Abstract
Objectives
The aim of this systematic review was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions (NCCLs) in terms of restoration retention as a function of time.
Methods
Medline Ovid and IADR abstracts were reviewed for NCCLs clinical trials from 1950 to 2013. The reference list of all eligible trials and relevant review articles was checked to find additional studies. The review did not have any language restrictions. Only randomized controlled clinical trials that evaluated at least two adhesives for a follow-up period of at least 18 months were included. Materials with adhesive potential were categorized into 6 main classes: 3-step etch&rinse adhesives (3E&Ra’s), 2-step etch&rinse adhesives (2E&Ra’s), 2-step self-etch adhesives (2SEa’s), 1-step self-etch adhesives (1SEa’s), glass-ionomers (GI’s) and self-adhesive composites (SAC’s). The first four can bond restorative composite to tooth tissue. Both 2SEa and 1SEa were further sub-divided in ‘mild’ and ‘intermediately strong (1/2SEa_m), with a pH ≥ 1.5, and ‘strong’ (1/2SEa_s), with a pH < 1.5. From the restoration retention rates as a function of time the average annual failure rate (AFR) per adhesive and adhesive class was calculated.
Results
The lowest AFR scores [mean (SD)] were recorded for GI [2.0 (1.4)] shortly followed by 2SEa_m [2.5 (1.5)], 3E&Ra [3.1 (2)] and 1SEa_m [3.6 (4.3)] (Tukey Contrasts: p > 0.05). Significantly higher AFR scores were recorded for 1SEa_s [5.4 (4.8)], 2E&R [5.8 (4.9)], and 2SEa_s [8.4 (7.9)] ( p > 0.05). In addition, significant differences in AFR were noticed between adhesives of the same class (Kruskal–Wallis sum test: p > 0.05), except for GI ( p = 0.7) and 2SEa_m ( p = 0.1). Finally, selective enamel etching did not significantly influence the retention rate of SEa (AFR SEa_etch = 0.43 (0.49), AFR SEa_non-etch = 1.43 (1.77).
Significance
The adhesive approach significantly influences the clinical effectiveness of adhesives in NCCLs. Within each class, except for GI, there was a wide variation in clinical bonding effectiveness.
1
Introduction
Non-carious cervical lesions (NCCLs) should be restored as minimally invasive as possible. Currently, adhesive materials indicated to restore NCCLs include glass-ionomers and their resin-modified version, poly-acid modified composites (most frequently referred to as ‘compomers’), composite and recently also self-adhesive composites . In contrast to GI, compomers and conventional composites require the use of a separate adhesive. In NCCLs, the major part of tooth surface to bond to consists of dentin, while at the incisal side the restoration margin is in enamel.
Contemporary adhesives can be classified according to their mode of action into etch&rinse (E&Ra) and self-etch (SEa) adhesives . Materials with adhesive potential to tooth tissue can be categorized into 6 main classes: 3-step etch&rinse adhesives (3E&Ra’s), 2-step etch&rinse adhesives (2E&Ra’s), 2-step self-etch adhesives (2SEa’s), 1-step self-etch adhesives (1SEa’s), all four can bond restorative composite to tooth tissue, glass-ionomers (GI’s) and self-adhesive composites (SAC’s; excluded in this study due to absence of clinical data). Both 2SEa and 1SEa can be sub-divided into ‘mild’ and ‘intermediately strong’ 1/2SEa (1/2SEa_m), having a pH ≥ 1.5 and leaving hydroxyapatite available as receptor for chemical interaction with the functional monomer contained in the adhesive, and ‘strong’ 1/2SEa (1/2SEa_s), having a pH < 1.5 and a functional monomer that etches (demineralizes) rather than chemically bonds to hydroxyapatite (HAp) .
