This prospective, double-blind, six-arm parallel randomised controlled trial aimed to compare the performance of two universal adhesives (UAs) in non-carious cervical lesions (NCCLs), using the FDI criteria, and analysed if participants/NCCLs’ characteristics influenced the outcome. Thirty-eight 18- to 65-year-old participants were seeking routine dental care at a university clinic. At baseline, 210 NCCLs were randomly allocated to six groups (35 restorations’ each). The UAs tested were FuturabondU (FBU) and AdheseUniversal (ADU) applied in either etch-and-rinse (ER) and self-etch (SE) modes. FuturabondDC (FBDC) in SE and in SE with selective enamel etching (SE-EE) modes were controls. NCCLs were restored with AdmiraFusion. The analysis included nonparametric tests, Kaplan-Meier and log-rank tests (α = 0.05). At 2-years, of 191 restorations, ten were missed due to retention loss (all groups, p > 0.05). FBDC (p = 0.037) and FBU (p = 0.041) performed worse than ADU in SE mode. FBDC and FBU also showed worse functional success rate (p = 0.012, p = 0.007, respectively) and cumulative retention rates (p = 0.022, p = 0.012, respectively) than ADU. Some participants/NCCLs’ characteristics influenced (p < 0.05) the outcomes. FBU did not perform as well as ADU, especially in SE mode and due to functional properties. Participants’ age and NCCLs’ degree of dentin sclerosis and internal shape angle influenced FBU performance.

Adhesive resins with guided application protocols have been developed with the main goal of reducing the number of clinical steps. Universal Adhesives (UA) can be applied with both Self-Etch (SE) or Etch-and-Rinse (ER) adhesion strategies. This review aims to evaluate the bond strength of UA, applied to dental tissues, by a systematic bibliometric review of in vitro studies. The research question, through the PICO model, aimed to assess the current knowledge of the immediate and long-term bond strength of UA, applied with a direct restorative technique. PubMed and ScienceDirect database searches focused on the bond resistance of UA applied with the ER and SE strategies. Studies assessing shear bond strength and microtensile bond strength, in both enamel and dentin, were included. From 1109 screened articles, 12 fulfilled the inclusion criteria. The bond strength of UA to enamel showed better results with the ER approach, while the adhesion strategy did not significantly affect the bond strength of UA to dentin. Evidence from in vitro studies has tended to suggest that the use of the SE adhesion approach seems to be a better choice to improve the bond strength to the dentin. The selective enamel etching is advisable when applied with the SE adhesion approach to optimize the UA bond strength to the enamel.

Amorphous calcium phosphate (ACP) is a well-established bioceramic material known to promote the remineralization of dental hard tissues. White spot lesions (WSLs) represent the initial stage of enamel demineralization and are frequently observed in patients with fixed orthodontic appliances or inadequate oral hygiene. Although recommendations for remineralizing agents include both the prevention of lesion progression and the stimulation of tissue remineralization, the clinical efficacy of ACP-based materials remains under debate. This systematic review, registered in the PROSPERO database (CRD42024540595), aims to evaluate the clinical efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-based products in the remineralization of WSLs and to compare these outcomes with those achieved using non-bioceramic approaches. Inclusion criteria comprised randomized clinical trials, prospective cohort studies, and pilot studies conducted on human subjects with WSLs affecting permanent teeth. Studies involving artificial WSLs or non-cariogenic enamel lesions were excluded. The quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Fourteen articles met the inclusion criteria and were analyzed. The main findings indicate that CPP-ACP is clinically effective in promoting the remineralization of WSLs, although the results were inconsistent across studies. Comparisons with placebo and resin infiltration treatments revealed greater efficacy for CPP-ACP. The combination of CPP-ACP with fluoride appeared to further enhance the remineralizing effect on WSLs. Additional standardized clinical studies with longer follow-up periods are warranted to confirm these outcomes.

Aim: Compare clinical performance and success/retention rates of two multi-mode (MM) adhesives, applied in self-etch (SE) or etch-and-rinse (ER) modes, with SE-all-in-one adhesive (SE/SE with enamel etching) in NCCL restorations at one-year follow-up. Material and methods: Prospective, double-blind RCT approved by the University Fernando Pessoa and the National-Clinical-Research-Ethics Committees (CEIC-20150305), ClinicalTrials.gov registered (NCT02698371), in 38 participants with 210 restorations (AdmiraFusion^®) randomly allocated to six groups (Adhesives_Adhesion mode), each with 35 restorations: G1-Control Futurabond^®DC_SE; G2-Control Futurabond^®DC_SE with enamel etching; G3-Futurabond^®U_ER; G4-Futurabond^®U_SE; G5-Adhese^®Universal_ER; G6-Adhese^®Universal_SE. Restorations evaluated at baseline and one-year by three calibrated examiners (ICC ≥0.952) using FDI criteria and statistical analysis with nonparametric tests (alpha = 0.05). Results: At one-year recall 36 participants, 199 restorations were available for examination; five (2.5%) restorations (G1 n = 2; G2, G3, G4 n = 1) were lost due to retention (p > .05); G1 showed less satisfying marginal adaptation (p < .05) than G2 and MM adhesives groups, particularly G6. Overall success rates (p > .05) were: 93.9% (G1), 97.0% (G2; G3; G4) and 100.0% (G5; G6). Conclusions: MM adhesives (Futurabond^®U and Adhese^®Universal) showed similar and acceptable performance/success rates but also better clinical outputs than the SE-all-in-one adhesive (Futurabond^®DC), particularly in SE mode. Success and retention rates were similar and not dependent on materials or adhesion modes.

This study aims to perform a meta-analysis on the effect of prophylactic/therapeutic agents in enamel tissue loss due to erosion. A paper search was done on Medline, PubMed, Embase, and Cochrane Library, and 732 papers were identified. The inclusion criteria were very restrictive in order to be able to compare different protocols and methodologies used on those studies. Sixteen papers were eligible, grouped according to the measurement method of enamel tissue loss, and a meta-analysis was done for each type of fluoride- and casein-based agent applied. Standardized mean differences were pooled across studies. There was a significant difference between all the treatment groups and their respective control groups. The highest standardized mean difference on enamel tissue loss (mean; 95% confidence interval) was obtained by stannous fluoride (4.789 μm; 1.968-7.610; P < 0.001), followed by amine fluoride (2.485 μm; 0.746-4.225; P < 0.010), and titanium tetrafluoride (1.787 μm; 1.106-2.469; P < 0.001); the lowest difference was obtained by casein phosphopeptide-amorphous calcium phosphate (0.869 μm; 0.007-1.731; P < 0.050) and sodium fluoride (0.820 μm; 0.417-1.223; P < 0.001). Stannous fluoride as a fluoride-based prophylactic/therapeutic agent allowed the lowest enamel tissue loss in erosive conditions. Standardization among future study protocols will allow better comparison regarding the prophylactic/therapeutic agent with the best clinical efficacy.