36-month Evaluation of Non-carious Cervical Lesion Restorations Using Different Modes of Universal Adhesive

36-month Evaluation of Non-carious Cervical Lesion Restorations Using Different Modes of Universal Adhesive | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 36-month Evaluation of Non-carious Cervical Lesion Restorations Using Different Modes of Universal Adhesive Hatice Tepe, Özge Çeliksöz, Batu Can Yaman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5174967/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Dec, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted 11 You are reading this latest preprint version Abstract Objective To evaluate the 36-month clinical performance of Single Bond Universal Adhesive (SBU; 3M ESPE, Germany) in non-carious cervical lesions (NCCLs) using different modes of adhesion according to the FDI criteria. Materials and methods In this study, the SBU Adhesive was applied to 246 NCCLs of 25 patients using different modes of adhesion: Self-etch (SE), selective-enamel-etching (SLE), and etch-and-rinse (ER). All lesions were restored with the same nanohybrid resin composite. The restorations were evaluated at the 1st, the 6th, 12th, 18th, and 36th month using the FDI criteria: marginal staining, fracture of material and retention, marginal adaptation, post-operative sensitivity and tooth vitality, recurrence of caries erosion and abfraction, and tooth integrity criteria. The differences between SE, SLE, and ER groups were tested using the Kruskal-Wallis and Mann-Whitney U tests where a value of p < 0.05 was accepted as a criterion for statistical significance. Results After 36-month the recall rate was 96%. The retention loss rates were 29.33% for SE, 16.66% for SLE, and 3.89% for ER modes. Interactions between time periods and adhesive modes were found to be statistically significant (p < 0.05) for all FDI criteria. ER mode performed significantly better than SE mode for marginal staining, fracture of material and retention, marginal adaptation and recurrence of caries erosion and abfraction criteria after the 36th month (p 0.05), nor between SLE and ER mode (p > 0.05). Conclusions After the 36-month evaluation of all adhesive modes used in the study, restorations performed with the ER adhesion mode were clinically good (2), while those performed with the SE adhesion mode and SLE adhesion mode were clinically satisfactory (3) according to the FDI criteria. Clinical Relevance: Restorations performed with the SE adhesion mode of universal adhesives exhibit clinically acceptable behavior after 36 months of evaluation, although with less success than those performed with the ER adhesion mode. Self-etch selective-enamel-etching etch-and-rinse FDI criteria universal adhesive non-carious cervical lesion Figures Figure 1 INTRODUCTION In recent years, the majority of dental research has focused on the progression of restorative techniques and materials. Universal adhesives are common dental materials that can be used on dental hard tissues and the application of universal adhesives in dental practice involves several strategies, each tailored to maximize adhesion and clinical outcomes. These strategies include a simple self-etch (SE) method, or with phosphoric acid in either etch-and-rinse (ER) or selective-enamel-etching (SLE) modes, and have been evaluated in various in vitro and clinical studies to determine their effectiveness in different clinical scenarios.[ 1 – 3 ] ER mode, phosphoric acid is applied to etch the tooth surface before the adhesive is used. This approach enhances bond strength, especially to enamel, by creating a thicker hybrid layer that allows for better resin impregnation.[ 3 ] As highlighted earlier, various studies have suggested the application of phosphoric acid on enamel margins for 10–15 seconds to improve long-term clinical outcomes, particularly enhancing marginal integrity and preventing marginal discoloration.[ 3 – 7 ] In the SE mode involves applying the adhesive directly to the tooth surface without prior etching. This method simplifies the bonding process and reduces technique sensitivity, making it advantageous in certain clinical situations. However, SE adhesives may form a thinner hybrid layer, which can affect bonding strength, particularly to sclerotic dentin. [ 3 , 8 ] The SLE mode combines both SE and ER approaches by selectively etching only the enamel while leaving the dentin unetched. This strategy aims to optimize adhesion to both substrates, leveraging the advantages of both methods. [ 3 , 9 ] A recent systematic review on the use of SE adhesive systems in NCCLs concluded that SLE prior to the application of the adhesive systems resulted in restorations with greater longevity and less marginal discoloration and retention loss.[ 10 ] These strategies have been evaluated in various in vitro and clinical studies to determine their effectiveness in different clinical scenarios.[ 3 ] NCCLs are frequently chosen for resin composite and adhesive application studies due to the absence of instrumentation requirements. Furthermore, these lesions have both dentin and enamel margins, allowing the observation of any bonding differences between these two surfaces.[ 11 ] NCCLs, on the other hand, are usually comprised of sclerotic dentin, which, due to its acid resistance, can prevent maximum adhesion, as a result, resin composites have a significantly lower bond strength to sclerotic dentin than to normal dentin.[ 12 , 13 ] To improve restoration retention, it is recommended that the dentin surface be textured with a rotary instrument, and some clinicians also incorporate mechanical retention.[ 10 ] On the contrary, according to a study, dentin roughening before the application of SE and ER modes did not affect the clinical performance of composite restorations placed in NCCLs.[ 14 ] Therefore, SE adhesives may not be appropriate for highly sclerotic surfaces.[ 15 ] Beveling of the enamel is more effectively etched than dentin and used to increase bonding area and retention, as well as to improve esthetics by gradually creating a color change between the restoration and tooth.[ 10 ] In addition, it increases the bonding surface area by enhancing micromechanical retention.[ 12 , 13 ] The SE, SLE, or ER application techniques are facilitated by including hydrophilic particular carboxylate and/or phosphate functional monomers.[ 16 ] Universal adhesives commonly contain the functional monomer 10-methacryloyloxydecyl dihydrogen phosphate (MDP), which can chemically interact with hydroxyapatite, is hydrolytically stable and improves adhesion strength.[ 17 – 20 ] The polyalkenoic acid copolymer (Vitrebond copolymer) used in certain Scotchbond Universal adhesives (3M Oral Care, USA) chemically attaches to calcium ions in hydroxyapatite, potentially enhancing long-term bond durability.[ 21 ] Scotchbond Universal and Single Bond Universal (3M ESPE, Germany) (SBU) are the same adhesive but sold in different regions of the world under different product names.[ 22 ] SBU is a versatile universal adhesive supported by various clinical studies, particularly evaluating its effectiveness on NCCLs. These studies have examined the long-term clinical performance of restorations using different application modes of SBU, including ER, SLE and SE methods. A series of studies have reported that using SBU in the ER mode results in higher retention rates and lower marginal discoloration.[ 3 , 6 , 20 , 23 ] Another study indicated that SBU demonstrated satisfactory clinical performance even in the SE mode, but the ER mode generally yielded better results.[ 24 ] In a study with a 24-month follow-up period, it was shown that using SBU in the ER mode provided high retention rates and low postoperative sensitivity in NCCLs.[ 25 ] In conclusion, these studies on the use of SBU in NCCLs indicate that the choice of adhesive strategy significantly affects the long-term success of restorations. This study specifically investigates the application modes of universal adhesive and their long-term clinical performance. Previous studies suggest that the performance of universal adhesives varies depending on the type of material used, and not all laboratory and clinical research supports the idea that any adhesive method can be applied with universal adhesives.[ 16 , 26 ] Therefore, it is crucial to investigate the most effective application strategies for universal adhesives to improve clinical outcomes. This one-bottle method undoubtedly simplifies adhesive procedures in dental tissue treatment. However, due to its recent introduction, studies assessing the effectiveness of this adhesive in the treatment of non-carious cervical lesions (NCCL) still lack sufficient follow-up periods. Therefore, there is a need for longer-term follow-up studies to fully evaluate the outcomes for NCCLs.[ 6 , 23 , 27 – 29 ] Considering the heterogeneity of previously published results, more clinical studies are required to clarify the clinical performance of universal systems. The purpose of this study was to compare the effectiveness of ER, SLE, and SE application modes of a universal adhesive in NCCL according to the Federation Dentaire Internationale (FDI) criteria after 36 months. The null hypothesis tested was that there would be no significant differences in clinical failure rates and clinical success between the ER, SE, and SLE modes of universal adhesive in restoring NCCLs according to FDI criteria over the evaluated time periods. MATERIALS AND METHODS Study Design The Non-Interventional Clinical Research Ethics Committee (E-25403353-050.99-2400074339.) approved the study and registered it with ClinicalTrials.gov (NCT06227715). This study is a retrospective analysis of patients who received treatment between May 2015 and July 2015 at the Faculty of Dentistry. All relevant data, including patient records and treatment outcomes, were retrospectively analyzed. Given the retrospective nature of this study, the design adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. For this study, 102 patients who were diagnosed with NCCLs and had their restorations completed in the Faculty of Dentistry for routine dental care by a single operative dentist between May 2015 and July 2015 were evaluated. 