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All these multiple restorations placed per patient, with the restoration domains were evaluated at the study level. During data being the experimental unit. All four studies15,28—30 were extraction and risk of bias assessment, any disagreements conducted in university settings. The age range of the participants For each aspect of the quality assessment, the risk of bias of included in the clinical trials was similar, except in one study, each domain was scored following the recommendations of whose authors did not report this information.
The length of the enamel bevel varied Only two out of the six domains in the Cochrane risk of bias from 0. In two studies,15,28 a the risk of bias of the studies. In another study30 the authors reported that they and allocation concealment key domains. Risk of bias within studies 2. Summary measures and synthesis of the results The assessment of the risk of bias of the selected studies is presented in Fig.
Few full-text studies reported the method The extracted data were analysed using Revman 5 Review of randomization employed or how the allocation conceal- Manager ver. As these two items were the key Denmark. Data from eligible studies were either dichotomous domains of the current systematic review, authors were retention rates or ordinal marginal discolouration.
Marginal contacted for further information. One study29 was considered Please cite this article in press as: In relation to blinding of participants and evaluators, this 3. Synthesis of the results: Regarding selective reporting, all stud- whose results were known available case analysis. JJOD; No. Underlined authors provided extra information by e-mail to allow assessment of the risk of bias.
The heterogeneity of the studies included in the analysis of studies: Discussion The assessment of the risk of bias of the included articles is very relevant since it evaluates important aspects of the study Meta-analysis takes the advantage of aggregating information design, such as randomization and allocation concealment.
The most important advantage of proper Meta-analysis cannot control for sources of bias of individual randomization is that it balances both known and unknown Fig. These results are not minimises selection bias, as clinical investigators in RCTs in agreement with the classical studies of the research group often find it difficult to maintain impartiality, which may of Van Meerbeek,16—18,21 which were not included in the produce non-comparable groups in baseline features.
In these studies, Unfortunately, the judgement of the risk of bias of these the authors compared cervical restorations placed in dentine two domains was not straightforward in the four studies without enamel involvement with cervical restorations placed included in the qualitative synthesis Table 2 , requiring in dentine with adjacent enamel margins bevelled and acid contact with authors.
However, only three of them15,28,30 etched. A control group with acid-etched enamel without answered. Although some studies reported that they random- bevelling was not included in their research design.
In regard to allocation concealment, this information superiority of the restorations where enamel bevelling was was rarely found in the articles. The two studies Preferably, participants and personnel should be blind in included in the meta-analysis had a short-term follow-up of 12 relation to the treatment in order to avoid performance bias.
Blinding of the participant was explicitly Considering that this decline follow a linear trend, composite described in three studies. Further studies with follow- standardised among the included RCTs. Variations in type of up periods longer than 5 years may be conducted to confirm instrument and bevel lengths were observed when reported.
These details were poorly described in the selected papers and This may also be valid for one-step self-etch adhesives. This class of adhesive has an annual failure rate very similar to Although variations in these parameters were not fully two-step etch-and-rinse,31 but worse results in terms of investigated, an in vitro study published in pointed marginal integrity.
Although this acid before application of the self-etch adhesives. Therefore, future in vitro studies should be performed In summary, one may conclude that there is no difference to identify a good protocol for enamel bevel preparation to be between bevelled and non-bevelled technique over the short- investigated in an RCT.
Additionally, there is not enough evidence to support this Relation of enamel prism orientation to microtensile bond strength. American Journal of Dentistry ; There is a need for — Critical appraisal. To bevel or not in this technique variation after longer-term follow-up periods. Journal of Esthetic and Restorative Dentistry ; Effect of Acknowledgments resin viscosity and enamel beveling on the clinical performance of Class V composite restorations: Operative Dentistry ; This study was conducted during the post-doctoral stage of Alessandra Reis under the supervision of the Prof.
Lucianne Evaluation of two dentin adhesives in cervical lesions. The authors of this study would like to thank the Journal of Prosthetic Dentistry ; Quintessence International ; This study was partially supported by National Council for Journal of Dental Research ; Epidemiology ; The prevalence and risk of bias in randomised trials. British Medical Journal severity of non-carious cervical lesions in a group of ; Journal Two- of Oral Rehabilitation ; The cervical lesions.