Bonding effectiveness of adhesives is frequently tested on sound tooth substrate under optimal laboratory conditions, showing large variability among the different classes of adhesives as well as among adhesives of the same class . Although several contemporary adhesives have been documented to provide a favorable ‘immediate’ bond to enamel and dentin, many studies noted a considerable drop in bonding effectiveness upon artificial aging . To determine the clinical effectiveness of adhesives , NCCLs are considered most ideal because NCCLs in need of restoration (1) are relatively highly prevalent, (2) are most frequently present at the easily accessible buccal surface, (3) do not require complicated restorative techniques, (4) can be restored with a large ‘free’ versus ‘bonded’ surface, (low C-factor), (5) involve both enamel and dentin, and most of all (6) commonly do not provide any or only minimal macro-retention, by which ineffective bonding will result in de-bonding and thus restoration loss. Retention, marginal integrity and clinical micro-leakage (discoloration) are usually the key parameters recorded to assess clinical effectiveness of adhesives. Among these criteria, retention is definitely the most objective one worldwide, especially when comparing clinical data from many different research groups as in the present meta-analysis .
Dental adhesive technology evolves quickly and continuously with a rapid turnover of commercial adhesives, a high number of laboratory studies on adhesive materials and a high demand for laboratory techniques and data in potential prediction of clinical effectiveness. In this context, an up-to-date systematic review on the clinical effectiveness of contemporary adhesives for the restoration of NCCLs is useful. Therefore, the aim of this literature meta-analysis was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of NCCLs in terms of restoration retention as a function of time (annual failure rate, AFR). The null hypothesis stated was that there is no difference in clinical effectiveness of contemporary resin-based adhesives (and glass-ionomers) for the restoration of NCCLs against the alternative hypothesis of a difference between (1) adhesives of the different adhesive (sub)classes, (2) adhesives within the same class, and (3) SEa’s with and without prior selective enamel etching.
2
Materials and methods
Randomized and non-randomized controlled clinical trials (RCT’s) comparing the clinical effectiveness of two or more adhesives (to bond a restorative composite or compomer), GI’s, SAC’s, and/or combinations of these in NCCLs were included in this review. Since not only adhesives as such were evaluated, but also GI’s and SAC’s, the term ‘adhesive material’ was used throughout the manuscript. All adhesive materials were classified into one of the 6 main classes (3E&Ra, 2E&Ra, 2SEa, 1SEa, GI, SAC), with the 1/2SEa sub-divided in 1/2SEa_m and 1/2SEa_s. To identify the studies to be considered for inclusion in this review, a search strategy for MEDLINE (via OVID) (1950–2013) was developed ( Table 1 ). The reference list of all eligible trials and relevant review articles was checked to find additional studies. Abstracts presented at all meetings of the International Association of Dental Research (IADR; 1965–2013) were searched as well. The review did not have any language restrictions. The list of exclusion criteria is reported in Table 2 .