25 volunteers (10 females, 15 males) with ages ranging from 36 to 72 (avg. age 50.2) and a total of 246 restorations were selected for this study according to predetermined criteria (Table 1) (Figure 1). The operator was not blind to the intervention, as the technique required the use of various clinical procedures. However, both examiners and all patients were unaware of the group assignment. Sample Size Calculation The sample size calculation was based on the retention rate of restoration, using G* Power statistical software. At least 238 restorations were required to achieve an effect size (Cohen 'D Effect Size) difference of 0.30 between the groups at 99% power, DF=2, and an alpha error of 5%. Patient Selection Adults who met the inclusion/exclusion criteria and required a restoration of at least one notch-shaped NCCL were included in the study. The inclusion criteria were the presence of at least 20 teeth and 6 NCCL, the absence of common caries, and the use of universal adhesive and nanohybrid resin composite. Candidates with poor oral hygiene, xerostomia, acute or chronic periodontal disease, and malocclusion were excluded. The data were retrospectively collected from patient records. The selection of adhesive modes for each patient was documented in their medical records at the time of treatment. These records were later analyzed to evaluate the performance of each adhesive mode. No randomization was performed in this retrospective analysis. Patient records, including details of the adhesive mode used (ER, SLE, or SE), the size of the lesions, the restorative materials, and the finishing techniques, were retrospectively reviewed. All procedures were standardized within the clinical setting at the time of treatment, but the study itself involved no intervention or randomization. It was required that at least one of the adhesive modes be applied to a minimum of six teeth per patient. After reviewing the patient forms, the necessary tooth groupings were made according to the data. Application Procedure of Restorations According to the clinical protocols at the time, prophylactic measures included the use of pumice stone and water. The height, width, and depth of the NCCL were recorded in the patients' medical records using a digital caliper and expressed in millimeters. According to the clinical protocols at the time, prophylactic measures included the use of pumice stone and water. Sclerotic dentin was abraded with a round diamond bur (GZ Instrumente, Austria) at low speed with water cooling, and the enamel surface was beveled (45°, 1-2 mm) with a flame diamond bur (GZ Instrumente, Austria). Isolation was achieved using retraction cords (Ultrapak, Ultradent Products, USA) and cotton rolls. Three different application modes of the universal dentin bonding (Single Bond Universal, 3M ESPE, Germany) adhesive were documented: ER, where both dentin and enamel were etched; SLE, where only the enamel was etched; and SE, where only the adhesive was applied (Table 2). For each patient, the adhesive mode used was applied to at least six teeth. In accordance with the manufacturer's recommendations documented at the time; in ER mode, enamel and dentin were etched with 35% orthophosphoric acid (Scotchbond Universal Etchant, 3M ESPE, Germany) for 15 seconds, washed for 15 seconds, and after air-drying, the adhesive was applied to enamel and dentin by rubbing for 20 seconds. In SLE mode, only the enamel margin was etched for 15 seconds, washed for 15 seconds, and dried, and the adhesive was applied to the dentin and enamel by rubbing for 20 seconds. In SE mode, the adhesive was applied to the dentin and enamel by rubbing for 20 seconds. After the adhesive was applied in all modes, it was dried for 5 seconds gently and polymerized for 10 seconds using a curing light (SmartLite Focus, Dentsply Sirona, USA). All restorations were then completed with the same nanohybrid resin composite (Filtek Z550, 3M ESPE, USA) following the layering technique. The final restorations were polished under water cooling using fine diamond burs (GZ Instrumente, Austria) and polishing discs (Soflex Finishing and Polishing Disc, 3M ESPE, USA). Assessment of Restorations The restorations were evaluated at the 1st, 6th, 12th, 18th, and 36th months based on the FDI criteria, and the results were retrospectively documented in the clinical records. Two experienced examiners, who had been previously calibrated, conducted the evaluations using a mirror and sond under reflector light. These calibrations were based on standardized photographs representing each score for the FDI criteria, ensuring consistent evaluations over time. As recorded in the clinical notes, periodic recalibration was conducted during the 36-month period to maintain consistency in the evaluation criteria. The examiners were not involved in the placement of the restorations, and according to the records, they were blinded to the group assignments. An inter-examiner and intra-examiner agreement of at least 85% was achieved, as documented in the calibration process.[15, 30] The patients were also noted to be unaware of which restorations were applied to their teeth. The primer outcome measure, as documented in the clinical records, was the fracture of material and retention of the restoration. The secondary outcomes assessed in the study were marginal staining, marginal adaptation, post-operative sensitivity and vitality, recurrence of caries, erosion and abfraction, and tooth integrity according to the FDI criteria[31]. According to the FDI criteria, these variables were ranked as follows: clinically very good (1), clinically good (2), clinically satisfactory (3), clinically unsatisfactory (4), and clinically poor (5). Based on these criteria, values of 1, 2, and 3 are clinically acceptable, while 4 and 5 are considered clinically not acceptable.[31] The difference between the adhesive modes and the time-dependent variation within each mode were evaluated. Among the evaluated restorations, those with retention loss were evaluated only according to the retention loss criteria and scored 5. Statistical Analysis Statistical analyses were performed using IBM SPSS 27 for Windows (IBM Corporation, Armonk, USA). Descriptive statistics were used to describe the distributions of the evaluated FDI criteria, which are considered ordinal categorical variables. Non-parametric tests, including Kruskal-Wallis and Mann-Whitney U tests, were used to compare the behavior of the three adhesion strategies applied at the 36-month follow-up period. The Friedman and Wilcoxon non-parametric tests were used to compare the data obtained for each adhesion strategy among recall times. The level of significance was set at α<0.05. RESULTS The study included a total of 25 patients, consisting of 10 females and 15 males. Participation was 100% in the 1st and 6th month evaluations, it dropped to 88% in the 12th month evaluations, but increased to 92% in the 18th month evaluations, and then to 96% in the 36th month evaluations. The patient who did not participate in the evaluation at the previous control was included in the study instead of being excluded from the study when he/she participated in the next evaluation. Therefore, the rates have increased. The study assessed a total of 246 dental restorations in 25 patients over a period of 36 months. The restorations were categorized into three types: 86 were SE, 78 were SLE, and 82 were ER. The purpose was to evaluate the performance of a universal adhesive agent in different usage modes. The evaluation was performed at the 1st, 6th, 12th, 18th, and 36th month using FDI criteria. The results for each FDI criterion were reported as medians and interquartile ranges (IQR). Statistical significance was determined using the appropriate non-parametric tests (p<0.05). The following results were found: The retention loss rate was 3.4% for SE, 1.25% for SLE, and 1.19% for ER at the end of 6th month; 8.10% for SE, 4.34% for SLE, and 1.36% for ER at the end of 12th month; 20.27% for SE, 8.69% for SLE, and 1.3% for ER at the end of 18th month; 29.33% for SE, 16.66% for SLE, and 3.89% for ER at the end of 36th month. (Table 3). Statistically significant interactions (p<0.05) were observed between the time periods and adhesive modes for certain FDI criteria. At the 36-month, the ER mode outperformed the SE mode in terms of marginal staining, fracture of material and retention, marginal adaptation, and the recurrence of caries, erosion, and abfraction (p0.05), nor between SLE and ER (p>0.05) (Table 4). ER was clinically good (2), SE and SLE were clinically satisfactory (3), and all adhesives were clinically acceptable with respect to marginal staining, fracture of material and retention, marginal adaptation, post-operative sensitivity and vitality, recurrence of caries, erosion and abfraction, and tooth integrity at the 36th month. DISCUSSION The null hypothesis was rejected, indicating statistically significant interactions between time periods and adhesive mechanisms for all FDI criteria, with the ER mode being clinically more successful than the SE and SLE modes (p < 0.05). Clinical studies suggest that the ER method is recommended for enhancing the survival rates of composite restorations in NCCLs.[ 16 , 23 ] The results of our study showed clinically acceptable performance of universal adhesives in NCCLs for SE, SLE, and ER strategies, according to the FDI criteria. However, there was a statistically significant difference between SE and ER adhesive strategies in terms of marginal staining, fracture of material and retention, marginal adaptation and recurrence of caries erosion and abfraction criteria at the 36-month follow-ups (p < 0,05). Additionally, the ER group showed slightly better retention rates during all follow-up periods. A 5-year study with the SBU adhesive comparing different modes found that the ER mode performed better.[ 23 ] A 2-year clinical evaluation of NCCLs found that the application of SBU adhesive in either ER or SE mode did not affect the marginal adaptation of the restoration. However, there was a higher incidence of marginal discoloration observed in the SE mode.[ 25 ] A recent systematic review on the use of SE adhesive systems in NCCLs concluded that SLE prior to the application of the adhesive systems yielded restorations with greater longevity and less marginal discoloration and loss of retention.[ 10 ] This indicates that etching may be an effective adjunct treatment for achieving better clinical outcomes in the management of NCCLs.[ 10 ] Some studies have shown that universal adhesives perform better when applied using the SE mode, while others have not shown a significant difference when comparing the ER and SE modes.[ 32 , 33 ] According to in vitro studies, phosphoric acid in SLE results in significantly improved bonding performance and durability.[ 5 , 34 ] In practice, etching enamel precisely without affecting exposed dentin can be challenging. However, studies have shown that universal adhesives can achieve adequate bonding to sclerotic dentin, ensuring sufficient penetration and bonding quality even when pre-etching occurs.[ 14 ] This highlights the importance of carefully selecting and applying adhesive strategies based on the clinical situation. Additionally, while the SE mode can be advantageous in certain situations due to its simplified application and reduced sensitivity to moisture, it is crucial to understand its limitations, especially regarding deeply demineralized dentin. [ 1 , 15 , 35 ] Therefore, it is crucial to adopt a customized approach based on the specific clinical context and the condition of the tooth structure to optimize bonding performance and ensure the longevity of the restorations. Our results showed higher retention with the ER mode of adhesive strategy. This is likely due to the deeper etching and better penetration of resin monomers into the dentin, creating a more stable bond. In spite of their technical sensitivity and increased number of steps, ER mode of adhesives appears more efficient than SLE and SE mode of adhesives. Due to the advantages of phosphoric acid etching on enamel, SLE is currently a widely used technique when universal adhesives are utilized. However, because the dentin surface is left unetched, SE and SLE share a bonding mechanism. When NCCLs treated with SBU adhesive were evaluated after 5 years, the absence of the acid etching of dentin was also associated with a higher retention loss, even when the enamel was selectively etched.[ 6 , 23 ] When considered in this context, it can be thought that this result may be due to the acidity of the adhesive. Because the pH of the SBU adhesive used in our study is mild, it is possible that it was insufficient for etching the dentin. As a result, while acid application increases enamel bonding in all universal adhesives, its effectiveness may vary depending on the acidity of the adhesive used in dentin etching.[ 8 , 36 , 37 ] However, the acidity of the adhesive itself can also affect the bond strength. In general, more acidic adhesives can achieve a stronger bond to dentin when used with acid etching, but excessive acidity can also damage the dentin and compromise bond strength. Therefore, it is important to carefully balance the acidity of the adhesive with the acid etching process to achieve the best possible bond strength without causing harm to the tooth structure.[ 38 , 39 ] MDP, one of the functional monomers that increase bonding in universal adhesive content, has been a part of the composition of dental adhesives for decades. The effectiveness of functional monomers in conditioning the enamel structure to prevent marginal staining in restorations has been doubted.