Page 9 - SPEMD_61-3

rev port estomatol med dent cir maxilofac . 2020;61(3):97-105 99

dures: Adhese Universal (ADH, Ivoclar Vivadent, Schaan, Liech-
Table 1. Distribution of restorations per tooth and arch.
tenstein) in the ER mode (ADH -ER) or Adhese Universal in the
SE technique ER technique SE mode (ADH -SE). A total of 117 cervical lesions were restored:
59 with ADH -ER and 58 with ADH -SE. Only a maximum of three
Tooth distribution
Incisors 11 8 restorations per group was placed in one patient so that, per
Canines 11 11 patient, restorations prepared following the two different pro-
Premolars 36 40 tocols were mutually compared.
Arch distribution The adhesive Adhese Universal (ADH) was used according
Maxillary 29 28 to the manufacturer’s instructions (Table 2). The resin compos-
Mandibular 29 31 ite (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Liechtenstein)
was applied in increments of up to 2 mm, each one light -cured
and approved the protocol and the consent form for this for 40 seconds under an LED light -curing unit (Elipar S10; 3M
2
study. Based on pre -established criteria, 26 participants, 15 ESPE, Seefeld, Germany) with a light intensity of 600 mW/cm
females and 11 males, with NCCLs in incisors, canines, and (6 J/cm²). The curing light’s output was periodically verified at
2
premolars (Table 1) were selected. Written informed consent >600 mW/cm with a radiometer (Curing Radiometer P/N
was obtained from all participants before treatment. 10503, Kerr, Orange, CA, USA) throughout the study. The resto-
As inclusion criteria, participants had to be at least 18 rations were finished immediately with fine -grain diamond
years old and in good general health. They needed to have at burs (Diatech Dental AG, Heerbrugg, Switzerland). Polishing
least 20 teeth in occlusion and an acceptable oral hygiene lev- was performed with rubber points (Astropol, Ivoclar Vivadent,
el. Their lesions had to be nonretentive, non -carious, and deep- Schaan, Liechtenstein).
er than 1 mm. The lesions had to involve both the enamel and Two calibrated independent experienced dentists evaluat-
dentin of vital teeth without mobility. The cavosurface margin ed the restorations with the aid of a 2.5x -magnification dental
could not involve more than 50% of the enamel. 15 Every tooth loupe at baseline and after 6 months. They were unaware of
included in the study was in occlusion and proximal contact which material had been used; thus, the study was double-
with the adjacent tooth. All patients were given oral hygiene -blind. Each restoration was documented by photographs. The
instructions before operative treatment. examiners were calibrated before the baseline evaluation,
Patients with heavy bruxism habits, xerostomia, poor oral evaluating 15 restorations representing each score for each
hygiene, severe or chronic periodontitis, or smoking habits criterion, from 15 different patients with cervical restorations
were excluded from the study. 8,9 that did not participate in this study. Each examiner evaluated
The same operator restored all lesions. The operator was each restoration on two different time points, on two consec-
not blinded to group assignment when administering inter- utive days. Cohen’s kappa statistic was used to analyze the
ventions, but the participants were. Each patient received at interexaminer agreement. An intraexaminer and interexam-
least two cervical restorations: one with the ER technique and iner agreement of at least 85% was required for the evaluation
the other with the SE technique. to begin. 17
Before isolation with the rubber dam, the operator anes- The restorations were evaluated under the World Dental
thetized the teeth with lidocaine 2% with epinephrine 1:80,000 Federation (FDI) criteria (Table 3). 18,19 Both examiners evaluat-
®
(Xilonibsa 2%; Inibsa, Barcelona, Spain). All teeth were then ed all the restorations once and independently; any discrep-
cleaned with pumice and water using a rubber prophylactic ancy between evaluators was resolved chairside.
cup to remove the salivary pellicle and dental plaque. They Sample size calculations were performed using the G*Pow-
were then rinsed with water and dried. The operator did not er Program Statistical Analysis (G*Power Program, Dusseldorf,
prepare any additional retention or bevel, following the Amer- Germany) with an α=0.05, a power of 80%, and a two -sided
ican Dental Association (ADA) guidelines. 16 test. 20,21 The minimal sample size was 50 restorations per
The teeth were randomly assigned, using randomization group in order to detect a difference of 20% among the tested
tables, for restoration with either of two application proce- groups.

Table 2. Components, composition (information supplied by the manufacturer), and application mode of the tested adhesive.

Material pH Components Manufacturer’s instructions
Adhese Universal 2,5 10 -MDP, 1. Just for etch -and -rinse procedure: Apply phosphoric acid gel onto the prepared enamel first,
Ivoclar Vivadent, Dimethacrylate and then on to the dentin. The etchant should be left to react on the enamel for 15–30 sec-
Schaan, resins, HEMA, onds and dentin for 10–15 seconds. Then rinse thoroughly with a vigorous stream of water
Liechstein Ethanol, Water, for at least 5 seconds and dry with oil - and water -free compressed air until the etched enam-
MCAP el surfaces appear chalky white.
(methacrylated 2. Application of the adhesive – Starting with the enamel, completely coat the tooth surfaces to
carboxylic acid be treated with Adhese Universal. – The adhesive must be scrubbed into the tooth surface for
polymer), Fillers, at least 20 seconds. This time must not be shortened. Applying the adhesive on the tooth
Initiators surface without scrubbing is inadequate. – Disperse Adhese Universal with oil - and moisture-
-free compressed air until a glossy, immobile film layer results. Important: Avoid pooling,
since this can compromise the fitting accuracy of the permanent restoration. Light -curing
the adhesive for 10 s.