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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 37-41

Comparative evaluation of two different isolation techniques in restoration of noncarious cervical lesions using flowable composite: A split-mouth in vivo study


1 Department of Conservative Dentistry and Endodontics, Vijayawada, Andhra Pradesh, India
2 Department of Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India

Date of Submission29-May-2020
Date of Acceptance13-Jan-2021
Date of Web Publication15-Feb-2021

Correspondence Address:
Jyothsna Kasireddy
Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_4_21

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  Abstract 


Context: Proper method of isolation plays a key role in the restoration of noncarious cervical lesions (NCCLs).
Aims: The aim of this in vivo study was to compare the efficacy of two isolation techniques in restoring NCCLs using flowable composite.
Settings and Design: Forty patients who fulfill the inclusion criteria were selected based on the power of the study (0.86). The participants were divided into two groups according to the split-mouth design.
Materials and Methods: In Group A, lesion isolation was done using the Mylar matrix band with photocurable gingival barrier, and in Group B, using Metal matrix band and gingival barrier. The restorations were assessed immediately and after 6 months, using modified US Public Health Service criteria: marginal integrity, marginal discoloration, wear, retention, secondary caries, and postoperative sensitivity.
Statistical Analysis: IBM SPSS (version 21.0) software was used. McNemar's and Chi-square tests were performed, considering P < 0.05 for statistical significance.
Results: Both the groups demonstrated satisfactory clinical performance. Upon inter- and intragroup comparison of the two isolation methods, there was no statistically significant difference (P > 0.05).
Conclusions: Within the limitations of the study, both the groups performed similarly in isolation of NCCLs. However, long-term clinical studies must be needed for further evaluation.

Keywords: Metal matrix, Mylar matrix, noncarious cervical lesions


How to cite this article:
Sudha K, Kasireddy J, Sowjanya DL, Ashwini M, Sakyarshi K. Comparative evaluation of two different isolation techniques in restoration of noncarious cervical lesions using flowable composite: A split-mouth in vivo study. J Oral Res Rev 2021;13:37-41

How to cite this URL:
Sudha K, Kasireddy J, Sowjanya DL, Ashwini M, Sakyarshi K. Comparative evaluation of two different isolation techniques in restoration of noncarious cervical lesions using flowable composite: A split-mouth in vivo study. J Oral Res Rev [serial online] 2021 [cited 2021 Mar 7];13:37-41. Available from: https://www.jorr.org/text.asp?2021/13/1/37/309439




  Introduction Top


Noncarious cervical lesions (NCCLs) have multifactorial etiology and present restorative challenges, including isolation and moisture control.[1],[2],[3],[4]

The intrinsic anatomical and morphological characteristics of this area limit the placement of the rubber dam clamp.[5]

Flowable composites are the materials of choice for restoration of NCCLs, due to their esthetic and physical properties (Pecie et al., 2011, and Perez et al., 2012).[6]

To date, very few studies have reported the isolation techniques of these lesions. Hence, the aim of this in vivo study was to compare the clinical efficacy of two different isolation techniques for the restoration of NCCLs using flowable composite.

Aim

The aim of the present in vivo study was to compare the efficacy of two different isolating techniques in restoring NCCLs with flowable composite using modified US Public Health Service (USPHS) criteria.


  Materials and Methods Top


Forty patients with a mean age of 35–50 years presenting with a chief complaint of NCCLs and dentinal hypersensitivity in the maxillary premolar region reported to the department of conservative dentistry and endodontics were selected for the study. Patients having at least four cervical lesions with lesion depth of 1.5–2 mm were included in the study. Root canal treated teeth, teeth with cervical caries, teeth with retentive clasps, and pulpally involved teeth were excluded from the study.

Approval was taken from the institutional ethical committee to conduct the study, and the procedures followed were in accordance with the institutional ethical standards. After confirming eligibility, the clinical procedure and the associated risks were explained to the patients. Informed consent was obtained from the patient after their approval.

The power of the study (0.86) was determined, and the sample size was set at 40. Patients who fulfill the inclusion criteria were divided into two groups (n = 40).

