Subido por Ivan Roditi


Effect of surface treatment and aging on bond strength of
composite resin onlays
Maria Cura, DDS, PhD,a Inmaculada González-González, DDS,b Victoria Fuentes, DDS, PhD,c and
Laura Ceballos, DDS, PhDd
Advances in adhesive dentistry
have increased the use of inStatement of problem. Additional polymerization of indirect composite resins enhances their
direct restorations.1-4 They are
physical properties but lessens the potential for chemical bonding.
indicated for extensive cavities
Purpose. The purpose of this in vitro study was to evaluate the influence of different surface
because the anatomic form,
treatments and 6-month water storage on the microtensile bond strength (mTBS) of composite resin
proximal contacts, and interonlays.
proximal contour are more
Material and methods. Composite resin onlays (Filtek Z250) randomly received 6 different surface
easily and accurately obtained
treatments: (1) airborne-particle abrasion with 27-mm alumina particles+Adper Scotchbond 1XT
than with direct composite
application, (2) airborne-particle abrasion with alumina particles+silane application
resin restorations.5,6 Moreover,
(ESPE SIL)+Adper Scotchbond 1XT, (3) airborne-particle abrasion with alumina
indirect restorations are less
particles+Scotchbond Universal adhesive, (4) tribochemical silica coating with 30-mm particles
prone to fracture7 and ensure a
(CoJet Sand)+Adper Scotchbond 1XT adhesive, (5) tribochemical silica coating+silane
application+Adper Scotchbond 1XT, and (6) tribochemical silica coating+Scotchbond Universal
better seal because the impact
adhesive. Onlays were luted to fresh composite resin specimens with RelyX Ultimate resin
of polymerization shrinkage
cement. Bonded assemblies were stored in water for 24 hours or 6 months at 37 C and
on adhesion is insignificant.
subjected to the mTBS test. Additional surface-treated composite resin onlays were analyzed with
Several properties of india contact profilometer to determine average roughness, and micromorphologic changes were
rect composite resins have
analyzed with scanning electron microscopy.
contributed to their selection
Results. Airborne-particle abrasion with alumina followed by Adper Scotchbond 1XT or Scotchbond
by practitioners over ceramic
Universal adhesive application provided the highest bond strength values at 24 hours. Lower values
materials. Composite resins
were obtained after tribochemical silica coating. After 6 months of artificial aging, airborne-particle
induce less wear of the
abrasion with alumina or silica-coated alumina particles followed by Scotchbond Universal
opposing tooth9 and are
application yielded the greatest bond strength results. Airborne-particle abrasion with alumina
easier to repair intraorally.10
produced the highest roughness values and a more irregular surface.
Moreover, better marginal
Conclusion. Adhesive selection seems to be relevant to the mTBS of luted composite resin onlays
quality11 has been reported,
after 6 months of water aging, as specimens treated with Scotchbond Universal, after alumina
as well as greater fatigue reairborne-particle abrasion or tribochemical silica coating, yielded the highest values and better
aging stability. (J Prosthet Dent 2016;116:389-396)
sistance12 and fracture resistance,11,13 especially before
their physical and mechanical properties,15 also lessens
the luting procedure.14 However, the additional polytheir potential for chemical bonding because the
merization of indirect composite resins, that enhances
Products used in this study provided by 3M ESPE. This study is part of a thesis submitted in partial fulfilment of doctoral degree requirements of author I.G.-G.
Fellow Researcher, Department of Stomatology, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
Doctoral student, Department of Stomatology, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
Assistant Professor, Department of Stomatology, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
Associate Professor, Department of Stomatology, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
Volume 116 Issue 3
Clinical Implications
Treating the surfaces of indirect composite resin
onlays with airborne-particle abrasion with alumina
or silica-coated alumina particles followed by
Scotchbond Universal application produces the
greatest bond strength after 6 months of artificial
quantity of residual free carbon double bonds
Several surface treatments have been proposed to
increase composite resin roughness to provide mechanical interlocking of the adhesive15,17-27 and to increase the number of unreacted methacrylate groups in
the larger surface area created.28 Specifically, airborneparticle abrasion with alumina has been shown to
improve bond strength to repaired composite resin29-32
and to indirect composite resin restorations.20,33 Also,
tribochemical silica coating has achieved promising
results as it provides a silica deposit on the composite
resin surface together with micromechanical retention.34 This silica-modified surface is reactive to silane
coupling agents that also react with the methacrylate
groups of the adhesive resins.30-32,35 Nevertheless,
when both airborne-particle abrasion treatments have
been compared, the results are controversial and the
advantage of these chemical interactions has not been
clearly demonstrated.29-31,36 Moreover, the benefit of
silane agents application, alone or followed by a
bonding agent, to indirect composite resins is not
completely clear5,31,37 and would imply additional
clinical steps.
