Glass hybrid (glass ionomer) versus composite for non-carious cervical lesions: Survival, restoration quality and costs in randomized controlled trial after 3 years.

Schwendicke, Falk; Müller, Anne; Seifert, Tilmann; Jeggle-Engbert, Linda-Maria; Paris, Sebastian; Göstemeyer, Gerd

OBJECTIVE This study compared survival, restoration quality and costs of glass hybrid (GH; EQUIA Forte Fil/EQUIA Forte Coat) and resin composite restorations (RC; OptiBond FL/Filtek Supreme XTE) of sclerotic non-carious cervical lesions. METHODS This is a cluster-randomized trial (ClinicalTrials.gov: NCT02631161). 88 patients (50-70 years) with 175 sNCCLs were randomized to receive GH or RC. Restorations were placed without mechanical cavity preparation and followed for a mean 36 (min/max: 31/55) months (variable follow-up due to COVID-19 lockdown). Restoration quality was re-evaluated at 1-, 18- and 36-months using FDI-criteria. Survival was assessed using multi-level Cox-regression analysis. Costs were estimated from a payer's perspective in Germany. Initial costs were determined based on micro-costing using time recordings and hourly costs, and follow-up costs based on statutory insurance fee-item-catalogues. RESULTS 88 patients (175 restorations) were treated; 43 received GH (83 restorations), 45 RC (92 restorations). 17 GH and 19 RC showed total retention loss, 5 GH were partially lost (p = 0.396/Cox). FDI ratings were not sufficiently different for any domain except surface luster, where RC showed higher score (p < 0.001). Costs were initially lower for GH (32.57; SD 16.36 €) than RC (44.25; SD 21.40), while re-treatment costs were similar (GH: 9.15; SD 15.70 €; RC: 7.35; SD 14.51 €), resulting in significantly lower costs for GH (GH: 41.72; SD 25.08 €) than RC (51.6; 26.17 €) (p < 0.001/GLM). CONCLUSIONS While survival was not significantly different, GH was significantly less costly both initially and long-term than RC for restoring non-carious cervical lesions. CLINICAL SIGNIFICANCE Within this trial, survival was not significantly different between GH and RC to restore sclerotic NCCLs. As GH was significantly less costly both initially and long-term than RC, using RC was only cost-effective for payers willing to invest high additional expenses per minimal survival gains.