| 1 | Tooth Cervix/and (lesion$ or cavit$).mp. |
| 2 | (“cementoenamel junction$” and (lesion$ or cavit$)).mp. |
| 3 | (((tooth or teeth) adj3 (cervix or cervical)) and (lesion$ or cavit$)).mp. |
| 4 | (“non-carious cervical lesion$” or “noncarious cervical lesion$” or “class v lesion$” or “non-carious lesion$” or “noncarious lesion$” or “abfraction lesion$” or “class v restor$”).mp. |
| 5 | (flexure adj3 (tooth or teeth)).mp. |
| 6 | ((tooth or teeth) adj3 sclerosis).mp. |
| 7 | 6 or 4 or 1 or 3 or 2 or 5 |
| 8 | Dental Restoration, Permanent |
| 9 | exp Dental Bonding/ |
| 10 | (adhesiv$ or bond$).mp. |
| 11 | Glass Ionomer Cements/ |
| 12 | Composite Resins/ |
| 13 | Resin Cements/ |
| 14 | (“acid etch$” or acid-etch$ or compomer$ or composite$ or nanocomposite$ or resin$ or “polyacid-modified composite resin$” or “polyacid modified composite resin$” or “glass ionomer$” or glass-ionomer$ or “self etch$” or self-etch$).mp. |
| 15 | 8 or 11 or 13 or 10 or 9 or 12 or 14 |
| 16 | 7 and 15 |
| Studies were excluded if : | |
| 1. | A combination of cervical carious and non-carious lesions were treated |
| 2. | A combination of cervical non-carious lesions and other classes of cavities were treated |
| 3. | The adhesive was not used according to the instructions of the manufacturer. An exception was made for the group of self-etch adhesives in case the adhesive was applied according to the instructions of the manufacturer with prior selective etching of the enamel cavity margins with phosphoric acid |
| 4. | The effectiveness of a single adhesive applied in different conditions was evaluated (e.g. variations in polymerization time, differences in occlusal loading of the restored teeth, …) |
| 5. | The study follow-up was less than 18 months |
| 6. | Studies reported extremely low recall rates (<75% after 18 months, <60% after 3 years and <50% after 5 years or more) |
| 7. | The data were reported incorrectly or with insufficient information so that it could not be used in the review, unless the authors supplied appropriate data |
| 8. | When the adhesive could not be classified into one of the 6 abovementioned classes |
Two reviewers (MP, AM), independently and in duplicate, assessed the relevance of the articles identified. Any disagreement regarding relevance of an article was resolved by discussion between the two reviewers, and if necessary by referral to a third reviewer (JDM). Full text versions of all articles that appeared to meet the inclusion criteria, regarding study method, kind of participants, intervention and outcome, were retrieved and subjected to data assessment. For each clinical trial, details of study, study method, participants, intervention and outcome were introduced into a specially custom-designed relational database (FileMaker Pro, FileMaker Inc., Santa Clara, CA, USA) ( Table 3 ). Multiple reports of the same clinical trial were linked together.
| 1. | Details of the study, including year of publication and first author |
| 2. | Details of study methods, including study design and total study duration |
| 3. | Details of participants, including number, age, gender, setting, source of recruitment, and criteria for inclusion |
| 4. | Details on the intervention, including number of adhesive materials, class of the adhesive materials, product name of adhesive materials, product name of restorative material, type of restorative material, cavity preparation (dentin surface roughening), enamel bevel, method of isolation |
| 5. | Details of the outcome collected and reported, including loss of retention, caries occurrence, marginal defects, marginal discoloration, recall percentage, reasons for drop out, statistical analysis |
In this review, we focused on loss of retention as a function of time and expressed as annual failure rate (AFR or percentage loss divided by the number of years followed up). AFR was calculated for each adhesive and each adhesive (sub)class. This AFR calculation, although commonly used in dental literature , implies that restorations fail at a constant rate over time. This effect will be analyzed and addressed by categorizing the studies in ‘short-term’ (18 months to 3 years), ‘medium-term’ (3–5 years) and ‘long-term’ (more than 5 years) studies. If a long-term study also included short- and medium-term results, these were also added to the short- and medium-term studies. Other subgroup analyses were performed to assess the influence of (1) the actual restorative material used, (2) the date the adhesive material was launched onto the market, as indicated by the date of the publication reporting on the adhesive material for the first time (‘young’ published between 2000 and 2013; ‘medium’ between 1994 and 1999; ‘old’ between 1985 and 1993), and (3) the recall rate (‘high’ > 95%; ‘medium’ = 75–95%; ‘low’ < 75%).
To partly correct for factors that were not evaluated, such as differences in evaluation criteria, patient selection, etc., a ‘study correction factor’ was calculated for each study and added to every observed AFR in the respective study. Therefore, for each adhesive material that was tested several times in the database, a weighted average AFR was calculated using a weight factor of 4 for a long-term study, of 2 for a medium-term study, and of 1 for a short-term study. The study correction factor was then calculated as the sum of differences between the observed AFR and each study’s weighted average AFR.