Recently, a new family of dental adhesives known as
‘‘universal’’ or ‘‘multimode’’ adhesive systems has been
introduced. These adhesives can be applied either with
the etch-and-rinse or the self-etch technique.38-41 In the
case of Scotchbond Universal (3M ESPE), it contains
silane in order to allow the luting of indirect restorations
with fewer clinical steps.42,43
The purpose of this in vitro study was to evaluate
the influence of different surface treatments, including
alumina airborne-particle abrasion and tribochemical
silica coating combined with an adhesive application,
preceded or not by a silane coupling agent, or using a
universal adhesive, on the microtensile bond strength
(mTBS) of composite resin onlays after 24 hours and 6
months of artificial aging. The effect of such treatments on composite resin roughness and morphology
was also determined. The null hypothesis was that
the bond strength of indirect composite resins would
not be influenced by the intaglio surface treatment or
by 6 months of water storage.
The composition and application technique of the materials tested are listed in Table 1. All were used according
to the manufacturers’ instructions.
Two-mm thick increments of a microhybrid composite resin (Filtek Z250, A3 shade; 3M ESPE) were
layered into a Teflon mold (8 mm diameter × 4 mm high)
to obtain composite resin onlays (n=36). Each increment
was then photopolymerized for 40 seconds (Elipar S10;
3M ESPE, output of 1200 mW/cm2). The specimens were
removed from the mold and polymerized in a unit
(Lumamat 100; Ivoclar Vivadent AG) with program 3 at
104 C and high light intensity for 25 minutes. The surfaces to be bonded were wet ground on a polishing
machine (Beta; Buehler) using 600 grit SiC abrasive papers and then ultrasonically cleaned for 10 minutes in
distilled water and air-dried. After 24 hours of dry storage, the composite resin onlays randomly received 1 of
the 6 treatments listed in Table 2. Software (Excel;
Microsoft Corp) was used to generate random numbers
from 1 to 6, according to the experimental treatment, that
were assigned to each composite resin onlay.
Thirty-six additional fresh composite resin cylinders
(Filtek Z250, Shade A1; 3M ESPE) (8 mm in diameter and
4 mm high) were luted to the pretreated substrates with
resin cement (RelyX Ultimate, Shade A1; 3M ESPE). Each
composite resin specimen was cemented maintaining a
constant force of 9.8 N during the first 5 minutes to
standardize the luting agent thickness.44 Photopolymerization was carried out with the same polymerization unit for 20 seconds buccally, 20 seconds lingually,
and thereafter for 40 seconds from the occlusal surface.
Specimens were randomly distributed using the Excel
software program, according to the storage period, 24
hours or 6 months, and, in both cases, kept at 37 C and
100% relative humidity until mTBS testing. The bonded
assemblies were sectioned perpendicularly to the adhesive interface in the x and y directions (IsoMet 5000;
Buehler), and beams with a cross-sectional area of
approximately 1 mm2 were obtained. The exact dimensions of the beams were determined with a digital
caliper (Mitutoyo Corp). Specimens were glued (Loctite
Super Glue-3 gel; Henkel) to the fixtures of a universal
testing machine (Instron 3345; Instron Co) and stressed
at a tensile load of 0.5 mm/min until failure. The bond
strength values were calculated in megapascals (MPa).
A single operator (I.G.-G.) determined the failure
modes using a stereomicroscope (Olympus SZX7;
Olympus Corp) at ×40 magnification to classify them as
cohesive (in cement, in fresh composite resin, or in
composite resin onlay); adhesive (between cement and
fresh composite resin, composite resin onlay and cement,
or both); or mixed (simultaneous adhesive and cohesive
fractures). The percentage for each failure mode was then
Cura et al
September 2016
Table 1. Chemical composition and application technique of tested materials
Chemical Composition
Application Technique
Adper Scotchbond 1XT
Bis-GMA, HEMA, dimethacrylate resins, ethanol, water,
photoinitiator, 5 nm spherical silica particles, methacrylate
copolymer of polyacrylic and polyitaconic acids
Apply adhesive for 20 seconds with vigorous agitation
Gently air-thin for 5 seconds
Photopolymerize for 20 seconds
Scotchbond Universal
MDP monomer, dimethacrylate resins, HEMA, Vitrebond
copolymer (3M ESPE), filler, ethanol, water, initiators, silane
Apply adhesive for 20 seconds with vigorous agitation
Gently air-thin for 5 seconds
Photopolymerize for 20 seconds.