[ 18 , 40 , 41 ] Previous studies have shown that while 10-MDP can enhance bond strength by forming a stable MDP-Ca salt with calcium in hydroxyapatite, its effectiveness in preventing marginal staining is less clear.[ 17 , 19 ] In our study, after 36 months, SBU exhibited varying degrees of marginal staining across different adhesive modes. Specifically, marginal staining was significantly higher in the SE mode compared to the ER and SLE modes. This finding aligns with previous clinical studies that have reported similar issues with SE mode of adhesives.[ 9 , 20 ] One possible explanation for the increased marginal staining in the SE mode is the inherent properties of adhesives, including their lower pH and reduced ability to remove the smear layer, which may hinder the complete penetration of resin monomers into the dentin substrate, leading to compromised bonding quality.[ 1 ] Upon evaluating all these findings, it can be concluded that using acid etch application is a favorable choice for universal adhesives to improve bonding with enamel. Clinical studies suggest that etching the enamel for SE mode of adhesives enhances the bonding of restorations, resulting in improved marginal integrity and less marginal discoloration.[ 23 , 24 ] Nevertheless, the quantity of resin impregnation in the SE mode was influenced by the formation of a hybrid layer that was thinner compared to the hybrid layer formed in the ER mode. It has been reported that the thickness of the hybrid layer did not significantly affect the bonding to dentin.[ 42 ] However, the presence of dentinal sclerosis can significantly impact dentin bonding. Sclerotic dentin, characterized by the occlusion of dentinal tubules with calcium salts, is more resistant to acid etching and may lead to reduced bonding efficacy.[ 12 ] According to a study, when using SE mode of adhesive, the bond strength to sclerotic dentin was found lower compared to normal dentin.[ 13 ] Another study also found that the use of SE and ER modes resulted in lower bond strength to sclerotic dentin compared to normal dentin.[ 43 ] In the past, various evaluation systems have been published for assessing restored teeth. The United States Public Health Service (USPHS) criteria and the FDI criteria are two frequently employed clinical assessment methods.[ 31 ] One fundamental component of the USPHS criteria involved creating standards for clinical testing and assessing their dependability. These criteria are widely accepted and utilized in dental restoration clinical trials. However, as dental restorative materials improved, a more discriminative and sensitive scale was needed. [ 31 , 44 ] Therefore, in 2007, the Science Committee of the FDI World Dental Federation proposed and approved the revised clinical criteria, now called the "FDI criteria". These criteria, described as practical, relevant, and standardized, offer a valuable framework for standardizing clinical judgment in restorative materials and study designs. Researchers are encouraged to employ these criteria to enhance standardization in their evaluations, facilitating comparisons with other studies.[ 31 , 44 ] In a 36-month evaluation of restorations using Scotchbond Universal adhesive, it was observed that the FDI criteria were more sensitive in detecting small changes compared to the modified USPHS criteria. Additionally, the flexibility of the FDI criteria in terms of criteria and scoring provides researchers with additional options. [ 24 , 31 ] As a result, FDI criteria, which offer a more sensitive evaluation of restorations and patients' opinions, were preferred in our study. These findings highlight the importance of carefully selecting and applying adhesive strategies based on the specific clinical situation to optimize bonding performance and ensure the longevity of restorations. This study is limited by its retrospective design, which may introduce selection bias due to the non-randomized nature of the data. Furthermore, retrospective data analysis relies on the accuracy and completeness of medical records, which may also affect the results. Additionally, the entire investigation was conducted within the controlled environment of a university, where the restorations were placed under optimal conditions by a single experienced operator, potentially limiting the generalizability of the findings to other clinical environments. Another constraint is the focus on a single brand of material, suggesting that further clinical studies are necessary to evaluate a broader range of materials and brands. Moreover, this study did not assess dentin sclerosis levels in lesions prior to restoration, a factor that may influence the outcomes and has been considered in other studies on universal adhesives. [ 24 , 25 ] CONCLUSIONS All adhesive modes used in the study were clinically acceptable in all the FDI criteria after a 36-month evaluation. ER mode of adhesive was found to be clinically good (2), while SE and SLE were clinically satisfactory (3). These findings support the use of the ER mode for long-term clinical success in non-carious cervical lesions. Declarations Conflict of Interest: The authors declare that they have no conflict of interest. Accnowlegments: Nil Clinical Trial registration: Clinical trials number- NCT06227715, Clinical trials link: https://clinicaltrials.gov/study/NCT06227715 Ethics approval and consent to participate: This clinical trial was conducted in Faculty of Dentistry- Osmangazi University, Turkey and was implemented following the ethical principles stated in the World Medical Association Declaration of Helsinki. The research protocol was reviewed and approved by the research ethics committee of the faculty with approval number E-25403353-050.99-2400074339 Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Accnowlegments: Nil Clinical Trial registration: Clinical trials number- NCT06227715, Clinical trials link: https://clinicaltrials.gov/study/NCT06227715 Ethics approval and consent to participate: This clinical trial was conducted in Faculty of Dentistry- Osmangazi University, Turkey and was implemented following the ethical principles stated in the World Medical Association Declaration of Helsinki. The research protocol was reviewed and approved by the research ethics committee of the faculty with approval number E-25403353-050.99-2400074339 Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. References Takamizawa T, Barkmeier WW, Tsujimoto A, Berry TP, Watanabe H, Erickson RL, et al. Influence of different etching modes on bond strength and fatigue strength to dentin using universal adhesive systems. 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Dent Mater. 2014;30(10):1089-103.https://doi.org/10.1016/j.dental.2014.07.007 Goodacre CJ, Eugene Roberts W, Munoz CA. Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration. J Prosthodont. 2023;32(2):e1-e18.10.1111/jopr.13585 Rouse MA, May JT, Platt JA, Cook NB, Capin OR, Adams BN, et al. Clinical evaluation of a universal adhesive in non‐carious cervical lesions. J Esthet Restor Dent. 2020;32(7):691-8.10.1111/jerd.12622 Tay FR, Nawareg MA, Abuelenain D, Pashley DH. Cervical sclerotic dentin: Resin bonding. Understanding Dental Caries: From Pathogenesis to Prevention and Therapy2016. p. 97-125. Wang J, Song W, Zhu L, Wei X. A comparative study of the microtensile bond strength and microstructural differences between sclerotic and Normal dentine after surface pretreatment. BMC Oral Health. 2019;19:1-10 Loguercio AD, Luque-Martinez IV, Fuentes S, Reis A, Muñoz MA. Effect of dentin roughness on the adhesive performance in non-carious cervical lesions: A double-blind randomized clinical trial. J Dent. 2018;69:60-9 Boushell LW, Heymann HO, Ritter AV, Sturdevant JR, Swift Jr EJ, Wilder Jr AD, et al. Six-year clinical performance of etch-and-rinse and self-etch adhesives. Dent Mater. 2016;32(9):1065-72.10.1016/j.dental.2016.06.003 Nagarkar S, Theis‐Mahon N, Perdigão J. Universal dental adhesives: Current status, laboratory testing, and clinical performance. J Biomed Mater Res B. 2019;107(6):2121-31.doi.org/10.1002/jbm.b.34305 Yoshida Y, Yoshihara K, Nagaoka N, Hayakawa S, Torii Y, Ogawa T, et al. Self-assembled nano-layering at the adhesive interface. J Dent Res. 2012;91(4):376-81.10.1177/00220345124373 Van Landuyt KL, Snauwaert J, De Munck J, Peumans M, Yoshida Y, Poitevin A, et al. Systematic review of the chemical composition of contemporary dental adhesives. Biomater. 2007;28(26):3757-85.10.1016/j.biomaterials.2007.04.044 Van Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J, Van Landuyt K. State of the art of self-etch adhesives. Dent Mater. 2011;27(1):17-28.https://doi.org/10.1016/j.dental.2010.10.023 Heintze SD, Rousson V, Mahn E. Bond strength tests of dental adhesive systems and their correlation with clinical results–a meta-analysis. Dent Mater. 2015;31(4):423-34.https://doi.org/10.1016/j.dental.2015.01.011 Sezinando A, Perdigão J, Ceballos L. Long-term In Vitro Adhesion of Polyalkenoate-based Adhesives to Dentin. J Adhes Dent. 2017;19(4).10.3290/j.jad.a38895 Single Bond Universal product information of the manufacturer: [Available from: https://multimedia.3m.com/mws/media/1400783O/single-bond-universal-adhesive-scientific-facts.pdf. Fuentes MV, Perdigão J, Baracco B, Giráldez I, Ceballos L. Effect of an additional bonding resin on the 5-year performance of a universal adhesive: A randomized clinical trial. Clin Oral Investig. 2023;27(2):837-48.10.1007/s00784-022-04613-8 Loguercio AD, De Paula EA, Hass V, Luque-Martinez I, Reis A, Perdigão J. A new universal simplified adhesive: 36-Month randomized double-blind clinical trial. J Dent. 2015;43(9):1083-92.10.1016/j.jdent.2015.07.005 Lawson NC, Robles A, Fu C-C, Lin CP, Sawlani K, Burgess JO. Two-year clinical trial of a universal adhesive in total-etch and self-etch mode in non-carious cervical lesions. J Dent. 2015;43(10):1229-34.10.1016/j.jdent.2015.07.009 Chen C, Niu L-N, Xie H, Zhang Z-Y, Zhou L-Q, Jiao K, et al. Bonding of universal adhesives to dentine–old wine in new bottles? J Dent. 2015;43(5):525-36.10.1016/j.jdent.2015.03.004 Ñaupari-Villasante R, Matos TP, de Albuquerque EG, Warol F, Tardem C, Calazans FS, et al. Five-year clinical evaluation of universal adhesive applied following different bonding techniques: A randomized multicenter clinical trial. Dent Mater. 2023;39(6):586-94 Yazici AR, Tekce AU, Kutuk ZB. Comparative evaluation of different adhesive strategies of a universal adhesive in class II bulk-fill restorations: A 48-month randomized controlled trial. J Dent. 2022;117:103921 Ruschel V, Stolf S, da Luz Baratieri C, Chung Y, Boushell L, Baratieri L, et al. Five-year clinical evaluation of universal adhesives in noncarious cervical lesions. Oper Dent. 2023;48(4):364-72 Schmalz G, Ryge G. Reprint of Criteria for the clinical evaluation of dental restorative materials. Clin Oral Investig. 2005;9:215-32 Hickel R, Peschke A, Tyas M, Mjor I, Bayne S, Peters M, et al. FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples. Clin Oral Investig. 2010;14(4):349-66.10.1007/s00784-010-0432-8 Yoshihara K, Hayakawa S, Nagaoka N, Okihara T, Yoshida Y, Van Meerbeek B. Etching efficacy of self-etching functional monomers. J Dent Res. 2018;97(9):1010-6.10.1177/002203451876360 Muñoz M, Luque-Martinez I, Malaquias P, Hass V, Reis A, Campanha N, et al. In vitro longevity of bonding properties of universal adhesives to dentin. Oper Dent. 2015;40(3):282-92.10.2341/14-055-L Manarte-Monteiro P, Domingues J, Teixeira L, Gavinha S, Manso MC. Universal Adhesives and Adhesion Modes in Non-Carious Cervical Restorations: 2-Year Randomised Clinical Trial. Polymers. 