Journal of Dentistry ; An evaluation of lesions in adults in Hubei Province, China. Community Dental different adhesive restorations in cervical lesions. Journal of Health ; Prosthetic Dentistry ; Distribution and Influence of acid etching Nigerian population. Nigerian Quarterly Journal of Hospital and enamel beveling on the 6-month clinical performance Medicine ; Compendium of Continuing 4.
Journal of Esthetic Dentistry ;3: Clinical 14—9. Retention of abrasions. Clinical trial of cervical composite Operative Dentistry ; Journal of Dental Research 6. Non- ; Clinical performance of 7. Effect of bur roughness on bond to ; Operative Brown KB, Bagby M. Okubo SR. Class V composite resin Dentistry ; Journal of Dental 8. Overview of Research ; Effect of enamel bevel on the resin-dentin bonds. Operative Dentistry the clinical performance of resin composite restorations ; Journal of Esthetic and 9.
Marginal leakage with different Restorative Dentistry ; Effect of cavity The design. Journal of Oral Rehabilitation ;3: Effect of cervical lesions.
Clinical performance of a self-etching ; American Journal of Dentistry Effect ; Clinical effectiveness of Paediatric Dentistry ; Oilo G, Jorgensen KD. Effect of bevelling on the occurrence clinical trials. Dental Materials ; Clinical fillings. Journal of Oral Rehabilitation ;4: A systematic review. Dental or without selective enamel etching. Dental Materials Journal Materials ; Three-year clinical A new universal simplified adhesive: Journal of Dentistry month clinical evaluation.
A randomized controlled 5-year prospective Microtensile study of two HEMA-free adhesives, a 1-step self etching and bond strength of self-etching adhesives to ground and a 3-step etch-and-rinse, in non-carious cervical lesions. Journal of Adhesive Dentistry ;4: Perdigao J, Geraldeli S.
Bonding characteristics of self- Eight-year clinical evaluation of Esthetic and Restorative Dentistry ; Loguercio AD. Durability of enamel bonding using one-step A randomized self-etch systems on ground and unground enamel. Defects were randomly ulus and margin configuration on the clinical divided into three Groups and restored according performance of resin-based composite restora- to the following techniques: Group 1—no enamel tions in Class V non-carious defects.
At two and three years, no significant ; e-mail: Post-operative sensitivity, mar- The protocol and consent form for this study were ginal discoloration and secondary caries were reviewed and approved by the Federal University of not affected by enamel beveling and restorative Santa Catarina Committee on Investigations Involving material.
Human Subjects. Written informed consent was Beveled enamel margins resulted in signifi- obtained from all participants. After screening several cantly better clinical retention in the first six potential participants, 50 participants ranging in age months only. One hundred and five defects composite restorations after three years.
This model is recommended by the Bayne, When applied to was used to determine tooth shade prior to rubber dam non-retentive cervical defects, the clinical performance isolation. Each part had three defects that were of resin-based composite restorations relies mostly on restored with a different material or margin configura- the bond generated by the adhesive, with retention tion.
All restorations were done by one operator SC.
A one- performance of the restoration. When compared to based composite Durafill VS, Heraeus Kulzer, hybrid composites, microfills have a lower elastic mod- Dormagen, Germany in two increments.
The defects were treated as in Group function. Even though the in vitro performance of these by blocked randomization, so that if a participant systems has been extensively tested in bond strengths received more than one restoration, they were placed and microleakage studies, such materials have to be with a different technique.
Eighteen participants validated in controlled clinical trials. Currently, few received three restorations, 19 received two restora- long-term clinical evaluation studies have been reported tions and 13 received one restoration.
The resin-based on such materials. This in vivo study evaluated the composites were applied into the defects in two incre- clinical performance of a microfill and flowable compos- ments, and each increment was polymerized for 40 sec- ites bonded on beveled and non-beveled, non-carious onds with a XL curing light 3M ESPE, St Paul, cervical defects with a total-etch, one-bottle adhesive MN, USA with a power output maintained at system.
Fine and extra-fine diamond burs of sensitivity and that post-operative sensitivity Brasseler USA were used for finishing and contour- decreased from baseline to the six-month evaluation. Retention results are plotted in Figure 1. Two Group 1. Microfill and flowable composites performed and a consensus was reached if the evaluations were similarly in beveled margins at six months.
At 12 not the same. The criteria evaluated in this study were months, statistical analysis revealed two equivalent retention, marginal discoloration, pre- and post-opera- subsets, Groups 1 and 2 and Groups 2 and 3.