3-methacryloxypropyltrimethoxysilane, ethyl alcohol, methyl
ethyl ketone
Apply and allow volatile silane solution to dry for 5 minutes
Filtek Z250
Shade: A3, A1
Organic matrix: Bis-GMA, UDMA, Bis-EMA, TEGDMA. Filler:
60% in volumen (range of 0.19-3.3 mm) zirconia and silica
Photopolymerize for 40 seconds
RelyX Ultimate
Base paste: methacrylate monomers, radiopaque, silanated
fillers, initiator components, stabilizers, rheologic additives
Catalyst paste: methacrylate monomers, radiopaque alkaline
(basic) fillers, initiator components, stabilizers, pigments,
rheologic additives, fluorescence dye, dark polymerization
activator Scotchbond Universal adhesive
Automix cement
Photopolymerize for 80 seconds
Bis-GMA, bisphenol-glycidyl methacrylate; HEMA 2, hidroxyethyl methacrylate; MDP, methacryloyloxydecyl dihydrogen phosphate; UDMA, urethane dimethacrylate; Bis-EMA, ethoxylated
bisphenol A glycol dimethacrylate; TEGDMA, triethylene glycol dimethacrylate.
Table 2. Experimental treatments
Surface Treatment
Application Technique
Airborne-particle abrasion with an intraoral device (RONDOflex Plus 360; KaVo) filled with 27 mm alumina particles (RONDOflex; Kavo) for 10
seconds at a pressure of 0.25 MPa from a distance of 10 mm. Following surface conditioning, they were rinsed copiously with water and dried
with air. Adper Scotchbond 1XT adhesive (3M ESPE) was applied and photopolymerized for 20 seconds with the same LED unit.
Airborne-particle abrasion was performed as described for the preceding group and a silane agent (ESPE Sil; 3M ESPE) was applied and left
undisturbed for 5 minutes. Adper Scotchbond 1XT adhesive was applied and photopolymerized.
Specimens were airborne-particle abraded as described earlier followed by Scotchbond Universal adhesive application according to
manufacturer’s instructions. Subsequently, the solvent was gently evaporated and photopolymerized for 20 seconds.
Tribochemical silica coating with 30 mm particles (Cojet Sand; 3M ESPE) using the parameters described for the Al2O3+1XT group, followed by
Adper Scotchbond 1XT adhesive application.
Tribochemical silica coating, followed by the same silane agent and Adper Scotchbond 1XT adhesive application.
Tribochemical silica coating, followed by Scotchbond Universal adhesive application.
calculated. After tensile testing, specimens with representative fracture patterns of each group were selected
and also observed under a scanning electron microscope
(XL30 ESEM; Philips) after gold sputter-coating (SCD
005 Sputter Coater; Bal-Tec).
Additional composite resin specimens (n=6) were
prepared to determine the surface roughness and
topographic changes induced by the following surface
treatments: polishing with 600 grit SiC papers; airborneparticle abrasion with 27 mm alumina particles (RONDOflex); and tribochemical silica coating with 30 mm
particles (CoJet Sand). The surface roughness was
determined by the parameter average roughness (Ra).
Five successive measurements in different directions
were made on each treated specimen with a contact
profilometer (Mitutoyo Surftest SJ 301; Mitutoyo); the
cutoff value for surface roughness was 0.8 mm, and the
sampling length for each measurement was 2.4 mm.
Another 3 specimens corresponding to the surface
treatments described earlier were sputter-coated with
gold and observed under the same scanning electron
microscope. Also, 10 quantitative elemental analyses
were carried out per specimen using energy-dispersive
x-ray spectroscopy (EDS) (XL-30; EDAX) at ×5000
Cura et al
A 2-way ANOVA was performed to analyze the effect
of the composite resin surface treatment and the aging
period on the mTBS of luted onlays. Multiple comparisons
were evaluated using the Tukey-Kramer test. The Student t test was applied to compare the mTBS values
before and after aging for each surface treatment. The Ra
was analyzed by 1-way ANOVA and the Tukey test. All
statistical tests were performed with software (IBM SPSS
v19; IBM Corp) (a=.05).