2.1
Statistics
Differences in AFR between the 8 (sub)classes were statistically analyzed for all three follow-up periods (short-, medium- and long-term) using general linear models and Tukey contrasts. To assess differences in AFR between adhesive materials of the same class, a subset of the data including only the adhesive materials that had been evaluated at least 3 times, was analyzed (non-parametric Kruskal–Wallis rank sum test). In addition, the results of the statistical tests used in the published clinical trials – analyzing the difference in retention rate between two adhesive (sub)classes – were recorded.
A general linear model was applied to statistically analyze the influence of the restorative material and the recall rate (high, medium, and low) on AFR. The influence of adhesive age (young, medium, and old) was evaluated with the help of descriptive statistics. Finally, to assess the effect of selective enamel etching prior to the use of 1/2 SEa’s on AFR, the odds ratios of the respective studies were calculated and the overall effect was assessed with the Mantel–Haenszel odds ratio.
All tests were performed at a significance level of α = 0.05 using a software package (R3.01, R Foundation for Statistical Computing, Vienna, Austria).
2
Materials and methods
Randomized and non-randomized controlled clinical trials (RCT’s) comparing the clinical effectiveness of two or more adhesives (to bond a restorative composite or compomer), GI’s, SAC’s, and/or combinations of these in NCCLs were included in this review. Since not only adhesives as such were evaluated, but also GI’s and SAC’s, the term ‘adhesive material’ was used throughout the manuscript. All adhesive materials were classified into one of the 6 main classes (3E&Ra, 2E&Ra, 2SEa, 1SEa, GI, SAC), with the 1/2SEa sub-divided in 1/2SEa_m and 1/2SEa_s. To identify the studies to be considered for inclusion in this review, a search strategy for MEDLINE (via OVID) (1950–2013) was developed ( Table 1 ). The reference list of all eligible trials and relevant review articles was checked to find additional studies. Abstracts presented at all meetings of the International Association of Dental Research (IADR; 1965–2013) were searched as well. The review did not have any language restrictions. The list of exclusion criteria is reported in Table 2 .
| 1 | Tooth Cervix/and (lesion$ or cavit$).mp. |
| 2 | (“cementoenamel junction$” and (lesion$ or cavit$)).mp. |
| 3 | (((tooth or teeth) adj3 (cervix or cervical)) and (lesion$ or cavit$)).mp. |
| 4 | (“non-carious cervical lesion$” or “noncarious cervical lesion$” or “class v lesion$” or “non-carious lesion$” or “noncarious lesion$” or “abfraction lesion$” or “class v restor$”).mp. |
| 5 | (flexure adj3 (tooth or teeth)).mp. |
| 6 | ((tooth or teeth) adj3 sclerosis).mp. |
| 7 | 6 or 4 or 1 or 3 or 2 or 5 |
| 8 | Dental Restoration, Permanent |
| 9 | exp Dental Bonding/ |
| 10 | (adhesiv$ or bond$).mp. |
| 11 | Glass Ionomer Cements/ |
| 12 | Composite Resins/ |
| 13 | Resin Cements/ |
| 14 | (“acid etch$” or acid-etch$ or compomer$ or composite$ or nanocomposite$ or resin$ or “polyacid-modified composite resin$” or “polyacid modified composite resin$” or “glass ionomer$” or glass-ionomer$ or “self etch$” or self-etch$).mp. |
| 15 | 8 or 11 or 13 or 10 or 9 or 12 or 14 |
| 16 | 7 and 15 |
| Studies were excluded if : | |
| 1. | A combination of cervical carious and non-carious lesions were treated |
| 2. | A combination of cervical non-carious lesions and other classes of cavities were treated |
| 3. | The adhesive was not used according to the instructions of the manufacturer. An exception was made for the group of self-etch adhesives in case the adhesive was applied according to the instructions of the manufacturer with prior selective etching of the enamel cavity margins with phosphoric acid |
| 4. | The effectiveness of a single adhesive applied in different conditions was evaluated (e.g. variations in polymerization time, differences in occlusal loading of the restored teeth, …) |
| 5. | The study follow-up was less than 18 months |
| 6. | Studies reported extremely low recall rates (<75% after 18 months, <60% after 3 years and <50% after 5 years or more) |
