Mahn Eduardo, Rousson Valentin, Heintze Siegward
J Adhes Dent. 2015 Aug;17(5):391-403. doi: 10.3290/j.jad.a35008.
To meta-analyze the literature on the clinical performance of Class V restorations to assess the factors that influence retention, marginal integrity, and marginal discoloration of cervical lesions restored with composite resins, glass-ionomer-cement-based materials [glass-ionomer cement (GIC) and resin-modified glass ionomers (RMGICs)], and polyacid-modified resin composites (PMRC).
The English literature was searched (MEDLINE and SCOPUS) for prospective clinical trials on cervical restorations with an observation period of at least 18 months. The studies had to report about retention, marginal discoloration, marginal integrity, and marginal caries and include a description of the operative technique (beveling of enamel, roughening of dentin, type of isolation). Eighty-one studies involving 185 experiments for 47 adhesives matched the inclusion criteria. The statistical analysis was carried out by using the following linear mixed model: log (-log (Y /100)) = β + α log(T ) + error with β = log(λ), where β is a summary measure of the non-linear deterioration occurring in each experiment, including a random study effect.
On average, 12.3% of the cervical restorations were lost, 27.9% exhibited marginal discoloration, and 34.6% exhibited deterioration of marginal integrity after 5 years. The calculation of the clinical index was 17.4% of failures after 5 years and 32.3% after 8 years. A higher variability was found for retention loss and marginal discoloration. Hardly any secondary caries lesions were detected, even in the experiments with a follow-up time longer than 8 years. Restorations placed using rubber-dam in teeth whose dentin was roughened showed a statistically significantly higher retention rate than those placed in teeth with unprepared dentin or without rubber-dam (p < 0.05). However, enamel beveling had no influence on any of the examined variables. Significant differences were found between pairs of adhesive systems and also between pairs of classes of adhesive systems. One-step self-etching had a significantly worse clinically index than two-step self-etching and three-step etch-and-rinse (p = 0.026 and p = 0.002, respectively).
The clinical performance is significantly influenced by the type of adhesive system and/or the adhesive class to which the system belongs. Whether the dentin/enamel is roughened or not and whether rubberdam isolation is used or not also significantly influenced the clinical performance. Composite resin restorations placed with two-step self-etching and three-step etch-and-rinse adhesive systems should be preferred over onestep self-etching adhesive systems, GIC-based materials, and PMRCs.
对V类洞修复体临床性能的文献进行荟萃分析，以评估影响复合树脂、玻璃离子水门汀基材料[玻璃离子水门汀（GIC）和树脂改性玻璃离子水门汀（RMGIC）]以及聚酸改性树脂复合材料（PMRC）修复的颈部病变的固位、边缘完整性和边缘变色的因素。
检索英文文献（MEDLINE和SCOPUS），查找观察期至少为18个月的颈部修复体前瞻性临床试验。这些研究必须报告固位、边缘变色、边缘完整性和边缘龋情况，并包括手术技术的描述（釉质斜面制备、牙本质粗糙化、隔离类型）。81项涉及47种粘结剂的185个实验符合纳入标准。采用以下线性混合模型进行统计分析：log（-log（Y/100））=β+αlog（T）+误差，其中β=log（λ），β是每个实验中发生的非线性劣化的汇总指标，包括随机研究效应。
平均而言，5年后12.3%的颈部修复体脱落，27.9%出现边缘变色，34.6%出现边缘完整性恶化。临床指数计算显示，5年后失败率为17.4%，8年后为32.3%。固位丧失和边缘变色的变异性更高。即使在随访时间超过8年的实验中，也几乎未检测到继发龋损。在牙本质粗糙化的牙齿上使用橡皮障隔离进行的修复，其固位率在统计学上显著高于在未处理牙本质或未使用橡皮障隔离的牙齿上进行的修复（p<0.05）。然而，釉质斜面制备对任何检查变量均无影响。在粘结剂系统对之间以及粘结剂系统类别对之间均发现显著差异。一步自酸蚀的临床指数显著低于两步自酸蚀和三步酸蚀冲洗（分别为p=0.026和p=0.002）。
临床性能受粘结剂系统类型和/或该系统所属粘结剂类别的显著影响 dentin/enamel是否粗糙化以及是否使用橡皮障隔离也显著影响临床性能。与一步自酸蚀粘结剂系统、GIC基材料和PMRC相比，应优先选择采用两步自酸蚀和三步酸蚀冲洗粘结剂系统进行的复合树脂修复。