The means and standard deviations of the mTBS values
yielded for each experimental group are summarized in
Table 3. The 2-way ANOVA revealed that bond
strength values were significantly influenced by the
intaglio surface treatment (P<.001), the aging period
(P<.001), and the interaction between these factors
Post hoc comparisons among the experimental
groups showed that 24 hours after the luting procedure,
airborne-particle abrasion with alumina particles followed by Adper Scotchbond 1XT or Scotchbond Universal adhesive application yielded the highest mTBS
mean values. However, the lowest results were obtained
Volume 116 Issue 3
Table 3. Mean mTBS values in MPa (standard deviation) to different
treated indirect composite resins after 24 hours and 6 months of water
24 hours
6 months
98 (18)*
52.8 (12.9)*
76.9 (19.9)*
54 (16.2)*
97.5 (18.9)
91 (19.15)
74.3 (13.5)*
55.7 (20.5)*
83.3 (15.6)*
68.3 (24.8)*
71.2 (18.3)
76.6 (15.8)
n, number of microbars tested. Different letters indicate statistically different mTBS values
among groups (P<.05) for each evaluation period (24 hours or 6 months). *Statistical
differences between mTBS results after 24 hours and 6 months of water storage.
Cohesive cement
Adhesive mixed
Adhesive composite onlay cement
Adhesive cement/A1
for specimens subjected to tribochemical silica coating
and Scotchbond Universal application.
After 6 months of water storage, the highest bond
strength values corresponded to those of specimens
airborne-particle abraded with alumina particles before
Scotchbond Universal adhesive application, followed by
composite resins treated with silica coating and the use of
the same adhesive.
The Student t test showed significant differences in
the mTBS after 24 hours and 6 months of aging for all the
experimental groups, except for specimens treated with
Scotchbond Universal after airborne-particle abrasion,
regardless of the powder selected.
No failures occurred before testing for any of the
experimental groups evaluated. The failure mode distribution observed for the different experimental groups is
shown in Figure 1. After 24-hour storage, failures were
primarily cohesive in resin cement, as can be seen in
Figure 2A, followed by mixed failures. However, after 6
months of artificial aging, mixed failure was the predominant type for all the experimental groups (Fig. 2B),
except for specimens treated with Scotchbond Universal
adhesive, which for the most part, showed cohesive
failures in the cement (Fig. 2C).
One-way ANOVA showed that surface roughness
was statistically different for the 3 treatments tested
(P<.001). The ranking of the surface roughness values
(Ra, mm) from the lowest to the highest was as follows:
600-grit SiC paper polishing (0.21 ±0.07) < tribochemical
silica coating (0.65 ±0.09) < alumina airborne-particle
abrasion (1.70 ±0.6).
The effect of the 600 grit SiC paper polishing and
airborne-particle abrasion either with 27 mm alumina
powder or 30 mm silica-coated alumina particles on the
composite resin topography is shown in Figure 3.
As shown in Figure 3A, the polishing procedure produced
scratches in the same direction. In contrast, airborneparticle abrasion with alumina or silica-coated alumina
powder significantly altered the composite resin
surface creating undercuts, grooves and edge-shaped
Cohesive cement
Adhesive cement/A1
Adhesive mixed
Adhesive composite onlay cement
Figure 1. Failure mode distribution in percentage (%) for treated
composite resin specimens after 24 hours (A) and 6 months (B) of water
microretentions (Fig. 3B, C). However, these modifications were slightly more irregular and noticeable after
airborne-particle abrasion with alumina (Fig. 3B).
EDS microanalysis showed an identical element distribution on composite resin surfaces airborne-particle
abraded with alumina or CoJet Sand, with 30% of Zr
and with 34% of Si. For composite resin surfaces polished
with SiC paper, the composition was essentially the
same, 31% Zr and 35% Si.
The present study examined the effect of 6 surface
treatments of an indirect composite resin on its adhesive properties when luted to a direct one by means of a
resin cement and on stability after 6 months of artificial
aging. According to the results, the null hypothesis
Cura et al
September 2016
Figure 2. Representative micrographs of debonded composite resin
surfaces (original magnification ×150). A, Large area of cement layer
from specimen airborne-particle abraded with alumina particles before
Adper Scotchbond 1XT application and fractured after 24 hours.