| 7. | The data were reported incorrectly or with insufficient information so that it could not be used in the review, unless the authors supplied appropriate data |
| 8. | When the adhesive could not be classified into one of the 6 abovementioned classes |
Two reviewers (MP, AM), independently and in duplicate, assessed the relevance of the articles identified. Any disagreement regarding relevance of an article was resolved by discussion between the two reviewers, and if necessary by referral to a third reviewer (JDM). Full text versions of all articles that appeared to meet the inclusion criteria, regarding study method, kind of participants, intervention and outcome, were retrieved and subjected to data assessment. For each clinical trial, details of study, study method, participants, intervention and outcome were introduced into a specially custom-designed relational database (FileMaker Pro, FileMaker Inc., Santa Clara, CA, USA) ( Table 3 ). Multiple reports of the same clinical trial were linked together.
| 1. | Details of the study, including year of publication and first author |
| 2. | Details of study methods, including study design and total study duration |
| 3. | Details of participants, including number, age, gender, setting, source of recruitment, and criteria for inclusion |
| 4. | Details on the intervention, including number of adhesive materials, class of the adhesive materials, product name of adhesive materials, product name of restorative material, type of restorative material, cavity preparation (dentin surface roughening), enamel bevel, method of isolation |
| 5. | Details of the outcome collected and reported, including loss of retention, caries occurrence, marginal defects, marginal discoloration, recall percentage, reasons for drop out, statistical analysis |
In this review, we focused on loss of retention as a function of time and expressed as annual failure rate (AFR or percentage loss divided by the number of years followed up). AFR was calculated for each adhesive and each adhesive (sub)class. This AFR calculation, although commonly used in dental literature , implies that restorations fail at a constant rate over time. This effect will be analyzed and addressed by categorizing the studies in ‘short-term’ (18 months to 3 years), ‘medium-term’ (3–5 years) and ‘long-term’ (more than 5 years) studies. If a long-term study also included short- and medium-term results, these were also added to the short- and medium-term studies. Other subgroup analyses were performed to assess the influence of (1) the actual restorative material used, (2) the date the adhesive material was launched onto the market, as indicated by the date of the publication reporting on the adhesive material for the first time (‘young’ published between 2000 and 2013; ‘medium’ between 1994 and 1999; ‘old’ between 1985 and 1993), and (3) the recall rate (‘high’ > 95%; ‘medium’ = 75–95%; ‘low’ < 75%).
To partly correct for factors that were not evaluated, such as differences in evaluation criteria, patient selection, etc., a ‘study correction factor’ was calculated for each study and added to every observed AFR in the respective study. Therefore, for each adhesive material that was tested several times in the database, a weighted average AFR was calculated using a weight factor of 4 for a long-term study, of 2 for a medium-term study, and of 1 for a short-term study. The study correction factor was then calculated as the sum of differences between the observed AFR and each study’s weighted average AFR.
2.1
Statistics
Differences in AFR between the 8 (sub)classes were statistically analyzed for all three follow-up periods (short-, medium- and long-term) using general linear models and Tukey contrasts. To assess differences in AFR between adhesive materials of the same class, a subset of the data including only the adhesive materials that had been evaluated at least 3 times, was analyzed (non-parametric Kruskal–Wallis rank sum test). In addition, the results of the statistical tests used in the published clinical trials – analyzing the difference in retention rate between two adhesive (sub)classes – were recorded.
