Which adhesive strategy for non-carious cervical lesions?

Area of Science:

• Dental Materials Science
• Restorative Dentistry
• Evidence-Based Dentistry

Background:

• Adhesive dentistry is crucial for the longevity and aesthetics of composite resin restorations.
• Different adhesive strategies, including self-etch and etch-and-rinse, are available, each with potential benefits and drawbacks.
• Understanding the long-term clinical performance of these adhesives is essential for informed clinical decision-making.

Purpose of the Study:

• To systematically evaluate and compare the clinical outcomes of self-etch and etch-and-rinse adhesive strategies in composite resin restorations.
• To assess the influence of bonding strategy on postoperative sensitivity, retention rates, and marginal discoloration.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (Medline, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, ProQuest, Periódicos Capes, clinical trial registries, and conference abstracts).
• Randomized controlled trials (RCTs) comparing parallel or split-mouth adhesive strategies were selected by two independent reviewers.
• Data were extracted for follow-up periods of 1, 1.5-2, 3, and 4-5 years. Study quality was assessed using the Cochrane risk of bias tool, and dichotomous outcomes were analyzed using relative risks and random-effects meta-analysis.

Main Results:

• Twenty-nine studies were included in the meta-analysis.
• No significant difference was found in postoperative sensitivity (Risk Ratio [RR] 1.04; 95% Confidence Interval [CI] 0.81 to 1.34) or retention rates (RR = 1.04; 95% CI 0.81 to 1.34) between the bonding strategies.
• The etch-and-rinse approach demonstrated significantly less marginal discoloration at 18 months to 2 years (RR 1.51; 95% CI 1.21 to 1.90) and at 4 to 5 years (RR 1.81; 95% CI 1.28 to 2.55) (p<0.0007).

Conclusions:

• Both self-etch and etch-and-rinse adhesives result in composite resin restorations with comparable clinical serviceability and postoperative sensitivity.
• The etch-and-rinse adhesive strategy is associated with a reduced incidence of marginal discoloration, particularly in the longer term.
• Clinicians can achieve similar functional outcomes with either adhesive system, but etch-and-rinse may offer an aesthetic advantage regarding marginal integrity.