2021;14(1):33.10.3390/polym14010033 Ikeda M, Kurokawa H, Sunada N, Tamura Y, Takimoto M, Murayama R, et al. Influence of previous acid etching on dentin bond strength of self-etch adhesives. J Oral Sci. 2009;51(4):527-34.10.2334/josnusd.51.527 Rosa WL, Piva E, Silva AF. Bond strength of universal adhesives: A systematic review and meta-analysis. J Dent. 2015;43(7):765-76.10.1016/j.jdent.2015.04.003 Van Meerbeek B, Van Landuyt K, De Munck J, Hashimoto M, Peumans M, Lambrechts P, et al. Technique-sensitivity of contemporary adhesives. Dent Mater J. 2005;24(1):1-13.10.4012/dmj.24.1 Choi A-N, Lee J-H, Son S-A, Jung K-H, Kwon YH, Park J-K. Effect of dentin wetness on the bond strength of universal adhesives. Mater. 2017;10(11):1224.https://doi.org/10.3390/ma10111224 Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, et al. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021;13(5):814.https://doi.org/10.3390/polym13050814 Yoshihara K, Yoshida Y, Nagaoka N, Hayakawa S, Okihara T, De Munck J, et al. Adhesive interfacial interaction affected by different carbon-chain monomers. Dent Mater. 2013;29(8):888-97.10.1016/j.dental.2013.05.006 Feitosa VP, Sauro S, Ogliari FA, Ogliari AO, Yoshihara K, Zanchi CH, et al. Impact of hydrophilicity and length of spacer chains on the bonding of functional monomers. Dent Mater. 2014;30(12):e317-e23.10.1016/j.dental.2014.06.006 Peumans M, De Munck J, Van Landuyt K, Van Meerbeek B. Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions. Dent Mater. 2015;31(3):308-14.10.1016/j.dental.2015.01.005 Karakaya S, Unlu N, Say EC, Oezer F, Soyman M, Tagami J. Bond strengths of three different dentin adhesive systems to sclerotic dentin. Dent Mater J. 2008;27(3):471-9.https://doi.org/10.4012/dmj.27.471 Hickel R, Roulet J-F, Bayne S, Heintze SD, Mjör IA, Peters M, et al. Recommendations for conducting controlled clinical studies of dental restorative materials. Clin Oral Investig. 2007;11:5-33.10.1007/s00784-006-0095-7 Tables Table 1: Distribution of NCCLs according to research subject and characteristics of lesions (nP: Number of patients, nR: Number of restorations) Characteristics of research subjects nP Gender Male 10 Female 15 Age 35 - 45 7 46 - 60 14 >60 4 Number of NCCLs nR Tooth Incisor 53 Canine 52 Premolar 122 Molar 19 Arc Maxillary 142 Mandibular 104 Height (mm) 4 39 Width (mm) 4 69 Depth (mm) 1 143 Table 2: Composition and Application Procedure of the Adhesive Adhesive Material Composition Mode Application Technique Lot No Single Bond Universal Adhesive 3M ESPE, Germany Mild pH:2.7 MDP Phosphate Monomer Dimethacrylate Resins 2-Hydroxyethyl Methacrylate (HEMA) Vitrebond Copolymer Filler Ethanol Water Initiators Silane ER Apply etchant for enamel and dentin 15 s Apply the adhesive for 20 s Gently air for 5 s Light cure for 10 s 521194 SLE Apply etchant for enamel margin 15 s Apply the adhesive for 20 s Gently air for 5 s Light cure for 10 s SE Apply the adhesive for 20 s Gently air for 5 s Light cure for 10 s Filtek Z 550 Universal Restorative 3M ESPE, USA Nanohybrid resin composite Bis-GMA UDMA TEGDMA PEGDMA Bis-EMA Silica Zirconia Polymerizes for 20 s for 2 mm layer N291350 Scotchbond Universal Etchant 3M ESPE, Germany pH: 0.1 Water Phosphoric acid (34%), Poly (vinyl alcohol) ER Enamel and dentin etched were for 15 s, washed for 15 s, and dried 594504 SLE Only enamel margin was etched for 15 s, washed for 15 s and dried Table 3: Retention loss rate according to months and adhesive modes Months Adhesive Modes SE SLE ER 6th Month 3,40% 1,25% 1,19% 12th Month 8,10% 4,34% 1,36% 18th Month 20,27% 8,69% 1,36% 36th Month 29,33% 16,66% 3,89% Table 4: Difference between groups according to time and adhesive modes according to the FDI criteria. Values in bold indicate significant statistical differences. (P value: Significance Difference) (* The mean difference is significant at the 0.05 level) P-values were calculated using appropriate non-parametric tests: Mann-Whitney U tests were used for pairwise comparisons between adhesive modes, and Friedman tests were used for comparing data across different time points within the same group. P Value 6 Month 12 Month 18 Month 36 Month Mod SE SLE ER SE SLE ER SE SLE ER SE SLE ER Marginal Staining SE 0.79 0.44 0.29 0.29 0.79 0.23 0.46 0.02 SLE 0.79 0.61 0.29 0.92 0.79 0.83 0.46 0.26 ER 0.44 0.61 0.29 0.92 0.23 0.83 0.02 0.26 Fracture of Material and Retention SE 0.05 0.22 0.63 0.35 0.44 0.07 0.95 0.01 SLE 0.05 0.54 0.63 0.67 0.44 0.25 0.95 0.18 ER 0.22 0.54 0.35 0.67 0.07 0.25 0.01 0.18 0.41 Marginal Adaptation SE 0.05 0.07 0.33 0.34 0.41 0.16 0.44 0.04 SLE 0.05 0.83 0.33 0.92 0.41 0.59 0.44 0.26 ER 0.07 0.83 0.34 0.92 0.16 0.59 0.04 0.26 Post-Op Sensitivity and Vitality SE 0.65 0.82 0.52 0.42 0.38 0.13 0.79 0.41 SLE 0.65 0.83 0.52 0.91 0.38 0.52 0.79 0.17 ER 0.82 0.83 0.42 0.91 0.13 0.52 0.41 0.17 Recurrence of Caries Erosion and Abfraction SE 0.22 0.20 0.61 0.42 0.26 0.09 0.51 0.04 SLE 0.22 0.98 0.61 0.78 0.26 0.63 0.51 0.15 ER 0.20 0.98 0.42 0.78 0.09 0.63 0.04 0.15 Tooth Integrity SE 0.37 0.34 0.95 0.73 0.45 0.10 0.51 0.05 SLE 0.37 0.98 0.95 0.65 0.45 0.33 0.51 0.15 ER 0.34 0.98 0.73 0.65 0.10 0.33 0.05 0.15 *. The mean difference is significant at the 0.05 level. Additional Declarations No competing interests reported. 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Universal adhesives are common dental materials that can be used on dental hard tissues and the application of universal adhesives in dental practice involves several strategies, each tailored to maximize adhesion and clinical outcomes. These strategies include a simple self-etch (SE) method, or with phosphoric acid in either etch-and-rinse (ER) or selective-enamel-etching (SLE) modes, and have been evaluated in various in vitro and clinical studies to determine their effectiveness in different clinical scenarios.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] ER mode, phosphoric acid is applied to etch the tooth surface before the adhesive is used. This approach enhances bond strength, especially to enamel, by creating a thicker hybrid layer that allows for better resin impregnation.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] As highlighted earlier, various studies have suggested the application of phosphoric acid on enamel margins for 10\u0026ndash;15 seconds to improve long-term clinical outcomes, particularly enhancing marginal integrity and preventing marginal discoloration.[\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] In the SE mode involves applying the adhesive directly to the tooth surface without prior etching. This method simplifies the bonding process and reduces technique sensitivity, making it advantageous in certain clinical situations. However, SE adhesives may form a thinner hybrid layer, which can affect bonding strength, particularly to sclerotic dentin. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] The SLE mode combines both SE and ER approaches by selectively etching only the enamel while leaving the dentin unetched. This strategy aims to optimize adhesion to both substrates, leveraging the advantages of both methods. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] A recent systematic review on the use of SE adhesive systems in NCCLs concluded that SLE prior to the application of the adhesive systems resulted in restorations with greater longevity and less marginal discoloration and retention loss.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] These strategies have been evaluated in various in vitro and clinical studies to determine their effectiveness in different clinical scenarios.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eNCCLs are frequently chosen for resin composite and adhesive application studies due to the absence of instrumentation requirements. Furthermore, these lesions have both dentin and enamel margins, allowing the observation of any bonding differences between these two surfaces.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] NCCLs, on the other hand, are usually comprised of sclerotic dentin, which, due to its acid resistance, can prevent maximum adhesion, as a result, resin composites have a significantly lower bond strength to sclerotic dentin than to normal dentin.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] To improve restoration retention, it is recommended that the dentin surface be textured with a rotary instrument, and some clinicians also incorporate mechanical retention.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] On the contrary, according to a study, dentin roughening before the application of SE and ER modes did not affect the clinical performance of composite restorations placed in NCCLs.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Therefore, SE adhesives may not be appropriate for highly sclerotic surfaces.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Beveling of the enamel is more effectively etched than dentin and used to increase bonding area and retention, as well as to improve esthetics by gradually creating a color change between the restoration and tooth.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] In addition, it increases the bonding surface area by enhancing micromechanical retention.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe SE, SLE, or ER application techniques are facilitated by including hydrophilic particular carboxylate and/or phosphate functional monomers.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Universal adhesives commonly contain the functional monomer 10-methacryloyloxydecyl dihydrogen phosphate (MDP), which can chemically interact with hydroxyapatite, is hydrolytically stable and improves adhesion strength.[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The polyalkenoic acid copolymer (Vitrebond copolymer) used in certain Scotchbond Universal adhesives (3M Oral Care, USA) chemically attaches to calcium ions in hydroxyapatite, potentially enhancing long-term bond durability.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Scotchbond Universal and Single Bond Universal (3M ESPE, Germany) (SBU) are the same adhesive but sold in different regions of the world under different product names.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] SBU is a versatile universal adhesive supported by various clinical studies, particularly evaluating its effectiveness on NCCLs. These studies have examined the long-term clinical performance of restorations using different application modes of SBU, including ER, SLE and SE methods. A series of studies have reported that using SBU in the ER mode results in higher retention rates and lower marginal discoloration.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Another study indicated that SBU demonstrated satisfactory clinical performance even in the SE mode, but the ER mode generally yielded better results.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] In a study with a 24-month follow-up period, it was shown that using SBU in the ER mode provided high retention rates and low postoperative sensitivity in NCCLs.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] In conclusion, these studies on the use of SBU in NCCLs indicate that the choice of adhesive strategy significantly affects the long-term success of restorations.\u003c/p\u003e \u003cp\u003eThis study specifically investigates the application modes of universal adhesive and their long-term clinical performance. Previous studies suggest that the performance of universal adhesives varies depending on the type of material used, and not all laboratory and clinical research supports the idea that any adhesive method can be applied with universal adhesives.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] Therefore, it is crucial to investigate the most effective application strategies for universal adhesives to improve clinical outcomes. This one-bottle method undoubtedly simplifies adhesive procedures in dental tissue treatment. However, due to its recent introduction, studies assessing the effectiveness of this adhesive in the treatment of non-carious cervical lesions (NCCL) still lack sufficient follow-up periods. Therefore, there is a need for longer-term follow-up studies to fully evaluate the outcomes for NCCLs.