A general linear model was applied to statistically analyze the influence of the restorative material and the recall rate (high, medium, and low) on AFR. The influence of adhesive age (young, medium, and old) was evaluated with the help of descriptive statistics. Finally, to assess the effect of selective enamel etching prior to the use of 1/2 SEa’s on AFR, the odds ratios of the respective studies were calculated and the overall effect was assessed with the Mantel–Haenszel odds ratio.
All tests were performed at a significance level of α = 0.05 using a software package (R3.01, R Foundation for Statistical Computing, Vienna, Austria).
3
Results
Following our search strategy, 915 study reports were introduced in the database, of which 679 did not involve a clinical/Class-V study. In the 236 remaining reports, 178 different clinical trials were identified. From these, 87 Class-V clinical trials met the inclusion criteria, for 15 of which only an abstract was found, and for 72 of which at least one peer-reviewed paper was published. Most studies were carried out at university, 1 study in general practice and 1 study in a hospital. The follow-up period was short-term for 78, medium-term for 18 and long-term for 10 studies. In total, 78 adhesive materials were tested. Table 4 shows a reference list of all eligible clinical trials. The most frequently tested adhesive materials were the 2E&Ra’s (65) and 1SEa’s (63), followed by the 3E&Ra’s (37), 2SEa’s (34) and GI’s (32), No clinical trials investigating SAC’s were available. Appendix A summarizes all the adhesive materials that were tested in the various clinical trials along with the AFR’s calculated for each adhesive material.
| St_25 | Reis A, Leite TM, Matte K, Michels R, Amaral RC, Geraldeli S, Loguercio AD. Improving clinical retention of one-step self-etching adhesive systems with an additional hydrophobic adhesive layer. J Am Dent Assoc 2009;140:877–85 |
| St_28 | Ritter AV, Swift Jr EJ, Heymann HO, Sturdevant JR, Wilder Jr AD. An eight-year clinical evaluation of filled and unfilled one-bottle dental adhesives. J Am Dent Assoc 2009;140:28–37 |
| Swift EJ Jr, Perdigao J, Wilder Jr AD, Heymann HO, Sturdevant JR, Bayne SC. Clinical evaluation of two one-bottle dentin adhesives at three years. J Am Dent Assoc 2001;132:1117–23 | |
| Swift Jr EJ, Perdigao J, Heymann HO, Wilder Jr AD, Bayne SC, May Jr KN, Sturdevant JR, Roberson TM. Eighteen-month clinical evaluation of a filled and unfilled dentin adhesive. J Dent 2001;29:1–6 | |
| St_30 | Van Landuyt KL, Peumans M, De Munck J, Cardoso MV, Ermis B, Van Meerbeek B. Three-year clinical performance of a HEMA-free one-step self-etch adhesive in non-carious cervical lesions. Eur J Oral Sci 2011;119:511–6 |
| Van Landuyt KL, De Munck J, Ermis RB, Peumans M, Van Meerbeek B. Five-year clinical performance of a HEMA-free one-step self-etch adhesive in noncarious cervical lesions. Clin Oral Invest 2013;17:1061–9 | |
| St_33 | Ritter AV, Heymann HO, Swift Jr EJ, Sturdevant JR, Wilder Jr AD. Clinical evaluation of an all-in-one adhesive in non-carious cervical lesions with different degrees of dentin sclerosis. Oper Dent 2008;33:370–8 |
| St_35 | van Dijken JW, Pallesen U. Long-term dentin retention of etch-and-rinse and self-etch adhesives and a resin-modified glass ionomer cement in non-carious cervical lesions. Dent Mater 2008;24:915–22 |
