ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Hemostatic Agents Reduce Bond Strength in Class V Restorations
Clinical Question In a healthy patient with a Class V carious lesion, does the use of retraction cord soaked with a hemostatic agent negatively impact the adhesion of the composite when compared to retraction cord with no hemostatic agent?
Clinical Bottom Line For patients with carious lesions adjacent to the gingival tissues, the bond strength of both total-etch and self-etch adhesives are reduced when the tooth structure has been contaminated by hemostatic agents. This finding is supported by a systematic review of in vitro studies as well as additional lab studies. The effect has been demonstrated with statistical significance with both types of adhesives, but the review contends that the effect is smaller with the total-etch system.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25359643Bernades/201420 in vitro studiesSystematic review of in vitro studies
Key resultsHemostatic contamination of dentin and enamel may inhibit adhesive properties of dental bonding agents. Self-etching adhesive systems are more negatively impacted by this phenomenon than etch-and-rinse systems.
#2) 26331146Sharafeddin/201560 caries-free mandibular molarsLaboratory study
Key resultsContamination with various hemostatic agents lowers the shear bonding strength of both total-etch and self-etch dental adhesive systems (p<.0001).
Evidence Search ("hemostatics"[Pharmacological Action] OR "hemostatics"[MeSH Terms] OR "hemostatics"[All Fields] OR "hemostatic"[All Fields]) AND ("dental bonding"[MeSH Terms] OR ("dental"[All Fields] AND "bonding"[All Fields]) OR "dental bonding"[All Fields]) / ("hemostatics"[Pharmacological Action] OR "hemostatics"[MeSH Terms] OR "hemostatics"[All Fields] OR "hemostatic"[All Fields]) AND contamination[All Fields] AND ("object attachment"[MeSH Terms] OR ("object"[All Fields] AND "attachment"[All Fields]) OR "object attachment"[All Fields] OR "bonding"[All Fields])
Comments on
The Evidence
Validity: In the systematic review, the included studies were all performed in vitro; however, the authors searched for articles thoroughly, used strict inclusion/exclusion criteria, and amassed a good number of studies for their review. This systematic review is lower on the evidence hierarchy than a systematic review of clinical trials. Additionally, the lack of a standardized methodology for contaminating the tooth samples across the included studies reduces the strength of the evidence and was one reason why statistical analysis or meta-analysis was not performed. Perspective: In vitro studies currently represent the best available evidence to answer to the question. More research is needed to definitively answer the question.
Applicability Because short appointments and enduring, esthetic restorations are highly valued by the patient, this information is important in directing clinical decisions. Use of hemostatic agent during class V restorations could potentially improve the speed of the procedure and the resulting esthetic quality, but these advantages come at the expense of a decreased bond strength and possible decreased longevity of the restoration.
Specialty/Discipline (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords hemostasis, bonding, contamination
ID# 3069
Date of submission: 04/13/2016spacer
E-mail deanma@livemail.uthscsa.edu
Author Mark Dean
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Mark LittleStar, DDS
Faculty mentor/Co-author e-mail littlestarm@uthscsa.edu
Basic Science Rationale
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