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Full analysis of the effects of modeler liquids on the properties of direct resin-based composites: a meta-analysis review of in vitro studies

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Abstract

Objectives

This study systematically revised the literature to answer the following question: do modeler liquids (MLs) affect the properties of direct resin-based composites (RBCs)?

Materials and methods

The review followed the PRISMA statement, and the search was conducted in PubMed, Scopus, Web of Science, Embase, and Lilacs databases. Studies were included if they investigated the properties of RBCs prepared using the restorative dental modeling insertion technique (RDMIT). The risk of bias was performed with the RoBDEMAT tool. Statistical analyses were conducted using Review Manager, and heterogeneity was assessed with the Cochran Q test and I2 statistics.

Results

From 309 studies identified, 25 met the eligibility criteria, and 23 were meta-analyzed. In total, 27 MLs and 23 RBCs were evaluated. Modeled and non-modeled RBCs showed similar results in terms of cohesive strength, flexural strength, load-to-fracture, modulus of elasticity, work of fracture, degree of conversion, solubility, weight change, microhardness, and color change. Sorption and roughness benefited from the use of MLs, whereas translucency and whitening index were more adequate in the non-modeled RBCs. Aging affected similarly the modeled and non-modeled RBCs. Most studies showed a moderate risk of bias.

Conclusions

Modeled and non-modeled RBCs performed similarly in most of the properties, and the use of non-solvated lubricants offered beneficial effects in some cases.

Clinical relevance

When a balance has to be made between the RDMIT and the conventional technique, our review supports the safe application of modeler liquids for the handling of composite increments during the sculpting fabrication of direct resin-based restorations.

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Data Availability

The data that support the findings of this study are available at the Open Science Framework (osf.io/uh7rk). Any additional information regarding the findings can be requested to the corresponding author.

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Funding

This study was partially supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

Author information

Authors and Affiliations

  1. Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil

    Eduardo Trota Chaves & Lisia Lorea Valente

  2. Graduate Program in Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil

    Eliseu Aldrighi Münchow

  3. Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, Santa CecíliaRS, CEP 90035-004, Brazil

    Eliseu Aldrighi Münchow

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  1. Eduardo Trota Chaves
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Contributions

E.T.C.: study idea; literature search; screening of titles and abstracts; writing of the manuscript; proofread; and final approval.

L.L.V.: study idea; literature search; screening of titles and abstracts; proofread; and final approval.

E.A.M.: data curation; data analysis; writing of the manuscript; proofread; and final approval.

Corresponding author

Correspondence to Eliseu Aldrighi Münchow.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary S1

Summary of subgroup meta-analysis findings comparing the cohesive strength of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: commercial product, non-solvated adhesive, or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 1286 kb)

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Supplementary S2

Summary of subgroup meta-analysis findings comparing the flexural strength of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 725 kb)

High resolution image (EPS 2377 kb)

Supplementary 1-S3

Summary of subgroup meta-analysis findings comparing the load-to-fracture of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 847 kb)

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Supplementary 2-S3

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Supplementary S4

Summary of subgroup meta-analysis findings comparing the modulus of elasticity of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 721 kb)

High resolution image (EPS 2208 kb)

Supplementary S5

Summary of subgroup meta-analysis findings comparing the work of fracture of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 764 kb)

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Supplementary S6

Summary of subgroup meta-analysis findings comparing the degree of conversion of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 911 kb)

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Supplementary S7

Summary of subgroup meta-analysis findings comparing the solubility of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 773 kb)

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Supplementary S8

Summary of subgroup meta-analysis findings comparing the sorption of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 723 kb)

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Supplementary S9

Summary of subgroup meta-analysis findings comparing the weight change of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the standardized mean difference (SMD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 752 kb)

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Supplementary S10

Summary of subgroup meta-analysis findings comparing the microhardness of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: commercial product, non-solvated adhesive, or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 1139 kb)

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Supplementary 1-S11

Summary of subgroup meta-analysis findings comparing the roughness of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: commercial product or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 745 kb)

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Supplementary 2-S11

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Supplementary S12

Summary of subgroup meta-analysis findings comparing the color change of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: commercial product, non-solvated adhesive, or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 1263 kb)

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Supplementary S13

Summary of subgroup meta-analysis findings comparing the translucency of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: non-solvated adhesive or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 860 kb)

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Supplementary S14

Summary of subgroup meta-analysis findings comparing the whitening index of modeled and non-modeled restorations, allocating studies according to the category of the modeler liquid: commercial product, non-solvated adhesive, or solvated adhesive. The analyses were conducted using the Inverse Variance statistical method and having the mean difference (MD) estimate with random-effects models and 95% confidence intervals (CI). (PNG 836 kb)

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Supplementary S15

Funnel plot graphs showing the meta-analysis results of included studies, which were allocated according to the evaluation of mechanical properties (A), physical properties (B), surface properties (C), optical properties (D), aging data from non-modeled restorations (E), and aging data from modeled restorations (F). There was not any suggestion of publication bias in the analyses shown in graphs a, b, d, and e; conversely, Egger’s test suggests the existence of publication bias on data from graphs c and f. (PNG 716 kb)

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Supplementary Table 2

(DOCX 37 kb)

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Chaves, E.T., Valente, L.L. & Münchow, E.A. Full analysis of the effects of modeler liquids on the properties of direct resin-based composites: a meta-analysis review of in vitro studies. Clin Oral Invest 27, 3289–3305 (2023). https://doi.org/10.1007/s00784-023-05062-7

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