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Effects of Cervical Restorations on the Periodontal Tissues After 5 Years
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In this randomized controlled split-mouth study, the gingival recession around resin-based non-carious lesion restorations was analyzed on 154 adult teeth (mean age, 49 years). The authors analyzed the gingival recession based on the isolation technique (cotton roll vs rubber dam) and the marginal adaptation (scores 1–5) of the restoration. The time required to restore was only 5 minutes longer using rubber dams compared with using cotton rolls. After 5 years, 13.6% of the teeth presented gingival recession. The data indicated that the teeth restored with rubber dams had a 2.65 higher risk for gingival recession compared with the cotton rolls group. In addition, higher risk (11.0) of gingival recession was observed in restorations with poor marginal adaptation (scores 4–5) compared with better marginal adaptation (scores 1–3).
- This study highlights the lack of adequate clinical guidelines to treat non-carious cervical lesions. By following the recommended protocol calling for placement of resin-based composite using the rubber dam, the patient is at higher risk of developing gingival recession. However, the use of cotton rolls as an isolation technique presents a challenge in maintaining the adequate environment and access to the cavity margin.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCL) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques.
METHODS
A randomized controlled split-mouth and blind trial was carried out. Patients (n = 38) with at least two NCCL were included. Beforehand the cervical restoration placement, the NCCL (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5-year. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95% confidence interval (95%CI) were calculated by Poisson regression (α < 0.05).
RESULTS
After 5-year, 31 teeth (13.6%) presented occurrence/progression of GR. In the multivariate analyses, occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95%CI: 2.65; 1.01 - 7.00) and lack of marginal adaptation of the restoration (RR; 95%CI: 10.98; 2.31 - 52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, presence of biofilm and presence of gingivitis did not present statistically significant higher risk for occurrence/progression of GR.
CONCLUSION
The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals that received a restoration for NCCL.
CLINICAL SIGNIFICANCE
Isolation with rubber dam and dental clamps may promote GR in sites with restored NCCL. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.
Additional Info
Effects of Cervical Restorations on the Periodontal Tissues: 5-Year Follow-Up Results of a Randomized Clinical Trial
J Dent 2020 Dec 29;[EPub Ahead of Print], M Favetti, AF Montagner, ST Fontes, TM Martins, AS Masotti, P Dos Santos Jardim, FOB Corrêa, MS Cenci, FWMG MunizFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.