Van Landuyt Kirsten L, De Munck Jan, Ermis R Banu, Peumans Marleen, Van Meerbeek Bart
KU Leuven BIOMAT, Department of Oral Health Sciences and University Hospitals Leuven, University of Leuven, KU Leuven, Kapucijnenvoer 7, B-3000, Leuven, Belgium.
Department of Restorative Dentistry and Endodontics, School of Dentistry, Suleyman Demirel University, Isparta, Turkey.
Clin Oral Investig. 2014 May;18(4):1045-1052. doi: 10.1007/s00784-013-1061-9. Epub 2013 Aug 15.
The objective of this randomized controlled trial was to evaluate the clinical performance of a 2-hydroxyethyl methacrylate (HEMA)-free one-step adhesive.
Two hundred sixty-seven cervical lesions in 52 patients were restored with the composite Gradia Direct (GC), bonded with either the one-step self-etch adhesive G-Bond (GC) or the three-step etch-and-rinse adhesive Optibond FL (Kerr) in a random order. The restorations were evaluated for retention, marginal integrity, marginal discoloration, and caries occurrence after 5 years. Specific statistics were used to account for the clustered data (multiple restorations per patient).
The clinical success rate for G-Bond (87.4 %) was not significantly different from that of Optibond FL (90.9 %). Both adhesives showed progressive marginal deterioration, but G-Bond exhibited more small enamel defects and marginal discoloration, and unlike previous recalls, several restorations failed because of deep microleakage. Large sclerotic lesions were a significant risk factor for retention loss with G-Bond. Irrespective of the adhesive, almost all restorations with retention loss were located in the lower jaw.
After 5 years of clinical service, restorations bonded with the HEMA-free one-step adhesive did not need repair or replacement more often than those with the three-step etch-and-rinse adhesive, and both adhesives had a high retention rate (>90 %). There were indications that G-Bond did not (self-)etch enough in some clinical situations, as G-Bond exhibited more incisal defects and marginal discolorations, and sclerotic lesions were at higher risk of retention loss.
The clinical performance of the HEMA-free one-step adhesive was clinically acceptable after 5 years.
本随机对照试验的目的是评估一种不含甲基丙烯酸羟乙酯（HEMA）的一步法粘结剂的临床性能。
52例患者的267处颈部病变用复合树脂Gradia Direct（GC）修复，随机顺序分别用一步法自酸蚀粘结剂G-Bond（GC）或三步法酸蚀冲洗粘结剂Optibond FL（ Kerr）进行粘结。5年后对修复体的固位、边缘完整性、边缘变色和龋病发生情况进行评估。采用特定统计方法处理聚类数据（每位患者有多个修复体）。
G-Bond的临床成功率（87.4%）与Optibond FL的临床成功率（90.9%）无显著差异。两种粘结剂均显示边缘逐渐恶化，但G-Bond出现更多小的釉质缺损和边缘变色，且与之前的报道不同，一些修复体因深层微渗漏而失败。大的硬化性病变是G-Bond固位丧失的显著危险因素。无论使用哪种粘结剂，几乎所有固位丧失的修复体都位于下颌。
临床使用5年后，与三步法酸蚀冲洗粘结剂相比，使用不含HEMA的一步法粘结剂粘结的修复体并不更常需要修复或更换，且两种粘结剂的固位率均较高（>90%）。有迹象表明，在某些临床情况下，G-Bond的（自）酸蚀不足，因为G-Bond出现更多切端缺损和边缘变色，且硬化性病变固位丧失的风险更高。
不含HEMA的一步法粘结剂在临床使用5年后的临床性能是可以接受的。