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Considering the heterogeneity of previously published results, more clinical studies are required to clarify the clinical performance of universal systems. The purpose of this study was to compare the effectiveness of ER, SLE, and SE application modes of a universal adhesive in NCCL according to the Federation Dentaire Internationale (FDI) criteria after 36 months. The null hypothesis tested was that there would be no significant differences in clinical failure rates and clinical success between the ER, SE, and SLE modes of universal adhesive in restoring NCCLs according to FDI criteria over the evaluated time periods.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Non-Interventional Clinical Research Ethics Committee (E-25403353-050.99-2400074339.) approved the study and registered it with ClinicalTrials.gov (NCT06227715). This study is a retrospective analysis of patients who received treatment between May 2015 and July 2015 at the Faculty of Dentistry. All relevant data, including patient records and treatment outcomes, were retrospectively analyzed. Given the retrospective nature of this study, the design adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. For this study, 102 patients who were diagnosed with NCCLs and had their restorations completed in the Faculty of Dentistry for routine dental care by a single operative dentist between May 2015 and July 2015 were evaluated. 25 volunteers (10 females, 15 males) with ages ranging from 36 to 72 (avg. age\u0026nbsp;50.2) and a total of 246 restorations were selected for this study according to predetermined criteria (Table 1) (Figure 1). The operator was not blind to the intervention, as the technique required the use of various clinical procedures. However, both examiners and all patients were unaware of the group assignment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size calculation was based on the retention rate of restoration, using G* Power statistical software. At least 238 restorations were required to achieve an effect size (Cohen \u0026apos;D Effect Size) difference of 0.30 between the groups at 99% power, DF=2, and an alpha error of 5%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdults who met the inclusion/exclusion criteria and required a restoration of at least one notch-shaped NCCL were included in the study. The inclusion criteria were the presence of at least 20 teeth and 6 NCCL, the absence of common caries, and the use of universal adhesive and nanohybrid resin composite. Candidates with poor oral hygiene, xerostomia, acute or chronic periodontal disease, and malocclusion were excluded.\u003c/p\u003e\n\u003cp\u003eThe data were retrospectively collected from patient records. The selection of adhesive modes for each patient was documented in their medical records at the time of treatment. These records were later analyzed to evaluate the performance of each adhesive mode. No randomization was performed in this retrospective analysis.\u003c/p\u003e\n\u003cp\u003ePatient records, including details of the adhesive mode used (ER, SLE, or SE), the size of the lesions, the restorative materials, and the finishing techniques, were retrospectively reviewed. All procedures were standardized within the clinical setting at the time of treatment, but the study itself involved no intervention or randomization. It was required that at least one of the adhesive modes be applied to a minimum of six teeth per patient. After reviewing the patient forms, the necessary tooth groupings were made according to the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApplication Procedure of Restorations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the clinical protocols at the time, prophylactic measures included the use of pumice stone and water.\u003c/p\u003e\n\u003cp\u003eThe height, width, and depth of the NCCL were recorded in the patients\u0026apos; medical records using a digital caliper and expressed in millimeters. According to the clinical protocols at the time, prophylactic measures included the use of pumice stone and water. Sclerotic dentin was abraded with a round diamond bur (GZ Instrumente, Austria) at low speed with water cooling, and the enamel surface was beveled (45\u0026deg;, 1-2 mm) with a flame diamond bur (GZ Instrumente, Austria). Isolation was achieved using retraction cords (Ultrapak, Ultradent Products, USA) and cotton rolls. Three different application modes of the universal dentin bonding (Single Bond Universal, 3M ESPE, Germany) adhesive were documented: ER, where both dentin and enamel were etched; SLE, where only the enamel was etched; and SE, where only the adhesive was applied (Table 2). For each patient, the adhesive mode used was applied to at least six teeth. In accordance with the manufacturer\u0026apos;s recommendations documented at the time; in ER mode, enamel and dentin were etched with 35% orthophosphoric acid (Scotchbond Universal Etchant, 3M ESPE, Germany) for 15 seconds, washed for 15 seconds, and after air-drying, the adhesive was applied to enamel and dentin by rubbing for 20 seconds. In SLE mode, only the enamel margin was etched for 15 seconds, washed for 15 seconds, and dried, and the adhesive was applied to the dentin and enamel by rubbing for 20 seconds. In SE mode, the adhesive was applied to the dentin and enamel by rubbing for 20 seconds. After the adhesive was applied in all modes, it was dried for 5 seconds gently and polymerized for 10 seconds using a curing light (SmartLite Focus, Dentsply Sirona, USA). \u0026nbsp;All restorations were then completed with the same nanohybrid resin composite (Filtek Z550, 3M ESPE, USA) following the layering technique. The final restorations were polished under water cooling using fine diamond burs (GZ Instrumente, Austria) and polishing discs (Soflex Finishing and Polishing Disc, 3M ESPE, USA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of Restorations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe restorations were evaluated at the 1st, 6th, 12th, 18th, and 36th months based on the FDI criteria, and the results were retrospectively documented in the clinical records. Two experienced examiners, who had been previously calibrated, conducted the evaluations using a mirror and sond under reflector light. These calibrations were based on standardized photographs representing each score for the FDI criteria, ensuring consistent evaluations over time. As recorded in the clinical notes, periodic recalibration was conducted during the 36-month period to maintain consistency in the evaluation criteria. The examiners were not involved in the placement of the restorations, and according to the records, they were blinded to the group assignments. An inter-examiner and intra-examiner agreement of at least 85% was achieved, as documented in the calibration process.[15, 30] The patients were also noted to be unaware of which restorations were applied to their teeth.\u003c/p\u003e\n\u003cp\u003eThe primer outcome measure, as documented in the clinical records, was the fracture of material and retention of the restoration. The secondary outcomes assessed in the study were marginal staining, marginal adaptation, post-operative sensitivity and vitality, recurrence of caries, erosion and abfraction, and tooth integrity according to the FDI criteria[31]. According to the FDI criteria, these variables were ranked as follows: clinically very good (1), clinically good (2), clinically satisfactory (3), clinically unsatisfactory (4), and clinically poor (5). Based on these criteria, values of 1, 2, and 3 are clinically acceptable, while 4 and 5 are considered clinically not acceptable.[31] The difference between the adhesive modes and the time-dependent variation within each mode were evaluated. Among the evaluated restorations, those with retention loss were evaluated only according to the retention loss criteria and scored 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using IBM SPSS 27 for Windows (IBM Corporation, Armonk, USA). Descriptive statistics were used to describe the distributions of the evaluated FDI criteria, which are considered ordinal categorical variables. Non-parametric tests, including Kruskal-Wallis and Mann-Whitney U tests, were used to compare the behavior of the three adhesion strategies applied at the 36-month follow-up period. The Friedman and Wilcoxon non-parametric tests were used to compare the data obtained for each adhesion strategy among recall times. The level of significance was set at \u0026alpha;\u0026lt;0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe study included a total of 25 patients, consisting of 10 females and 15 males. Participation was 100% in the 1st and 6th month evaluations, it dropped to 88% in the 12th month evaluations, but increased to 92% in the 18th month evaluations, and then to 96% in the 36th month evaluations. The patient who did not participate in the evaluation at the previous control was included in the study instead of being excluded from the study when he/she participated in the next evaluation. Therefore, the rates have increased. The study assessed a total of 246 dental restorations in 25 patients over a period of 36 months. The restorations were categorized into three types: 86 were SE, 78 were SLE, and 82 were ER. The purpose was to evaluate the performance of a universal adhesive agent in different usage modes. The evaluation was performed at the 1st, 6th, 12th, 18th, and 36th month using FDI criteria. The results for each FDI criterion were reported as medians and interquartile ranges (IQR). Statistical significance was determined using the appropriate non-parametric tests (p\u0026lt;0.05). The following results were found:\u003c/p\u003e\n\u003cp\u003eThe retention loss rate was 3.4% for SE, 1.25% for SLE, and 1.19% for ER at the end of 6th month; 8.10% for SE, 4.34% for SLE, and 1.36% for ER at the end of 12th month; 20.27% for SE, 8.69% for SLE, and 1.3% for ER at the end of 18th month; 29.33% for SE, 16.66% for SLE, and 3.89% for ER at the end of 36th month. (Table 3).\u003c/p\u003e\n\u003cp\u003eStatistically significant interactions (p\u0026lt;0.05) were observed between the time periods and adhesive modes for certain FDI criteria. At the 36-month, the ER mode outperformed the SE mode in terms of marginal staining, fracture of material and retention, marginal adaptation, and the recurrence of caries, erosion, and abfraction (p\u0026lt;0.05). There was no statistically significant difference between SE and SLE (p\u0026gt;0.05), nor between SLE and ER (p\u0026gt;0.05) (Table 4). ER was clinically good (2), SE and SLE were clinically satisfactory (3), and all adhesives were clinically acceptable with respect to marginal staining, fracture of material and retention, marginal adaptation, post-operative sensitivity and vitality, recurrence of caries, erosion and abfraction, and tooth integrity at the 36th month.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe null hypothesis was rejected, indicating statistically significant interactions between time periods and adhesive mechanisms for all FDI criteria, with the ER mode being clinically more successful than the SE and SLE modes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eClinical studies suggest that the ER method is recommended for enhancing the survival rates of composite restorations in NCCLs.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] The results of our study showed clinically acceptable performance of universal adhesives in NCCLs for SE, SLE, and ER strategies, according to the FDI criteria. However, there was a statistically significant difference between SE and ER adhesive strategies in terms of marginal staining, fracture of material and retention, marginal adaptation and recurrence of caries erosion and abfraction criteria at the 36-month follow-ups (p\u0026thinsp;\u0026lt;\u0026thinsp;0,05). Additionally, the ER group showed slightly better retention rates during all follow-up periods. A 5-year study with the SBU adhesive comparing different modes found that the ER mode performed better.