies. The quality of each included study was assessed in duplicate by two independent reviewers.

Randomised controlled trials (RCTs) comparing at least two adhesives in non-carious cervical lesions (NCCLs), with at least 18 months follow-up were selected. The primary outcome was retention loss, with marginal adaptation and marginal discoloration as secondary outcomes

26 studies were included, (13 parallel group studies, 11 paired design and two had quadrant allocation) the majority being conducted in university dental hospitals.  Only 5 were considered to be of low risk of bias.  The quality of the available data did not permit meta-analysis so a qualitative summary was presented.  While studies with low overall risk of bias demonstrated good clinical performance for adhesives with all four bonding strategies the  studies showed wide variation between adhesives of the same category.

The authors concluded:-

There is not enough evidence to support one adhesive or bonding strategy over another. Consequently, the null hypothesis of no difference cannot be supported or rejected with the data currently available. There is a need for better standardisation and reporting of randomised controlled trials investigating adhesive performance.

Chee B, Rickman L, Satterthwaite JD. Adhesives for the restoration of non-carious cervical lesions: a systematic review. J Dent. 2012 Feb 18. [Epub ahead of print] PubMed PMID: 22353603

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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