Influência das características clínicas e fatores associados a lesões cervicais não-cariosas e tipo de resina composta sobre o sucesso restaurador: observações in silico, in vitro, in vivo e revisão sistemática
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Data
2020-02-11
Autores
Correia, Ayla Macyelle de Oliveira
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Universidade Estadual Paulista (Unesp)
Resumo
O presente trabalho teve como objetivos: (1) analisar, in silico, o efeito de diferentes técnicas restauradoras sobre a concentração de tensão em lesões cervicais não cariosas (LCNCs); (2) avaliar in silico e in vitro a influência do ângulo cavo-superficial sobre a concentração de tensão em LCNCs simuladas; (3) avaliar, in silico e in vitro, a influência da extensão da cavidade e do material restaurador na formação de fendas marginais, e na concentração de tensão em restaurações de resina composta; (4) avaliar, in vivo, a influência da geometria de LCNCs e material restaurador no desempenho clínico das restaurações e (5) analisar, por revisão sistemática e metanálise, a influência dos aspectos relacionados ao dente e cavidade de LCNCs sobre a retenção de restaurações de resina composta. Material e métodos: (1) Um pré-molar superior foi modelado em software CAD, e uma LCNC do tipo cunha foi simulada. Cinco técnicas restauradoras foram reproduzidas com as resinas FiltekTM Z350 XT (N) ou FiltekTM Bulk Fill (BF) e analisadas pelo software Ansys 17.0; (2) Cavidades cilíndricas com mesmo volume (17,67 mm3) foram preparadas em 45 incisivos bovinos. As amostras foram divididas de acordo com o ângulo cavo-superficial, em três grupos: 90o, 120o, 135o, e restauradas com o adesivo Futurabond U e resina GrandioSO. As fendas marginais foram medidas em estereomicroscópio, e análise por elementos finitos (FEA); (3) Cavidades simulando LCNCs com 2 mm (profundidade) C 4 mm (distância cérvico-incisal) foram preparadas em 60 incisivos bovinos em duas dimensões mésio-distais (2,9 mm ou 1,4 mm) e restauradas com N ou BF (n=30). A fenda marginal foi avaliada em estereomicroscópio antes e após da termociclagem, e realizada análise por FEA em cavidades iguais; (4) Cento e quarenta LCNCs foram restauradas em 77 pacientes. As lesões foram previamente classificadas quanto à extensão gengivo- oclusal (1,5 mm ± 10% e 3 mm ± 10%). Em seguida, as lesões foram alocadas aleatoriamente em quatro grupos (n=35). Após a aplicação de um adesivo autocondicionante, as restaurações foram realizadas com N ou BF. As restaurações foram avaliadas após 7 dias, 6 e 12 meses pelos critérios USPHS modificados; (5) Buscas nas principais bases de dados eletrônicas foram realizadas. Estudos clínicos em pacientes com LCNCs restauradas com resina composta foram incluídos. A retenção da restauração foi o desfecho primário. A qualidade metodológica e risco de viés dos artigos incluídos foi avaliada utilizando a ferramenta Cochrane para ensaios clínicos randomizados e o sistema GRADE. Resultados: (1) A menor concentração de tensão ocorreu no grupo restaurado com resina BF; (2) O ângulo cavo-superficial de 90o promoveu maiores tensões na interface da restauração, com maior fenda marginal; (3) Ocorreu maior concentração de tensão na margem do esmalte, com maior pico de tensão (17,0 MPa) para cavidade pequena restaurada com resina N; (4) A taxa de retenção das restaurações após 12 meses foi de 100% para as LCNCs restauradas com N e de 97% para as LCNCs restauradas com BF; (5) A localização do dente e a presença de facetas de desgaste podem afetar a retenção de resinas compostas em LCNCs.