In Group A, lesion isolation was done using photocurable gingival resin barrier material (Gingiva Shield VLC, Prevest Denpro Limited, Jammu, India) with Mylar strip (PREHMA matrix strips, Keystone Industries, FL, USA) placement and in Group B using Metal matrix band (Hawe Steel Matrices Bands [0.030 mm], Kerrhawe SA, Switzerland) with a gingival barrier material.

The methodology was based on the split-mouth system. For standardization purposes, the tooth pairs chosen for restoration had to be similar in size and depth. A premolar from each half of the maxillary arch was selected to compare the restorative efficiency of these two isolation methods.

Preparation of the teeth for restoration

In both the groups, teeth to be restored were first cleaned with prophylactic paste (Ivoclar Proxyt paste) under a rubber cup and subsequently rinsed with water. The enamel margins were beveled to improve adhesion and esthetics. 2% lidocaine local anesthetic spray (Dentaids Lidayn Spray) was applied on the tissue adjacent to the lesion to prevent discomfort while placing the matrix bands. The next step is the key to the successful restoration, i.e., placement and fixation of the matrix band around the teeth.

Matrix insertion techniques

In Group A, the Mylar matrix (PREHMA matrix strips, Keystone Industries, FL, USA) was cut and positioned at an angulation (=45°) such that it should facilitate the insertion of flowable resin (Filtek™ Supreme XTE Flow). The strip was carefully inserted into the gingival sulcus, involving the entire cervical wall of the cavity, and was fixed on both sides with wooden wedges (Apexdent Global) [Figure 1].
Figure 1: Isolation of noncarious cervical lesion using Mylar Matrix. (a) Preoperative photograph. (b) Application of Mylar matrix. (c) Baseline photograph. (d) Six.month recall photograph

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In Group B, the Metal matrix band (Hawe Steel Matrices Bands [0.030 mm], Kerrhawe SA, Switzerland) was molded using finger pressure to form a convex, arch-shaped form to follow the cervical contour of the cavity. The modified matrix was then placed around the prepared tooth into the gingival sulcus, gently pushed to move the tissue, and was finally stabilized in place with wooden wedges (Apexdent Global) [Figure 2].
Figure 2: Isolation of noncarious cervical lesion using Metal matrix. (a) Preoperative photograph. (b) Application of Mylar matrix. (c) Baseline photograph. (d) Six.month recall photograph

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After placing the matrix bands, the prepared teeth were acid etched with 37% phosphoric acid gel (Prime Dental) for 15 s, rinsed with water for 20 s, and blotted to dry. A photocurable gingival barrier material (Gingiva Shield VLC, Prevest Denpro Limited, Jammu, India) was injected around the two preparation methods and was light cured according to manufacturer instructions in order to seal the preparation against fluid contamination and stabilization of matrices. With the help of an applicator tip southern dental industries limited, Victoria, AU(SDI), bonding agent (3M ESPE ADPER Single Bond 2) was applied to the cavity and light cured for 20 s with a light-curing unit (Woodpecker light-emitting diode light-curing unit). It was followed by the placement of flowable composite (Filtek™ Supreme XTE Flow) in an incremental pattern, and each increment was light cured for 20 s. After the placement of the last increment, a little bit of finishing was done using fine-grit diamond burs (Mani Inc., Japan) and discs (Sof-Lex™), followed by polishing using composite polishing paste (Prisma-Gloss, Dentsply Caulk, Milford, DE, USA).

Clinical evaluation

All the restorations were placed by a single operator. The co-investigator who was blinded to the materials and methodology of the study has evaluated the restorations using mouth mirror, explorer, and three-way syringe. The results were analyzed using the modified USPHS criteria, which was based on the Alpha (A), Bravo (B), and Charlie (C) ranking.[7] The restorations were assessed at baseline and after 6 months of follow-up time.

Statistical analysis

SPSS version 21.0 (Armonk, NY, USA: IBM Corp) software was used to carry out the statistical analysis of the data. In both the isolation groups, the performance of the restorations for each category of USPHS criteria at baseline and 6 months of recall time was evaluated by McNemar's test (P < 0.05). Chi-square test (P < 0.05) was used to compare all the criteria between the two groups. P = 0.05 was considered to be statistically significant.


