Effects of cervical restorations on the periodontal tissues: 5-year follow-up results of a randomized clinical trial.

Favetti, Morgana; Montagner, Anelise Fernandes; Fontes, Silvia Terra; Martins, Thiago Marchi; Masotti, Alexandre Severo; Dos Santos Jardim, Patricia; Corrêa, Fernanda Oliveira Bello; Cenci, Maximiliano Sergio; Muniz, Francisco Wilker Mustafa Gomes

OBJECTIVE This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCL) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques. METHODS A randomized controlled split-mouth and blind trial was carried out. Patients (n = 38) with at least two NCCL were included. Beforehand the cervical restoration placement, the NCCL (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5-year. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95% confidence interval (95%CI) were calculated by Poisson regression (α < 0.05). RESULTS After 5-year, 31 teeth (13.6%) presented occurrence/progression of GR. In the multivariate analyses, occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95%CI: 2.65; 1.01 - 7.00) and lack of marginal adaptation of the restoration (RR; 95%CI: 10.98; 2.31 - 52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, presence of biofilm and presence of gingivitis did not present statistically significant higher risk for occurrence/progression of GR. CONCLUSION The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals that received a restoration for NCCL. CLINICAL SIGNIFICANCE Isolation with rubber dam and dental clamps may promote GR in sites with restored NCCL. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.