The aim of the present study was (1) to analyze in silico the effect of different restorative techniques on the stress concentration in non-carious cervical lesions (NCCLs); (2) to evaluate in silico and in vitro the influence of cavosurface margin angle on stress concentration in simulated NCCLs; (3) to evaluate in silico and in vitro the influence of cavity extension and restorative material on the marginal gap formation, and on the stress concentration in resin restoration; (4) to evaluate in vivo the influence of the geometry of NCCLs and restorative material on the clinical performance of restoration and (5) to analyze, through a systematic review and meta-analysis, the influence of tooth- and cavity-related of NCCLs on the retention of resin composite restorations. Materials and Methods: (1) A superior premolar was modeled in CAD software, and a NCCLs of the wedge type was simulated. Five restorative techniques were designed with FiltekTM Z350 XT (N) or FiltekTM Bulk Fill (BF) and analyzed by Ansys 17.0 software; (2) Cylindrical cavities with the same volume (17.67 mm3) were prepared in 45 bovine incisors. The samples were divided according to the cavo-superficial angle in three groups: 90o, 120o, 135o, and restored with Futurabond U adhesive and GrandioSO resin. The marginal gaps were analyzed in stereomicroscope and FEA; (3) Cavities simulating NCCLs with 2 mm (depth) C 4 mm (cervical-incisal distance) were prepared in 60 bovine incisors in two mesiodistal dimensions (2.9 mm or 1.4 mm) and restored with N or BF (n=30. The marginal gap was evaluated using a stereomicroscope before and after thermocycling, and FEA analysis was performed in equal cavities; (4) One hundred and forty NCCLs were restored in 77 patients. The lesions were previously classified for occlusogingival distance (1.5 mm ± 10% and 3 mm ± 10%). Thereafter, the lesions were randomly allocated into four groups (n=35). After applying a self-etching adhesive, the restorations were performed using N or BF. The restorations were evaluated after 7 days, 6 and 12 months using the modified USPHS criteria; (5) Searches in major electronic databases were performed. Clinical studies in patients with NCCLs restored with resin composite were included. Restoration retention was the primary outcome. The quality of the evidence and risk of bias of the included articles was evaluated using the Cochrane tool for randomized clinical trials and the GRADE. Results: (1) The lowest concentration of stress occurred in the group restored with BF resin; (2) The cavosuperficial angle of 90o promoted higher stresses at the interface of the restoration, with a larger marginal gap; (3) Higher stress concentration occurred at the enamel margin, with highest stress peak (17.0 MPa) for small cavity restored with N; (4) The retention rate of the restorations after 12 months was 100% for the NCCLs restored with N and 97% for the NCCLs restored with BF; (5) The tooth location and the presence of wear facets can affect the retention of composite resins in NCCLs.
The aim of the present study was (1) to analyze in silico the effect of different restorative techniques on the stress concentration in non-carious cervical lesions (NCCLs); (2) to evaluate in silico and in vitro the influence of cavosurface margin angle on stress concentration in simulated NCCLs; (3) to evaluate in silico and in vitro the influence of cavity extension and restorative material on the marginal gap formation, and on the stress concentration in resin restoration; (4) to evaluate in vivo the influence of the geometry of NCCLs and restorative material on the clinical performance of restoration and (5) to analyze, through a systematic review and meta-analysis, the influence of tooth- and cavity-related of NCCLs on the retention of resin composite restorations. Materials and Methods: (1) A superior premolar was modeled in CAD software, and a NCCLs of the wedge type was simulated. Five restorative techniques were designed with FiltekTM Z350 XT (N) or FiltekTM Bulk Fill (BF) and analyzed by Ansys 17.0 software; (2) Cylindrical cavities with the same volume (17.67 mm3) were prepared in 45 bovine incisors. The samples were divided according to the cavo-superficial angle in three groups: 90o, 120o, 135o, and restored with Futurabond U adhesive and GrandioSO resin. The marginal gaps were analyzed in stereomicroscope and FEA; (3) Cavities simulating NCCLs with 2 mm (depth) C 4 mm (cervical-incisal distance) were prepared in 60 bovine incisors in two mesiodistal dimensions (2.9 mm or 1.4 mm) and restored with N or BF (n=30. The marginal gap was evaluated using a stereomicroscope before and after thermocycling, and FEA analysis was performed in equal cavities; (4) One hundred and forty NCCLs were restored in 77 patients. The lesions were previously classified for occlusogingival distance (1.5 mm ± 10% and 3 mm ± 10%). Thereafter, the lesions were randomly allocated into four groups (n=35). After applying a self-etching adhesive, the restorations were performed using N or BF. The restorations were evaluated after 7 days, 6 and 12 months using the modified USPHS criteria; (5) Searches in major electronic databases were performed. Clinical studies in patients with NCCLs restored with resin composite were included. Restoration retention was the primary outcome. The quality of the evidence and risk of bias of the included articles was evaluated using the Cochrane tool for randomized clinical trials and the GRADE. Results: (1) The lowest concentration of stress occurred in the group restored with BF resin; (2) The cavosuperficial angle of 90o promoted higher stresses at the interface of the restoration, with a larger marginal gap; (3) Higher stress concentration occurred at the enamel margin, with highest stress peak (17.0 MPa) for small cavity restored with N; (4) The retention rate of the restorations after 12 months was 100% for the NCCLs restored with N and 97% for the NCCLs restored with BF; (5) The tooth location and the presence of wear facets can affect the retention of composite resins in NCCLs.
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Palavras-chave
Resinas compostas, Desgaste dos dentes, Análise de elementos finitos, Ensaio clínico controlado aleatório, Metanálise, Composite resins, Tooth wear, Finite element analysis, Randomized controlled trial, Meta-analysis