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] A 2-year clinical evaluation of NCCLs found that the application of SBU adhesive in either ER or SE mode did not affect the marginal adaptation of the restoration. However, there was a higher incidence of marginal discoloration observed in the SE mode.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] A recent systematic review on the use of SE adhesive systems in NCCLs concluded that SLE prior to the application of the adhesive systems yielded restorations with greater longevity and less marginal discoloration and loss of retention.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] This indicates that etching may be an effective adjunct treatment for achieving better clinical outcomes in the management of NCCLs.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSome studies have shown that universal adhesives perform better when applied using the SE mode, while others have not shown a significant difference when comparing the ER and SE modes.[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] According to in vitro studies, phosphoric acid in SLE results in significantly improved bonding performance and durability.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] In practice, etching enamel precisely without affecting exposed dentin can be challenging. However, studies have shown that universal adhesives can achieve adequate bonding to sclerotic dentin, ensuring sufficient penetration and bonding quality even when pre-etching occurs.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] This highlights the importance of carefully selecting and applying adhesive strategies based on the clinical situation. Additionally, while the SE mode can be advantageous in certain situations due to its simplified application and reduced sensitivity to moisture, it is crucial to understand its limitations, especially regarding deeply demineralized dentin. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] Therefore, it is crucial to adopt a customized approach based on the specific clinical context and the condition of the tooth structure to optimize bonding performance and ensure the longevity of the restorations. Our results showed higher retention with the ER mode of adhesive strategy. This is likely due to the deeper etching and better penetration of resin monomers into the dentin, creating a more stable bond. In spite of their technical sensitivity and increased number of steps, ER mode of adhesives appears more efficient than SLE and SE mode of adhesives.\u003c/p\u003e \u003cp\u003eDue to the advantages of phosphoric acid etching on enamel, SLE is currently a widely used technique when universal adhesives are utilized. However, because the dentin surface is left unetched, SE and SLE share a bonding mechanism. When NCCLs treated with SBU adhesive were evaluated after 5 years, the absence of the acid etching of dentin was also associated with a higher retention loss, even when the enamel was selectively etched.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] When considered in this context, it can be thought that this result may be due to the acidity of the adhesive. Because the pH of the SBU adhesive used in our study is mild, it is possible that it was insufficient for etching the dentin. As a result, while acid application increases enamel bonding in all universal adhesives, its effectiveness may vary depending on the acidity of the adhesive used in dentin etching.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] However, the acidity of the adhesive itself can also affect the bond strength. In general, more acidic adhesives can achieve a stronger bond to dentin when used with acid etching, but excessive acidity can also damage the dentin and compromise bond strength. Therefore, it is important to carefully balance the acidity of the adhesive with the acid etching process to achieve the best possible bond strength without causing harm to the tooth structure.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMDP, one of the functional monomers that increase bonding in universal adhesive content, has been a part of the composition of dental adhesives for decades. The effectiveness of functional monomers in conditioning the enamel structure to prevent marginal staining in restorations has been doubted.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] Previous studies have shown that while 10-MDP can enhance bond strength by forming a stable MDP-Ca salt with calcium in hydroxyapatite, its effectiveness in preventing marginal staining is less clear.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] In our study, after 36 months, SBU exhibited varying degrees of marginal staining across different adhesive modes. Specifically, marginal staining was significantly higher in the SE mode compared to the ER and SLE modes. This finding aligns with previous clinical studies that have reported similar issues with SE mode of adhesives.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] One possible explanation for the increased marginal staining in the SE mode is the inherent properties of adhesives, including their lower pH and reduced ability to remove the smear layer, which may hinder the complete penetration of resin monomers into the dentin substrate, leading to compromised bonding quality.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eUpon evaluating all these findings, it can be concluded that using acid etch application is a favorable choice for universal adhesives to improve bonding with enamel. Clinical studies suggest that etching the enamel for SE mode of adhesives enhances the bonding of restorations, resulting in improved marginal integrity and less marginal discoloration.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Nevertheless, the quantity of resin impregnation in the SE mode was influenced by the formation of a hybrid layer that was thinner compared to the hybrid layer formed in the ER mode. It has been reported that the thickness of the hybrid layer did not significantly affect the bonding to dentin.[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] However, the presence of dentinal sclerosis can significantly impact dentin bonding. Sclerotic dentin, characterized by the occlusion of dentinal tubules with calcium salts, is more resistant to acid etching and may lead to reduced bonding efficacy.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] According to a study, when using SE mode of adhesive, the bond strength to sclerotic dentin was found lower compared to normal dentin.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Another study also found that the use of SE and ER modes resulted in lower bond strength to sclerotic dentin compared to normal dentin.[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn the past, various evaluation systems have been published for assessing restored teeth. The United States Public Health Service (USPHS) criteria and the FDI criteria are two frequently employed clinical assessment methods.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] One fundamental component of the USPHS criteria involved creating standards for clinical testing and assessing their dependability. These criteria are widely accepted and utilized in dental restoration clinical trials. However, as dental restorative materials improved, a more discriminative and sensitive scale was needed. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] Therefore, in 2007, the Science Committee of the FDI World Dental Federation proposed and approved the revised clinical criteria, now called the \"FDI criteria\". These criteria, described as practical, relevant, and standardized, offer a valuable framework for standardizing clinical judgment in restorative materials and study designs. Researchers are encouraged to employ these criteria to enhance standardization in their evaluations, facilitating comparisons with other studies.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] In a 36-month evaluation of restorations using Scotchbond Universal adhesive, it was observed that the FDI criteria were more sensitive in detecting small changes compared to the modified USPHS criteria. Additionally, the flexibility of the FDI criteria in terms of criteria and scoring provides researchers with additional options. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] As a result, FDI criteria, which offer a more sensitive evaluation of restorations and patients' opinions, were preferred in our study.\u003c/p\u003e \u003cp\u003e These findings highlight the importance of carefully selecting and applying adhesive strategies based on the specific clinical situation to optimize bonding performance and ensure the longevity of restorations.\u003c/p\u003e \u003cp\u003eThis study is limited by its retrospective design, which may introduce selection bias due to the non-randomized nature of the data. Furthermore, retrospective data analysis relies on the accuracy and completeness of medical records, which may also affect the results. Additionally, the entire investigation was conducted within the controlled environment of a university, where the restorations were placed under optimal conditions by a single experienced operator, potentially limiting the generalizability of the findings to other clinical environments. Another constraint is the focus on a single brand of material, suggesting that further clinical studies are necessary to evaluate a broader range of materials and brands. Moreover, this study did not assess dentin sclerosis levels in lesions prior to restoration, a factor that may influence the outcomes and has been considered in other studies on universal adhesives. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eAll adhesive modes used in the study were clinically acceptable in all the FDI criteria after a 36-month evaluation. ER mode of adhesive was found to be clinically good (2), while SE and SLE were clinically satisfactory (3). These findings support the use of the ER mode for long-term clinical success in non-carious cervical lesions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccnowlegments:\u0026nbsp;\u003c/strong\u003eNil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial registration:\u0026nbsp;\u003c/strong\u003eClinical trials number- NCT06227715, Clinical trials link: https://clinicaltrials.gov/study/NCT06227715\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis clinical trial was conducted in Faculty of Dentistry- Osmangazi University, Turkey and was implemented following the ethical principles stated in the World Medical Association Declaration of Helsinki. The research protocol was reviewed and approved by the research ethics committee of the faculty with approval number \u003cstrong\u003eE-25403353-050.99-2400074339\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccnowlegments:\u0026nbsp;\u003c/strong\u003eNil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial registration:\u0026nbsp;\u003c/strong\u003eClinical trials number- NCT06227715, Clinical trials link: https://clinicaltrials.gov/study/NCT06227715\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis clinical trial was conducted in Faculty of Dentistry- Osmangazi University, Turkey and was implemented following the ethical principles stated in the World Medical Association Declaration of Helsinki. The research protocol was reviewed and approved by the research ethics committee of the faculty with approval number \u003cstrong\u003eE-25403353-050.99-2400074339\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTakamizawa T, Barkmeier WW, Tsujimoto A, Berry TP, Watanabe H, Erickson RL, et al. Influence of different etching modes on bond strength and fatigue strength to dentin using universal adhesive systems. Dent Mater. 