At 24 and 36 months, there was for each criterion among the three groups were sub- no significant difference in retention rates among the jected to statistical analysis using a proportion test at a three Groups. All participants ineralization, infiltration and polymerization. In gen- were recalled at all evaluation times.
Statistical analy- eral, adhesives include components that contemplate sis of the data collected in each recall interval revealed each of these principles. Analysis of and the adhesive are combined in the same solution. The high con- centration of solvent Table 1: Effect of Resin Viscosity and Enamel Beveling on Clinical Performance of Composites others reported a mean shear bond strength of out enamel beveling.
For the multi-bottle adhesive 7. Our results Research has shown that simplified adhesives do not for the beveled margins restored with flowable resin always result in a more effective bond.
That might cervical lesions. Consensus seemingly exists that These authors reported no difference in retention one-bottle adhesives are more sensitive to the tech- between a hybrid flowable composite and a microfilled nique than systems of two or more components Kanca, composite.
However, Fitchie and oth- that can influence the retention rate of Class V restora- ers found no such differences.
The use of flow- tions in vivo. These variables include, but are not limited able composites for Class V restorations has been sug- to, patient age, occlusion, etiology of the lesion, location, gested Miller, ; Christensen, In theory, degree of dentin sclerosis, avail- able enamel at the margins, geometry, depth and size of the lesion, margin configuration of the preparation, restorative technique used and restorative material used.
Retention rates for Class V composite restora- tions placed in non-carious lesions as reported in the litera- ture are variable. Retention rates for the different groups over time. In this study, all of the above factors have apparently collaborated to Christensen G Restoration of Class V tooth defects-state enhance three-year clinical results of retention in the of art Clinical Research Associates Newsletter 20 Such results may well indicate that Microleakage of a new dental adhesive comparing microfilled initial adhesion to dentin using the One-Step system is and hybrid resin composites Quintessence International 26 7 poorer than enamel bond.
However, after the second However, this bonding: Focusing on dentinal adhesion factors Journal of the American Dental Association 5 A two-year clinical study Journal of the reported. It can be concluded from these observations American Dental Association 6 American Journal of Dentistry 6 4 Effect of drying time and dis- tance American Journal of Dentistry 9 6 Based on the results of this study, beveled enamel mar- Kanca J 3rd One-step bond strength to enamel and dentin gins resulted in better retention rates for Class V adhe- American Journal of Dentistry 10 1 The viscosity of the increased flexibility Journal of Dental Research 69 6 restorative material appeared not to affect the clinical Miller M Flowable composite Reality 11 Products for use on bond strengths of one-bottle adhesives Quintessence Dentin and Enamel Adhesive Materials, June available International 30 12 Shear bond strengths of one-bottle dentin adhesives using multiple applications Operative Dentistry 22 5 Laboratory testing of enamel bevel reports many advantages; however clinical studies on this topic are scarce and controversial.
Purpose of the Study: To evaluate the effect of enamel bevel on the retention rates of composite restorations placed in non-carious cervical lesions NCCLs. Materials and Methods: Forty-two patients with more than 20 teeth in occlusion and having at least two NCCLs participated in this study. Eight-four restorations were placed and evaluated at baseline, after 6 and 12 months according to the modified U. Public Health Service criteria.
Enamel beveling may not be clinically relevant for the retention of composite restorations in NCCLs after 12 months. Dentin treated by controlling the etiological factor and, when in NCCLs is usually sclerotic, with partial or total indicated, restoring the missing tooth structure. DOI Thus, the purpose of this paired-tooth clinical bonding to dentin in NCCLs, such as increasing the trial was to evaluate the influence of enamel beveling on phosphoric acid etching time,10 citric acid etching for the retention of composite restorations placed in 30 seconds,11 removal of superficial sclerotic dentin NCCLs with a 2-step etch-and-rinse system.
A etching with phosphoric acid. Considering NCCLs,28 and this adhesive system performed bonding to enamel, performing a bevel on the satisfactorily over a 4-year observation period in enamel margin may be a good option, taking into Class I and II restorations.
This research was in NCCLs. They should have an acceptable oral hygiene shown poor performance in several previous level and present at least 20 teeth under occlusion.
These lesions had to be between beveled and non-beveled groups may non-carious, non-retentive, at least 1 mm deep, and be due unacceptable bonding provided by involve both enamel and dentin of vital teeth without this adhesive material.