  Results Top


Results were analyzed based on the A (Alpha-excellent), B (Bravo-acceptable), and C (Charlie-unsatisfactory) ranking given in modified USPHS criteria. Intragroup comparison among the variables was based on McNemar's test [Table 1], and it shows that there was no statistically significant difference in terms of marginal integrity, marginal discoloration, wear, retention, secondary caries, and postoperative sensitivity at baseline and after 6 months of follow-up. Chi-square test [Table 2] was performed for intergroup comparison, which reveals that there was no significant difference between the two groups at baseline and after 6 months of follow-up.
Table 1: Intragroup comparison of the results obtained by US Public Health Service criteria at baseline and after 6 months

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Table 2: Intergroup comparison of the results obtained by US Public Health Service criteria at baseline and after 6 months

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  Discussion Top


NCCLs have long been a topic of concern for patients and clinicians due to their high prevalence and associated undesirable clinical problems, including esthetic compromise and dentinal sensitivity. The prevalence and severity of these lesions have been found to increase with age. Kaoru et al. conducted a study on NCCLs and showed that more than half of the lesions (55%) were found in patients with an age range of 35–50 years.[8]

Maxillary premolars were the most affected teeth by NCCLs, followed by molars and canines. The higher incidence of NCCLs in premolars could be explained by the greater occlusal loading and the higher number of premature contacts found in these teeth. Other hypotheses would be the limited protection offered by saliva in this region and the relatively imperfect anatomical morphology of the teeth.[8],[9]

NCCLs in human teeth usually have little or no enamel at the cervical margin; therefore, restorative materials come into contact with cementum or dentin, and for this reason, it is essential to obtain a reliable dentin bond to the restorative material. Flowable composites were the materials of choice in restoring NCCLs.[10],[11]

Flowable restorative resins are used for the restoration of minimally invasive preparations, especially cervical Class V lesions, due to their low viscosity and increased elasticity. The filler loading of flowable is lower than microfilled resins, resulting in an enhanced flow and a reduced elastic modulus. An improved flow is likely to facilitate adaptation, and the reduced elastic modulus may provide the material with stress absorbing ability.[5]

Xie et al. evaluated the dentin bond strength and microleakage of three Class V restorations, namely flowable composite, compomer, and glass ionomer, and concluded that flowable composite provided stronger dentin bond strengths and better margin sealing than compomer and conventional glass-ionomer cement.[11] Karaman et al. evaluated the clinical performance of cervical restorations using nanohybrid and flowable resin composite and concluded that both the materials showed similar clinical performance in restoring NCCLs.[12]

The use of a customized matrix band along with a photocurable gingival barrier offers a simpler approach to attaining isolation and better marginal adaptation as rubber dam placement is difficult in these lesions.[13] Hence, the study was undertaken to evaluate the effect of two methods of isolation for the restoration of NCCLs.

Gingiva Shield VLC (Prevest Denpro Limited) is a light-curing resin-based, gingival barrier material in syringe packing for isolating gums and neighboring teeth. It provides both isolation and stability for the matrix bands along with wooden wedges. It is easily removable from the gum and intertooth spaces. It is a safe and effective barrier to protect soft tissues and teeth with an impervious seal.

Mylar matrix (PREHMA matrix strips, Keystone Industries, FL, USA) is not only a simple and time-saving procedure but also provides visibility and controlled flow of the flowable resin and thus minimizes the time for finishing and polishing. It also helps in preventing gingival overextension and easy adaptation of the composite resin. Mylar matrix brings some advantages, including less risk of damage to soft tissue during penetration into the gingival sulcus and better light transmission and visualization.[5]

The matrix was placed at an angle so that it will allow the necessary volume of restorative material to be inserted without any excess and adequate penetration between the gingiva and tooth.[5]

The use of a metal matrix (Hawe Steel Matrices Bands, Kerrhawe SA, Switzerland) provided valid local isolation, displaced the gingiva in a nontraumatic way, and allowed clear access to the entire lesion, including the cervical margin. The metal matrix (Hawe Steel Matrices Bands, Kerrhawe SA)used in the present study provided a valid local isolation by minimally displacing the gingiva as the metal matrix bandswere easy to shape and mold into desirable form, they fit perfectly into the interproximal areas with the help of wooden wedges. Hence this method provides a simple approach for isolation and good at restoring the anatomical contours with minimum overhangs.[4]

In the present study, both the groups were found to be equally effective in restoring NCCLs immediately and after 6 months of placement. Hence, the choice of isolation technique depends on the clinical conditions and clinician choice. Classic matrix bands are both economical and effective tools when used creatively and cautiously to resolve some of the challenges faced during isolation.

