Twenty-four-month clinical performance of a glass hybrid restorative in non-carious cervical lesions of patients with bruxism: a split-mouth, randomized clinical trial

  • Uzay Koc VuralEmail author
  • Ece Meral
  • Esra Ergin
  • Sevil Gürgan
Original Article



The aim of the present study was to evaluate the clinical performance of a glass hybrid restorative compared with a nano-ceramic composite resin in non-carious cervical lesions (NCCLs) of patients with bruxism.

Materials and methods

Twenty-five patients with NCCLs and bruxism were enrolled in the present study. Before treatment, the dimensions of the NCCLs (depth, cervico-incisal height, and mesio-distal width) and internal angles were measured. Degree of tooth wear (TWI) and gingival conditions were recorded. A total of 148 NCCLs were randomly restored with a glass hybrid restorative system (GH) (Equia Forte Fil, GC, Tokyo, Japan) or a nano-ceramic composite resin (RBC) (Ceram.X One Universal, Dentsply, DeTrey, Konstanz, Germany). The restorations were evaluated at baseline and after 6, 12, and 24 months according to the modified USPHS criteria. Data were analyzed with Pearson’s chi-square, Fisher’s exact, Mann-Whitney U, and Cochran’s Q tests (P < 0.05).


At the 24-month recall, 126 restorations in 22 patients were evaluated. The recall rate was 88.0%. No significant difference was found between the materials for retention (P = 0.285), and no relationships were found between internal angle, depth, cervico-incisal height, or mesio-distal width and retention of the restorations (P > 0.05). A significant difference was observed between the materials for marginal adaptation (P = 0.002), but no relationships were found among depth, cervico-incisal height, and mesio-distal width and marginal adaptation (P > 0.05). RBC showed better results for marginal adaptation. Between marginal adaptation, TWI, and the gingival index, correlations were significant (P < 0.001, P = 0.002). A significant change was found in marginal discoloration in GH and RBC over time (P = 0.039 and P = 0.004, respectively). Neither secondary caries nor tooth sensitivity was observed on any of the restorations at any evaluation.


Although nano-ceramic RBC showed better marginal adaptation than GH, both tested restoratives showed clinically acceptable performance for the restoration of NCCLs of patients with bruxism after 24 months of clinical service.

Trial registration

This study is registered on under protocol record KA-16020, Clinical Performance of a Glass Hybrid Restorative in NCCL’s of Patients With Bruxism.


Glass hybrid restorative Nano-ceramic composite resin NCCL Bruxism Class V 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in this study.