TABLE 1. The degree of clinical trial. Participants with a compromised medical dentin sclerosis31—33 was evaluated according to the history, a severe or active periodontal or carious disease description in Table 1.
The cavity dimensions in or with a poor oral hygiene were excluded from the mm height, width and depth and the geometry of study. Restorative Procedure also recorded Figures 1 and 2. The following the same protocol described earlier.
The cervical tooth anatomy was restored by applying three increments of resin composite 4 Seasons, Ivoclar Vivadent. Each increment was light cured for 40 seconds. Definition of the cavity geometry of the non-carious cervical lesions NCCLs. Restorations were evaluated at baseline and after 6 and 12 months of clinical service by two other examiners that were trained and calibrated to evaluate the The interventions were standardized by a detailed modified US Public Health Service criteria.
A experienced examiners specialized in Operative preliminary cleaning of the tooth surface with pumice Dentistry and with more than 15 years of clinical and water aimed at removing the salivary pellicle and practice were not involved in the placement of the any residual dental plaque, followed by rinsing and restorations and were blinded to the experimental drying.
The proper shade of composite was then groups. Local anesthesia was used if needed to retention but the following secondary endpoints were prevent participant discomfort during intervention.
All also evaluated: These variables were ranked in the following scores: TABLE 2. Materials used: The evaluation for each group. Statistical Analysis Randomization Descriptive statistics were used to demonstrate the All participants received one restoration from each frequency distribution of the evaluated criteria. For placement.
Only participants who attended the recalls were Just one dentist participating in the study enrolled included in the data analyses. Flow diagram of the study participants in the different study phases.
Inclusion started in Numbers Analyzed August in and ended in August Follow-up started in February and ended in Out of the 42 patients included, the analysis for the February Due to two losses of retention in the non-beveled group at the 6-month Baseline Data recall, 36 patients were analyzed for secondary outcomes in this group. At the month recall, just 34 Participants selected for this study were 19 women and participants were analyzed for the primary endpoint.
In 23 men. The mean age of participants was 49! Eighty-four restorations were placed, 36 in the restorations were lost, leaving 31 and 30 restorations, maxillary arch and 48 in the mandibular arch. Other features can also be observed in Table 1. A Outcomes and Estimation homogeneity of these characteristics between the study groups is clearly seen Table 1. Reasons for not endpoints at baseline.
TABLE 3. At the month recall, five restorations of the participant concerning the restoration had fractures three in the beveled group and two Figure 3.
The clinical data for the primary in the non-beveled groups. Two restorations one in outcome and the retention rate are summarized the beveled group after 6 months and one in the in Table 3. The relative risk was 1. The beveled group retention may be present in the non-beveled groups. All restorations from marginal adaptation in the beveled group, which was the non-beveled group were performed, finished, and not observed in the present study, since both groups polished as butt joint in an aim to avoid composite had similar performance.
Marginal discoloration is probably caused by During placement and composite smoothing with a flat accumulation of stains into marginal defects, such as a instrument or brush, resin composite easily overlaps chip fracture of a slight flash of material covering unground enamel adjacent to the cavity margin.
According to Peumans and others49 after enamel beveling, including the present one. Therefore, the results of the present trial apply to the adult population having NCCLs with features After 12 months of clinical service, no caries adjacent to similar to the ones selected to be included in this restorations were found, which is in agreement with clinical trial. The authors do not have any financial interest in the companies whose materials are included in this article.
In regard to the prevalence of fractures, only This study was not funded by any sponsoring company. This study was partially supported by the showed microfractures, being classified as a bravo. This study has not evaluated other benefits of enamel beveling such as esthetics.
Miller WD. Experiments and observations on the wasting Therefore, the study conclusions are limited to the of tooth tissue variously designated as erosion, abrasion, ability of enamel bevel to improve retention. Dent Cosmos ; Although the sample size was calculated to find a 2. J Esthet Dent ;3: Retention sample size had been larger. Furthermore, the of microfilled and hybrid resin-based composite in evaluation period of this study was short, non-carious class 5 lesions: Oper Dent ; J Dent ; The prevalence and composite restorations in NCCLs.
Additionally, treatment implications of cervical abrasion in the elderly. J Adhes Dent systems in cervical lesions. Quintessence Int ;2: Micro-tensile bond Dent Mater ; Bond strengths of restorations: Dent Mater J ; Terzaghi - Excel e VBA www.
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