2016;32(2):e9-e21.10.1016/j.dental.2015.11.005\u003c/li\u003e\n\u003cli\u003ePerdig\u0026atilde;o J, Ceballos L, Gir\u0026aacute;ldez I, Baracco B, Fuentes MV. Effect of a hydrophobic bonding resin on the 36-month performance of a universal adhesive - a randomized clinical trial. Clin Oral Investig. 2020;24(2):765-76.10.1007/s00784-019-02940-x\u003c/li\u003e\n\u003cli\u003eVan Meerbeek B, Yoshihara K, Van Landuyt K, Yoshida Y, Peumans M. From Buonocore\u0026apos;s Pioneering Acid-Etch Technique to Self-Adhering Restoratives. A Status Perspective of Rapidly Advancing Dental Adhesive Technology. J Adhes Dent. 2020;22(1):7-34.10.3290/j.jad.a43994\u003c/li\u003e\n\u003cli\u003eMu\u0026ntilde;oz MA, Luque I, Hass V, Reis A, Loguercio AD, Bombarda NHC. Immediate bonding properties of universal adhesives to dentine. J Dent. 2013;41(5):404-11.10.1016/j.jdent.2013.03.001\u003c/li\u003e\n\u003cli\u003eOz FD, Ergin E, Canatan S. Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL\u0026ndash;a randomized controlled clinical trial. J Appl Oral Sci. 2019;27.10.1590/1678-7757-2018-0358\u003c/li\u003e\n\u003cli\u003ede Paris Matos T, Perdig\u0026atilde;o J, De Paula E, Coppla F, Hass V, Scheffer RF, et al. Five-year clinical evaluation of a universal adhesive: a randomized double-blind trial. Dent Mater. 2020;36(11):1474-85.10.1016/j.dental.2020.08.007\u003c/li\u003e\n\u003cli\u003eComba A, Baldi A, Carossa M, Paolone G, Stura I, Migliaretti G, et al. A Three-Step Etch-and-Rinse vs a Universal Adhesive in Nanohybrid Composite Anterior Restorations: A Retrospective Clinical Evaluation. J Adhes Dent. 2023;25(1):87-97.https://dx.doi.org/10.3290/j.jad.b4043039\u003c/li\u003e\n\u003cli\u003eMarchesi G, Frassetto A, Mazzoni A, Apolonio F, Diolosa M, Cadenaro M, et al. Adhesive performance of a multi-mode adhesive system: 1-year in vitro study. J Dent. 2014;42(5):603-12.10.1016/j.jdent.2013.12.008\u003c/li\u003e\n\u003cli\u003ePeumans M, De Munck J, Mine A, Van Meerbeek B. Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review. Dent Mater. 2014;30(10):1089-103.https://doi.org/10.1016/j.dental.2014.07.007\u003c/li\u003e\n\u003cli\u003eGoodacre CJ, Eugene Roberts W, Munoz CA. Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration. J Prosthodont. 2023;32(2):e1-e18.10.1111/jopr.13585\u003c/li\u003e\n\u003cli\u003eRouse MA, May JT, Platt JA, Cook NB, Capin OR, Adams BN, et al. Clinical evaluation of a universal adhesive in non‐carious cervical lesions. J Esthet Restor Dent. 2020;32(7):691-8.10.1111/jerd.12622\u003c/li\u003e\n\u003cli\u003eTay FR, Nawareg MA, Abuelenain D, Pashley DH. Cervical sclerotic dentin: Resin bonding. Understanding Dental Caries: From Pathogenesis to Prevention and Therapy2016. p. 97-125.\u003c/li\u003e\n\u003cli\u003eWang J, Song W, Zhu L, Wei X. A comparative study of the microtensile bond strength and microstructural differences between sclerotic and Normal dentine after surface pretreatment. BMC Oral Health. 2019;19:1-10\u003c/li\u003e\n\u003cli\u003eLoguercio AD, Luque-Martinez IV, Fuentes S, Reis A, Mu\u0026ntilde;oz MA. Effect of dentin roughness on the adhesive performance in non-carious cervical lesions: A double-blind randomized clinical trial. J Dent. 2018;69:60-9\u003c/li\u003e\n\u003cli\u003eBoushell LW, Heymann HO, Ritter AV, Sturdevant JR, Swift Jr EJ, Wilder Jr AD, et al. Six-year clinical performance of etch-and-rinse and self-etch adhesives. Dent Mater. 2016;32(9):1065-72.10.1016/j.dental.2016.06.003\u003c/li\u003e\n\u003cli\u003eNagarkar S, Theis‐Mahon N, Perdig\u0026atilde;o J. Universal dental adhesives: Current status, laboratory testing, and clinical performance. J Biomed Mater Res B. 2019;107(6):2121-31.doi.org/10.1002/jbm.b.34305\u003c/li\u003e\n\u003cli\u003eYoshida Y, Yoshihara K, Nagaoka N, Hayakawa S, Torii Y, Ogawa T, et al. Self-assembled nano-layering at the adhesive interface. J Dent Res. 2012;91(4):376-81.10.1177/00220345124373\u003c/li\u003e\n\u003cli\u003eVan Landuyt KL, Snauwaert J, De Munck J, Peumans M, Yoshida Y, Poitevin A, et al. Systematic review of the chemical composition of contemporary dental adhesives. Biomater. 2007;28(26):3757-85.10.1016/j.biomaterials.2007.04.044\u003c/li\u003e\n\u003cli\u003eVan Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J, Van Landuyt K. State of the art of self-etch adhesives. Dent Mater. 2011;27(1):17-28.https://doi.org/10.1016/j.dental.2010.10.023\u003c/li\u003e\n\u003cli\u003eHeintze SD, Rousson V, Mahn E. Bond strength tests of dental adhesive systems and their correlation with clinical results\u0026ndash;a meta-analysis. Dent Mater. 2015;31(4):423-34.https://doi.org/10.1016/j.dental.2015.01.011\u003c/li\u003e\n\u003cli\u003eSezinando A, Perdig\u0026atilde;o J, Ceballos L. Long-term In Vitro Adhesion of Polyalkenoate-based Adhesives to Dentin. J Adhes Dent. 2017;19(4).10.3290/j.jad.a38895\u003c/li\u003e\n\u003cli\u003eSingle Bond Universal product information of the manufacturer: [Available from: https://multimedia.3m.com/mws/media/1400783O/single-bond-universal-adhesive-scientific-facts.pdf.\u003c/li\u003e\n\u003cli\u003eFuentes MV, Perdig\u0026atilde;o J, Baracco B, Gir\u0026aacute;ldez I, Ceballos L. Effect of an additional bonding resin on the 5-year performance of a universal adhesive: A randomized clinical trial. Clin Oral Investig. 2023;27(2):837-48.10.1007/s00784-022-04613-8\u003c/li\u003e\n\u003cli\u003eLoguercio AD, De Paula EA, Hass V, Luque-Martinez I, Reis A, Perdig\u0026atilde;o J. A new universal simplified adhesive: 36-Month randomized double-blind clinical trial. J Dent. 2015;43(9):1083-92.10.1016/j.jdent.2015.07.005\u003c/li\u003e\n\u003cli\u003eLawson NC, Robles A, Fu C-C, Lin CP, Sawlani K, Burgess JO. Two-year clinical trial of a universal adhesive in total-etch and self-etch mode in non-carious cervical lesions. J Dent. 2015;43(10):1229-34.10.1016/j.jdent.2015.07.009\u003c/li\u003e\n\u003cli\u003eChen C, Niu L-N, Xie H, Zhang Z-Y, Zhou L-Q, Jiao K, et al. Bonding of universal adhesives to dentine\u0026ndash;old wine in new bottles? J Dent. 2015;43(5):525-36.10.1016/j.jdent.2015.03.004\u003c/li\u003e\n\u003cli\u003e\u0026Ntilde;aupari-Villasante R, Matos TP, de Albuquerque EG, Warol F, Tardem C, Calazans FS, et al. Five-year clinical evaluation of universal adhesive applied following different bonding techniques: A randomized multicenter clinical trial. Dent Mater. 2023;39(6):586-94\u003c/li\u003e\n\u003cli\u003eYazici AR, Tekce AU, Kutuk ZB. Comparative evaluation of different adhesive strategies of a universal adhesive in class II bulk-fill restorations: A 48-month randomized controlled trial. J Dent. 2022;117:103921\u003c/li\u003e\n\u003cli\u003eRuschel V, Stolf S, da Luz Baratieri C, Chung Y, Boushell L, Baratieri L, et al. Five-year clinical evaluation of universal adhesives in noncarious cervical lesions. Oper Dent. 2023;48(4):364-72\u003c/li\u003e\n\u003cli\u003eSchmalz G, Ryge G. Reprint of Criteria for the clinical evaluation of dental restorative materials. Clin Oral Investig. 2005;9:215-32\u003c/li\u003e\n\u003cli\u003eHickel R, Peschke A, Tyas M, Mjor I, Bayne S, Peters M, et al. FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples. Clin Oral Investig. 2010;14(4):349-66.10.1007/s00784-010-0432-8\u003c/li\u003e\n\u003cli\u003eYoshihara K, Hayakawa S, Nagaoka N, Okihara T, Yoshida Y, Van Meerbeek B. Etching efficacy of self-etching functional monomers. J Dent Res. 2018;97(9):1010-6.10.1177/002203451876360\u003c/li\u003e\n\u003cli\u003eMu\u0026ntilde;oz M, Luque-Martinez I, Malaquias P, Hass V, Reis A, Campanha N, et al. In vitro longevity of bonding properties of universal adhesives to dentin. Oper Dent. 2015;40(3):282-92.10.2341/14-055-L\u003c/li\u003e\n\u003cli\u003eManarte-Monteiro P, Domingues J, Teixeira L, Gavinha S, Manso MC. Universal Adhesives and Adhesion Modes in Non-Carious Cervical Restorations: 2-Year Randomised Clinical Trial. Polymers. 2021;14(1):33.10.3390/polym14010033\u003c/li\u003e\n\u003cli\u003eIkeda M, Kurokawa H, Sunada N, Tamura Y, Takimoto M, Murayama R, et al. Influence of previous acid etching on dentin bond strength of self-etch adhesives. J Oral Sci. 2009;51(4):527-34.10.2334/josnusd.51.527\u003c/li\u003e\n\u003cli\u003eRosa WL, Piva E, Silva AF. Bond strength of universal adhesives: A systematic review and meta-analysis. J Dent. 2015;43(7):765-76.10.1016/j.jdent.2015.04.003\u003c/li\u003e\n\u003cli\u003eVan Meerbeek B, Van Landuyt K, De Munck J, Hashimoto M, Peumans M, Lambrechts P, et al. Technique-sensitivity of contemporary adhesives. Dent Mater J. 2005;24(1):1-13.10.4012/dmj.24.1\u003c/li\u003e\n\u003cli\u003eChoi A-N, Lee J-H, Son S-A, Jung K-H, Kwon YH, Park J-K. Effect of dentin wetness on the bond strength of universal adhesives. Mater. 2017;10(11):1224.https://doi.org/10.3390/ma10111224\u003c/li\u003e\n\u003cli\u003eHardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, et al. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021;13(5):814.https://doi.org/10.3390/polym13050814\u003c/li\u003e\n\u003cli\u003eYoshihara K, Yoshida Y, Nagaoka N, Hayakawa S, Okihara T, De Munck J, et al. Adhesive interfacial interaction affected by different carbon-chain monomers. Dent Mater. 2013;29(8):888-97.10.1016/j.dental.2013.05.006\u003c/li\u003e\n\u003cli\u003eFeitosa VP, Sauro S, Ogliari FA, Ogliari AO, Yoshihara K, Zanchi CH, et al. Impact of hydrophilicity and length of spacer chains on the bonding of functional monomers. Dent Mater. 2014;30(12):e317-e23.10.1016/j.dental.2014.06.006\u003c/li\u003e\n\u003cli\u003ePeumans M, De Munck J, Van Landuyt K, Van Meerbeek B. Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions. Dent Mater. 2015;31(3):308-14.10.1016/j.dental.2015.01.005\u003c/li\u003e\n\u003cli\u003eKarakaya S, Unlu N, Say EC, Oezer F, Soyman M, Tagami J. Bond strengths of three different dentin adhesive systems to sclerotic dentin. Dent Mater J. 2008;27(3):471-9.https://doi.org/10.4012/dmj.27.471\u003c/li\u003e\n\u003cli\u003eHickel R, Roulet J-F, Bayne S, Heintze SD, Mj\u0026ouml;r IA, Peters M, et al. Recommendations for conducting controlled clinical studies of dental restorative materials. Clin Oral Investig. 