Limitations of the study

One major problem with this technique is related to cervical lesions in molars. In the case of a specific molar involved, insertion of the matrix was done in two steps since the cervical configuration of the cavity is different in molars. Another drawback is that each tooth has to be isolated individually.


  Conclusions Top


Within the limitations of the present study,

  • Both the techniques provided satisfactory clinical performance in the isolation and restoration of cervical lesions
  • There was no statistical difference observed in terms of marginal integrity, marginal discoloration, wear, retention, secondary caries, and postoperative sensitivity in both the methods
  • However, further long-term clinical studies must be needed to evaluate the performance of the matrices in isolation and restoration of NCCLs accurately.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Grippo JO, Simring M, Schreiner S. Attrition, abrasion, corrosion, and abfraction revisited: A new perspective on tooth surface lesions. J Am Dent Assoc 2004;135:1109-18.  Back to cited text no. 1
    
2.
Perez CR, Gonzalez MR, Prado NA, De Miranda MS, Macêdo MD, Fernandes BM. Restoration of non-carious cervical lesions: When, why, and how. Int J Dent 2012:1-8.  Back to cited text no. 2
    
3.
Wood I, Jawad Z, Paisley C, Brunton P. Non-carious cervical tooth surface loss: A literature review. J Dent 2008;36:759-66.  Back to cited text no. 3
    
4.
Giachetti L. A simple method for treating subgingival Class V lesions. Oper Dent 2019;44:333-5.  Back to cited text no. 4
    
5.
Perez CR. Alternative technique for Class V resin composite restorations with minimum finishing/polishing procedures. Oper Dent 2010;35:375-9.  Back to cited text no. 5
    
6.
Lührs AK, Jacker-Guhr S, Günay H, Herrmann P. Composite restorations placed in non-carious cervical lesions – Which cavity preparation is clinically reliable? Clin Exp Dent Res 2020;6:1-0.  Back to cited text no. 6
    
7.
Fabianna da Conceição Dantas de M, Marquiony Marques S, Isaac Jordão de Souza A, Isabela Pinheiro Cavalcanti L. Clinical evaluation of two materials in the restoration of abfraction lesions. Braz J Oral Sci 2015;14:287-93.  Back to cited text no. 7
    
8.
Kaoru Y, Dos-Rios LF, Sobral MA, Aranha AC, Mendes FM, Scaramucci T. Clinical features and factors associated with non-carious cervical lesions and dentin hypersensitivity. J Oral Rehabil 2017;44:112-8.  Back to cited text no. 8
    
9.
Flores AJ. Cervical abrasion injuries in current dentistry. J Dent Health Oral Disord Ther 2018;9:189-92.  Back to cited text no. 9
    
10.
Powell LV, Gordon GE, Johnson GH. Clinical evaluation of direct esthetic restorations in cervical abrasion/erosion lesions: One-year results. Quintessence Int 1991;22:687-92.  Back to cited text no. 10
    
11.
Xie H, Zhang F, Wu Y, Chen C, Liu W. Dentine bond strength and microleakage of flowable composite, compomer, and glass ionomer cement. Aust Dent J 2008;53:325-31.  Back to cited text no. 11
    
12.
Karaman E, Yazici AR, Ozgunaltay G, Dayangac B. Clinical evaluation of a nanohybrid and a flowable resin composite in non-carious cervical lesions: 24-month results. J Adhes Dent 2012;14:485-92.  Back to cited text no. 12
    
13.
Brackett MG, Ryan JM, Haddock FJ, Romero MF, Brackett WW. Use of a modified matrix band technique to restore subgingival root caries. Oper Dent 2018;43:467-71.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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