| St_37 | Loguercio AD, Reis A. Application of a dental adhesive using the self-etch and etch-and-rinse approaches: an 18-month clinical evaluation. J Am Dent Assoc 2008;139:53–61 |
| St_39 | Celik C, Ozgunaltay G, Attar N. Clinical evaluation of flowable resins in non-carious cervical lesions: two-year results. Oper Dent 2007;32:313–21 |
| St_40 | van Dijken JW, Sunnegardh-Gronberg K, Lindberg A. Clinical long-term retention of etch-and-rinse and self-etch adhesive systems in non-carious cervical lesions. A 13 years evaluation. Dent Mater 2007;23:1101–7 |
| St_44 | Peumans M, De Munck J, Van Landuyt KL, Kanumilli P, Yoshida Y, Inoue S, Lambrechts P, Van Meerbeek B. Restoring cervical lesions with flexible composites. Dent Mater 2007;23:749–54 |
| Van Meerbeek B, Kanumilli PV, De Munck J, Van Landuyt K, Lambrechts P, Peumans M. A randomized, controlled trial evaluating the three-year clinical effectiveness of two etch & rinse adhesives in cervical lesions. Oper Dent 2004;29:376–85 | |
| Peumans M, De Munck J, Van Landuyt KL, Poitevin A, Lambrechts P, Van Meerbeek B. A 13-year clinical evaluation of two three-step etch-and-rinse adhesives in non-carious class-V lesions. Clin Oral Investig 2012;16:129–37 | |
| St_45 | Peumans M, De Munck J, Van Landuyt K, Lambrechts P, Van Meerbeek B. Five-year clinical effectiveness of a two-step self-etching adhesive. J Adhes Dent 2007;9:7–10 |
| Peumans M, Munck J, Van Landuyt K, Lambrechts P, Van Meerbeek B. Three-year clinical effectiveness of a two-step self-etch adhesive in cervical lesions. Eur J Oral Sci 2005;113:512–8 | |
| Van Meerbeek B, Kanumilli P, De Munck J, Van Landuyt K, Lambrechts P, Peumans M. A randomized controlled study evaluating the effectiveness of a two-step self-etch adhesive with and without selective phosphoric-acid etching of enamel. Dent Mater 2005;21:375–83 | |
| St_47 | Loguercio AD, Bittencourt DD, Baratieri LN, Reis A. A 36-month evaluation of self-etch and etch-and-rinse adhesives in noncarious cervical lesions. J Am Dent Assoc 2007;138:507–14; quiz 535–537 |
| St_48 | Burrow MF, Tyas MJ. Clinical evaluation of three adhesive systems for the restoration of non-carious cervical lesions. Oper Dent 2007;32:11–5 |
| St_50 | Abdalla AI, Garcia-Godoy F. Clinical evaluation of self-etch adhesives in Class V non-carious lesions. Am J Dent 2006;19:289–92 |
| St_51 | Saboia Vde P, Almeida PC, Ritter AV, Swift Jr EJ, Pimenta LA. 2-Year clinical evaluation of sodium hypochlorite treatment in the restoration of non-carious cervical lesions: a pilot study. Oper Dent 2006;31:530–5 |
| St_52 | Reis A, Loguercio AD. A 24-month follow-up of flowable resin composite as an intermediate layer in non-carious cervical lesions. Oper Dent 2006;31:523–9 |
| Reis A, Loguercio AD. A 36-month clinical evaluation of ethanol/water and acetone-based etch-and-rinse adhesives in non-carious cervical lesions. Oper Dent 2009;34:384–91 | |
| St_54 | Franco EB, Benetti AR, Ishikiriama SK, Santiago SL, Lauris JR, Jorge MF, Navarro MF. 5-Year clinical performance of resin composite versus resin modified glass ionomer restorative system in non-carious cervical lesions. Oper Dent 2006;31:403–8 |
| St_55 | Kubo S, Kawasaki K, Yokota H, Hayashi Y. Five-year clinical evaluation of two adhesive systems in non-carious cervical lesions. J Dent 2006;34:97–105 |