2007;11:5-33.10.1007/s00784-006-0095-7\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Distribution of NCCLs according to research subject and characteristics of lesions (nP: Number of patients, nR: Number of restorations)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics of research subjects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u003cstrong\u003enP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e35 - 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e46 - 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u0026gt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of NCCLs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u003cstrong\u003enR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTooth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003eIncisor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003eCanine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003ePremolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003eMolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArc\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003eMaxillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003eMandibular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u0026lt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e2-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u0026gt;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWidth (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u0026lt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e2-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u0026gt;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepth (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u0026lt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.7778%;\"\u003e\n \u003cp\u003e\u0026gt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.2222%;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Composition and Application Procedure of the Adhesive\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdhesive Material\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComposition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eApplication Technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLot No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003eSingle Bond Universal Adhesive\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3M ESPE, Germany\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMild pH:2.7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003eMDP Phosphate Monomer\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDimethacrylate Resins\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2-Hydroxyethyl Methacrylate (HEMA)\u003c/p\u003e\n \u003cp\u003eVitrebond Copolymer Filler\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Ethanol\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Water\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Initiators\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Silane\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eER\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eApply etchant for enamel and dentin 15 s\u003c/p\u003e\n \u003cp\u003eApply the adhesive for 20 s\u003c/p\u003e\n \u003cp\u003eGently air for 5 s\u003c/p\u003e\n \u003cp\u003eLight cure for 10 s\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e521194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eApply etchant for enamel margin 15 s\u003c/p\u003e\n \u003cp\u003eApply the adhesive for 20 s\u003c/p\u003e\n \u003cp\u003eGently air for 5 s\u003c/p\u003e\n \u003cp\u003eLight cure for 10 s\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eApply the adhesive for 20 s\u003c/p\u003e\n \u003cp\u003eGently air for 5 s\u003c/p\u003e\n \u003cp\u003eLight cure for 10 s\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiltek Z 550 Universal Restorative\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3M ESPE,\u003c/p\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNanohybrid resin composite\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBis-GMA\u003c/p\u003e\n \u003cp\u003eUDMA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTEGDMA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePEGDMA\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Bis-EMA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSilica\u003c/p\u003e\n \u003cp\u003eZirconia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePolymerizes for 20 s\u003c/p\u003e\n \u003cp\u003efor 2 mm layer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eN291350\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eScotchbond Universal Etchant\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3M ESPE,\u003c/p\u003e\n \u003cp\u003eGermany\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003epH: 0.1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWater Phosphoric acid (34%),\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Poly (vinyl alcohol)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;ER\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEnamel and dentin etched were for 15 s,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ewashed for 15 s, and dried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e594504\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;SLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOnly enamel margin was etched for 15 s,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ewashed for 15 s and dried\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3: Retention loss rate according to months and adhesive modes\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"620\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonths\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdhesive Modes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eER\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6th Month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e3,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e1,25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e1,19%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12th Month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e8,10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e4,34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e1,36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18th Month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e20,27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e8,69%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e1,36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36th Month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e29,33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e16,66%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e3,89%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4: Difference between groups according to time and adhesive modes according to the FDI criteria. Values in bold indicate significant statistical differences. (P value: Significance Difference) (* The mean difference is significant at the 0.05 level) P-values were calculated using appropriate non-parametric tests: Mann-Whitney U tests were used for pairwise comparisons between adhesive modes, and Friedman tests were used for comparing data across different time points within the same group.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 Month\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12 Month\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18 Month\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36 Month\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMod\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSLE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eER\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSLE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eER\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSLE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eER\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSLE\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eER\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarginal Staining\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSLE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFracture of Material and Retention\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSLE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarginal Adaptation\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSLE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Op Sensitivity and Vitality\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n 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style=\"width: 35px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTooth Integrity\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eSE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n 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\u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*. The mean difference is significant at the 0.05 level.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Self-etch, selective-enamel-etching, etch-and-rinse, FDI criteria, universal adhesive, non-carious cervical lesion","lastPublishedDoi":"10.21203/rs.3.rs-5174967/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5174967/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the 36-month clinical performance of Single Bond Universal Adhesive (SBU; 3M ESPE, Germany) in non-carious cervical lesions (NCCLs) using different modes of adhesion according to the FDI criteria.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eIn this study, the SBU Adhesive was applied to 246 NCCLs of 25 patients using different modes of adhesion: Self-etch (SE), selective-enamel-etching (SLE), and etch-and-rinse (ER). All lesions were restored with the same nanohybrid resin composite. The restorations were evaluated at the 1st, the 6th, 12th, 18th, and 36th month using the FDI criteria: marginal staining, fracture of material and retention, marginal adaptation, post-operative sensitivity and tooth vitality, recurrence of caries erosion and abfraction, and tooth integrity criteria. The differences between SE, SLE, and ER groups were tested using the Kruskal-Wallis and Mann-Whitney U tests where a value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was accepted as a criterion for statistical significance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter 36-month the recall rate was 96%. The retention loss rates were 29.33% for SE, 16.66% for SLE, and 3.89% for ER modes. Interactions between time periods and adhesive modes were found to be statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) for all FDI criteria. ER mode performed significantly better than SE mode for marginal staining, fracture of material and retention, marginal adaptation and recurrence of caries erosion and abfraction criteria after the 36th month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistically significant difference between SE and SLE mode (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), nor between SLE and ER mode (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e After the 36-month evaluation of all adhesive modes used in the study, restorations performed with the ER adhesion mode were clinically good (2), while those performed with the SE adhesion mode and SLE adhesion mode were clinically satisfactory (3) according to the FDI criteria.\u003c/p\u003e\u003ch2\u003eClinical Relevance:\u003c/h2\u003e \u003cp\u003eRestorations performed with the SE adhesion mode of universal adhesives exhibit clinically acceptable behavior after 36 months of evaluation, although with less success than those performed with the ER adhesion mode.\u003c/p\u003e","manuscriptTitle":"36-month Evaluation of Non-carious Cervical Lesion Restorations Using Different Modes of Universal Adhesive","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 13:19:54","doi":"10.21203/rs.3.rs-5174967/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-11T03:43:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-07T12:46:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233843261200457155858554791158917209162","date":"2024-11-04T06:20:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-28T22:47:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-26T12:56:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174044816613539257789931054383797402325","date":"2024-10-18T15:51:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107907293182628209526921027601537194568","date":"2024-10-15T11:20:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-15T09:59:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-02T04:17:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-02T04:17:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2024-09-29T12:46:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1f9e7e59-d1e6-4935-9210-c03387590bf4","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-30T15:59:03+00:00","versionOfRecord":{"articleIdentity":"rs-5174967","link":"https://doi.org/10.1007/s00784-024-06126-y","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2024-12-28 15:57:04","publishedOnDateReadable":"December 28th, 2024"},"versionCreatedAt":"2024-12-09 13:19:54","video":"","vorDoi":"10.1007/s00784-024-06126-y","vorDoiUrl":"https://doi.org/10.1007/s00784-024-06126-y","workflowStages":[]},"version":"v1","identity":"rs-5174967","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5174967","identity":"rs-5174967","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}