  1. 1.
    Ommerborn MA, Schneider C, Giraki M, Schafer R, Singh P, Franz M et al (2007) In vivo evaluation of non-carious cervical lesions in sleep bruxism subjects. J Prosthet Dent 98:150–158. CrossRefPubMedGoogle Scholar
  2. 2.
    Litonjua LA, Andreana S, Bush PJ, Tobias TS, Cohen RE (2003) Non-carious cervical lesions and abfractions: a re-evaluation. J Am Dent Assoc 134:845–850. CrossRefPubMedGoogle Scholar
  3. 3.
    Xhonga FA (1977) Bruxism and its effect on the teeth. J Oral Rehabil 4:65–76. CrossRefPubMedGoogle Scholar
  4. 4.
    Telles D, Pegoraro LF, Pereira JC (2000) Prevalence of non-carious cervical lesions and their relation to occlusal aspects: a clinical study. J Esthet Dent 12:10–15CrossRefPubMedGoogle Scholar
  5. 5.
    Levitch LC, Bader JD, Shugars DA, Heymann HO (1994) Non-carious cervical lesions. J Dent 22:195–207. CrossRefPubMedGoogle Scholar
  6. 6.
    Tay FR, Pashley DH (2004) Resin bonding to cervical sclerotic dentin: a review. J Dent 32:173–196. CrossRefPubMedGoogle Scholar
  7. 7.
    Ichim IP, Schmidlin PR, Li Q, Kieser JA, Swain MV (2007) Restoration of non-carious cervical lesions part II. Restorative material selection to minimise fracture. Dent Mater 23:1562–1569. CrossRefPubMedGoogle Scholar
  8. 8.
    Peumans M, De Munck J, Mine A, Van Meerbeek B (2014) Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review. Dent Mater 30:1089–1103. CrossRefPubMedGoogle Scholar
  9. 9.
    Pecie R, Krejci I, Garcia-Godoy F, Bortolotto T (2011) Non-carious cervical lesions (NCCL)—a clinical concept based on the literature review. Part 2: restoration. Am J Dent 24:183–192PubMedGoogle Scholar
  10. 10.
    Pereira LC, Nunes MC, Dibb RG, Powers JM, Roulet JF, Navarro MF (2002) Mechanical properties and bond strength of glass-ionomer cements. J Adhes Dent 4:73–80PubMedGoogle Scholar
  11. 11.
    van Dijken JW (2005) Retention of a resin-modified glass ionomer adhesive in non-carious cervical lesions. A 6-year follow-up. J Dent 33:541–547. CrossRefPubMedGoogle Scholar
  12. 12.
    Vaid DS, Shah NC, Bilgi PS (2015) One year comparative clinical evaluation of EQUIA with resin-modified glass ionomer and a nano-hybrid composite in non-carious cervical lesions. J Conserv Dent 18:449–452. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Schwendicke F, Kniess J, Paris S, Blunck U (2017) Margin integrity and secondary caries of lined or non-lined composite and glass hybrid restorations after selective excavation in vitro. Oper Dent 42:155–164. CrossRefPubMedGoogle Scholar
  14. 14.
  15. 15.
    Mitra SB, Wu D, Holmes BN (2003) An application of nanotechnology in advanced dental materials. J Am Dent Assoc 134:1382–1390. CrossRefPubMedGoogle Scholar
  16. 16.
  17. 17.
    van Dijken JW, Pallesen U (2008) Long-term dentin retention of etch-and-rinse and self-etch adhesives and a resin-modified glass ionomer cement in non-carious cervical lesions. Dent Mater 24:915–922. CrossRefPubMedGoogle Scholar
  18. 18.
    Smith BG, Knight JK (1984) An index for measuring the wear of teeth. Br Dent J 156:435–438CrossRefPubMedGoogle Scholar
  19. 19.
    Loe H (1967) The gingival index, the plaque index and the retention index systems. J Periodontol 38:610–616. CrossRefGoogle Scholar
  20. 20.
    Loguercio AD, Luque-Martinez I, Lisboa AH, Higashi C, Queiroz VA, Rego RO et al (2015) Influence of isolation method of the operative field on gingival damage, patients’ preference, and restoration retention in non-carious cervical lesions. Oper Dent 40:581–593. CrossRefPubMedGoogle Scholar
  21. 21.
    Kubo S, Yokota H, Yokota H, Hayashi Y (2009) Two-year clinical evaluation of one-step self-etch systems in non-carious cervical lesions. J Dent 37:149–155. CrossRefPubMedGoogle Scholar
  22. 22.
    Wood I, Jawad Z, Paisley C, Brunton P (2008) Non-carious cervical tooth surface loss: a literature review. J Dent 36:759–766. CrossRefPubMedGoogle Scholar
  23. 23.
    Luiz de Barreto Aranha R, Nogueira Guimaraes de Abreu MH, Serra-Negra JM, Martins RC (2018) Evidence-based support for sleep bruxism treatment other than oral appliances remains insufficient. J Evid Based Dent Pract 18:159–161. CrossRefPubMedGoogle Scholar
  24. 24.
    Leal NMS, Silva JL, Benigno MIM, Bemerguy EA, Meira JBC, Ballester RY (2017) How mechanical stresses modulate enamel demineralization in non-carious cervical lesions? J Mech Behav Biomed Mater 66:50–57. CrossRefPubMedGoogle Scholar
  25. 25.
    Perdigao J, Dutra-Correa M, Saraceni SH, Ciaramicoli MT, Kiyan VH (2012) Randomized clinical trial of two resin-modified glass ionomer materials: 1-year results. Oper Dent 37:591–601. CrossRefPubMedGoogle Scholar
  26. 26.
    Coe J (2017) Which adhesive strategy for non-carious cervical lesions? Evid Based Dent 18:119–120. CrossRefPubMedGoogle Scholar
  27. 27.
    Burrow MF, Tyas MJ (2007) Clinical evaluation of three adhesive systems for the restoration of non-carious cervical lesions. Oper Dent 32:11–15. CrossRefPubMedGoogle Scholar
  28. 28.
    Onal B, Pamir T (2005) The two-year clinical performance of esthetic restorative materials in non-carious cervical lesions. J Am Dent Assoc 136:1547–1555. CrossRefPubMedGoogle Scholar
  29. 29.