| Kubo S, Yokota H, Takada H, Hayashi Y. Eight-year clinical evaluation of two adhesives in non-carious cervical lesions. J Dent Res 2008;87B [Abstr. No. 1786] | |
| Kubo S, Kubo H, Yokota H, Yokota Y, Hayashi Y. Twelve-year clinical evaluation of two adhesives in non-carious cervical Lesions. J Dent Res 2013;92A [Abstr. No. 3101] | |
| St_57 | Onal B, Pamir T. The two-year clinical performance of esthetic restorative materials in noncarious cervical lesions. J Am Dent Assoc 2005;136:1547–55 |
| St_62 | Gladys S, Van Meerbeek B, Lambrechts P, Vanherle G. Marginal adaptation and retention of a glass-ionomer, resin-modified glass-ionomers and a polyacid-modified resin composite in cervical Class-V lesions. Dent Mater 1998;14:294–306 |
| Gladys S, Van Meerbeek B, Lambrechts P, Vanherle G. Clinical effectiveness of a glass-ionomer, resin-modified glass-ionomers and a polyacid-modified resin composite in cervical Class V lesions after 3 years. J Dent Res 2001;80:1205 [Abstr. No. 33] | |
| St_63 | Van Meerbeek B, Peumans M, Gladys S, Braem M, Lambrechts P, Vanherle G. Three-year clinical effectiveness of four total-etch dentinal adhesive systems in cervical lesions. Quintessence Int 1996;27:775–84 |
| St_69 | Ozgunaltay G, Onen A. Three-year clinical evaluation of a resin modified glass-ionomer cement and a composite resin in non-carious class V lesions. J Oral Rehabil 2002;29:1037–41 |
| St_72 | Ermis RB. Two-year clinical evaluation of four polyacid-modified resin composites and a resin-modified glass-ionomer cement in Class V lesions. Quintessence Int 2002;33:542–8 |
| St_78 | Folwaczny M, Mehl A, Kunzelmann KH, Hickel R. Clinical performance of a resin-modified glass-ionomer and a compomer in restoring non-carious cervical lesions. 5-Year results. Am J Dent 2001;14:153–6 |
| St_81 | Brackett WW, Browning WD, Ross JA, Brackett MG. Two-year clinical performance of a polyacid-modified resin composite and a resin-modified glass-ionomer restorative material. Oper Dent 2001;26:12–6 |
| St_83 | Matis BA, Cochran M, Carlson T. Longevity of glass-ionomer restorative materials: results of a 10-year evaluation. Quintessence Int 1996;27:373–82 |
| St_85 | Perdigao J, Carmo AR, Geraldeli S. Eighteen-month clinical evaluation of two dentin adhesives applied on dry vs moist dentin. J Adhes Dent 2005;7:253–8 |
| St_86 | Dalton Bittencourt D, Ezecelevski IG, Reis A, Van Dijken JW, Loguercio AD. An 18-months’ evaluation of self-etch and etch & rinse adhesive in non-carious cervical lesions. Acta Odontol Scand 2005;63:173–8 |
| St_87 | Brackett WW, Brackett MG, Dib A, Franco G, Estudillo H. Eighteen-month clinical performance of a self-etching primer in unprepared class V resin restorations. Oper Dent 2005;30:424–9 |
| St_89 | Gallo JR, Burgess JO, Ripps AH, Walker RS, Ireland EJ, Mercante DE, Davidson JM. Three-year clinical evaluation of a compomer and a resin composite as Class V filling materials. Oper Dent 2005;30:275–81 |
| St_90 | Perdigao J, Carmo AR, Anauate-Netto C, Amore R, Lewgoy HR, Cordeiro HJ, Dutra-Correa M, Castilhos N. Clinical performance of a self-etching adhesive at 18 months. Am J Dent 2005;18:135–40 |
| St_91 | Turkun LS. Five-year clinical performance of an antibacterial adhesive system. J Dent Res 2009;87C [Abstr. No. 623] |
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