Avaliação clínica de diferentes sistemas adesivos e técnicas de adesão em lesões cervicais não cariosas

Abstract

Objectives: To evaluate different long-term adhesion techniques, being etch-and-rinse (ER), self-etch (SE) and selective enamel etch (SEE) from different adhesive systems, conventional (CV) and universal (U), two criteria World Federation Criteria (FDI) and United States Public Health Service (USPHS) and two types of resin, conventional flowable and modified flowable. Methods: Three studies were carried out: three randomized clinical trials (RCTs). RCTs were double-blind, performed on 101 patients, according to the inclusion and exclusion criteria, 39, 35 and 27 in each study, respectively. In study (1) the ER technique was used on dry and moist dentin, SEE and SE, a U adhesive system, evaluated by the FDI and USPHS criteria and restored with conventional resin, in study (2) the technique used was ER, a conventional adhesive system, the FDI evaluation criteria and conventional resin, in the study (3) the SEE adhesive technique, a U adhesive, the FDI and USPHS evaluation criteria and flow resin were used. Study 1 and 2 are long-term evaluations of 5 years and study 3 is a one-year evaluation. The evaluation criteria of all studies followed the following items: retention / fracture, marginal adaptation, marginal color, postoperative sensitivity and caries recurrence. Results: In the study (1), after 5 years, the clinical behavior of the universal adhesive in the ER strategy was better when compared to the SE strategy. The use of selective acid enamel conditioning (SEE) is highly recommended for the self-etching strategy. The FDI and USPHS evaluation criteria showed similar results after 5 years. In study (2) both ER system technique, Adper Single Bond 2, a adhevise containing polyalkenoic acid, and Ambar, a adhesive containing 10-MDP, had comparable and high clinical performances after five years of clinical evaluation. In the RCT (3), the clinical performance of the universal adhesive associated with a flowable composite based on ormocer or methacrylate was considered promising after one year of clinical evaluation. Conversely, a high viscosity fluid composite should not be indicated for non-carious cervical lesions. Conclusions: The ER technique is superior to SE, but the SE technique when using selective enamel conditioning (SEE) is a viable option. Both adhesives, one containing polyalkenoic acid, and other containing MDP, had comparable and high clinical performances after 5 years of clinical evaluation. A high viscosity flowable composite was not indicated to restore non-carious cervical lesions due to the high loss of retention (11.5%) after one year.