    Reis A, Loguercio AD (2006) A 24-month follow-up of flowable resin composite as an intermediate layer in non-carious cervical lesions. Oper Dent 31:523–529. CrossRefPubMedGoogle Scholar
  30. 30.
    Goswami S (2018) Biomimetic dentistry. J Oral Res Rev 10:28–32. CrossRefGoogle Scholar
  31. 31.
    Rathore M, Singh A, Pant VA (2012) The dental amalgam toxicity fear: a myth or actuality. Toxicol Int 19:81–88. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Hafshejani TM, Zamanian A, Venugopal JR, Rezvani Z, Sefat F, Saeb MR, Vahabi H, Zarrintaj P, Mozafari M (2017) Antibacterial glass-ionomer cement restorative materials: a critical review on the current status of extended release formulations. J Control Release 262:317–328. CrossRefPubMedGoogle Scholar
  33. 33.
    GC. Introducing the restorative innovation of glass hybrid technology 2018 [Available from:
  34. 34.
    Gurgan S, Kutuk ZB, Ergin E, Oztas SS, Cakir FY (2017) Clinical performance of a glass ionomer restorative system: a 6-year evaluation. Clin Oral Investig 21:2335–2343. CrossRefPubMedGoogle Scholar
  35. 35.
    Diem VT, Tyas MJ, Ngo HC, Phuong LH, Khanh ND (2014) The effect of a nano-filled resin coating on the 3-year clinical performance of a conventional high-viscosity glass-ionomer cement. Clin Oral Investig 18:753–759. CrossRefPubMedGoogle Scholar
  36. 36.
    Franco EB, Benetti, A.R., Ishikiriama, S.K., Santiago, S.L., Lauris, J.R. (2006), Jorge, M.F., Navarro, M.F. 5-year clinical performance of resin composite versus resin modified glass ionomer restorative system in non-carious cervical lesions. Oper Dent 31:403–408. DOI: CrossRefPubMedGoogle Scholar
  37. 37.
    Oginni AO, Adeleke AA (2014) Comparison of pattern of failure of resin composite restorations in non-carious cervical lesions with and without occlusal wear facets. J Dent 42:824–830. CrossRefPubMedGoogle Scholar
  38. 38.
    Santos MJ, Ari N, Steele S, Costella J, Banting D (2014) Retention of tooth-colored restorations in non-carious cervical lesions—a systematic review. Clin Oral Investig 18:1369–1381. CrossRefPubMedGoogle Scholar
  39. 39.
    Carvalho RM, Manso AP, Geraldeli S, Tay FR, Pashley DH (2012) Durability of bonds and clinical success of adhesive restorations. Dent Mater 28:72–86. CrossRefPubMedGoogle Scholar
  40. 40.
    Ozgunaltay GO, A. (2002) Three-year clinical evaluation of a resin modified glass-ionomer cement and a composite resin in non-carious class V lesions. J Oral Rehabil 29:1037–1041. CrossRefPubMedGoogle Scholar
  41. 41.
    Koc Vural U, Gokalp S, Kiremitci A (2016) Clinical performance of composite restorations with resin-modified glass ionomer lining in root surface carious lesions. Oper Dent 41:268–275. CrossRefPubMedGoogle Scholar
  42. 42.
    Waldenlind L (1978) Studies on thiamine and neuromuscular transmission. Acta Physiol Scand Suppl 459:1–35PubMedGoogle Scholar
  43. 43.
    Santamaria MP, Casati MZ, Nociti FH, Sallum AW, Sallum EA, Aukhil I, Wallet SM, Shaddox LM (2012) Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesions: microbiological and immunological results. Clin Oral Investig 17:67–77. CrossRefPubMedGoogle Scholar
  44. 44.
    Paolantonio M, D’ercole S, Perinetti G, Tripodi D, Catamo G, Serral E, Brue C, Piccolomini R (2004) Clinical and microbiological effects of different restorative materials on the periodontal tissues adjacent to subgingival class V restorations. 1-year results. J Clin Periodontol 31(3):200–207. CrossRefPubMedGoogle Scholar
  45. 45.
    Santos VR, Lucchesi JA, Cortelli SC, Amaral CM, Feres M, Duarte PM (2007) Effects of glass ionomer and microfilled composite subgingival restorations on periodontal tissue and subgingival biofilm: a 6-month evaluation. J Periodontol 78(8):1522–1528. CrossRefPubMedGoogle Scholar
  46. 46.
    Hussainy SN, Nasim I, Thomas T, Ranjan M (2018) Clinical performance of resin-modified glass ionomer cement, flowable composite, and polyacid-modified resin composite in non-carious cervical lesions: one-year follow-up. J Conserv Dent 21:510–515. CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Mena-Serrano A, Kose C, De Paula EA, Tay LY, Reis A, Loguercio AD, Perdigão J (2012) A new universal simplified adhesive: 6-month clinical evaluation. J Esthet Restor Dent 25(1):55–69. CrossRefPubMedGoogle Scholar
  48. 48.
    Perdigão J, Kose C, Mena-Serrano A, De Paula E, Tay L, Reis A, Loguercio A (2014) A new universal simplified adhesive: 18-month clinical evaluation. Oper Dent 39:113–127. CrossRefPubMedGoogle Scholar
  49. 49.
    Heintze SD, Rousson V, Hickel R (2015) Clinical effectiveness of direct anterior restorations—a meta-analysis. Dent Mater 31:481–495. CrossRefPubMedGoogle Scholar
  50. 50.
    Daudt E, Lopes GC, Vieira LC (2013) Does operatory field isolation influence the performance of direct adhesive restorations? J Adhes Dent 15:27–32. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Uzay Koc Vural
    • 1
    Email author
  • Ece Meral
    • 1
  • Esra Ergin
    • 1
  • Sevil Gürgan
    • 1
  1. 1.School of Dentistry, Department of Restorative DentistryHacettepe UniversityAltındag AnkaraTurkey

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