B, Cement remnants layering on composite resin surface from specimen
treated by tribochemical silica coating before Adper Scotchbond 1XT
application and fractured after 6 months of aging. C, Large cement layer
from experimental group in which composite resin onlay was silica
coated before Scotchbond Universal adhesive application and fractured
after 6 months of aging.
was rejected as the composite resin surface conditioning and the aging period did affect bond strength
Cura et al
Figure 3. Scanning electron micrographs of treated resin composite
resin surfaces (original magnification ×1000). A, Polished with 600 grit
SiC papers. B, Airborne-particle abraded with 27 mm alumina particles.
C, Tribochemical silica coating with 30 mm particles (CoJet Sand).
After 24 hours of water storage, airborne-particle
abrasion with alumina particles followed by the
application of Adper Scotchbond 1XT or Scotchbond
Universal adhesives was the surface treatment that
provided the highest mTBS mean values. Other authors have previously reported the effectiveness of
this surface treatment as it creates micromechanical
retentions and increases the wettability of the
Curiously, tribochemical silica-coated composite
resins displayed lower mTBS mean values, although both
powders were selected with a similar particle size (27 mm
for alumina and 30 mm for silica-coated alumina),
because a more relevant influence on bond strength has
been attributed to different particle sizes than to their
different chemical composition.29 Accordingly, microroughness results were significantly lower for tribochemical silica-coated composite resins than for
airborne-particle abraded alumina, and, as shown in
Figure 3, tribochemical silica coating produced a less
uneven surface.29-31 Moreover, no differences in composite resin composition were detected between
airborne-particle abrasion with alumina or silica-coated
alumina powders29 by EDS analysis.
Therefore, the microretentive pattern created by the
surface treatment would have a main function on composite resin bond strength at 24 hours after luting. Previous studies have reported similar bond strength values
for both airborne-particle abrasion techniques,29-31,36
without any advantage for tribochemical silica-coating
followed or not by a silane coupling agent application.30,31 Moreover, in a clinical situation, with the
presence of enamel and/or dentin, silica coating may
adversely affect composite resin bond strength22 or
marginal quality.45 However, in the present study, the
presence of natural tooth tissues was avoided as onlay
composite resins were luted to fresh composite resin in
order to detect the effect of the different surface treatments without the interference of microstructural variations of natural dental tissues.1 Furthermore, in a clinical
situation the adhesive substrate is mainly composite
resin, in that it is usually used as a base or liner underneath inlay and onlay preparations to avoid unnecessary
tissue sacrifice to accommodate the geometric restrictions
of indirect restorations and functions as pulpal protection
during the interim restoration phase.2,3,46
The adhesive interfaces established during indirect
composite resin luting should remain stable over time,5,34
although in most studies the specimens are tested shortly
after the luting procedure.5,18,20 In the present study, the
effect of the surface treatments tested on bond strength
was evaluated not only after 24 hours but also after 6
months of water storage. This storage time was chosen as
it is the one commonly used to analyze the degradation
of resin dentin bonds.39-41 Moreover, specimens were not
sectioned before their storage to simulate a clinical situation in which the inner part of the restoration is protected by the external one and to follow the methodology
previously used.23
According to the results obtained, a significant
decrease in bond strength values was registered after the
aging procedure24,25 for all experimental treatments,
Volume 116 Issue 3
except for specimens in which Scotchbond Universal
adhesive was applied after alumina or silica-coated
airborne-particle abrasion. Several studies have also reported a tendency for lower bond strength after an aging
procedure,25 while other authors find adhesive interfaces
stable for different evaluation periods.22,26
The better performance detected for composite resins
treated with the universal adhesive is supported by previous studies that have found that the adhesive system
used is a main influence on the composite resin bond
strength after an aging procedure.17,22,26 In agreement
with our results, Tantbirojn et al27 reported that the
application of Scotchbond Universal adhesive to repair
freshly polymerized or aged composite resin restored the
cohesive strength of the original monolithic composite
resin, unlike Adper Single Bond Plus.
The hydrophilicity of the adhesives has been suggested as a reason for interface degradation due to
water absorption over time.47,48 A possible explanation
for the stability of specimens treated with Scotchbond
Universal could be the incorporation of 10-MDP
monomer in its formulation. This functional selfetching monomer is considered hydrophobic and
relatively hydrolytically stable, keeping water at a distance.48 It is also present in Clearfil SE Bond adhesive
(Kuraray), which exhibited higher repair bond strength
of composite resin than other adhesives such as AdheSE One F (Ivoclar Vivadent AG) and Adper Scotchbond Multi-Purpose (3M ESPE) after 1 and 12 months
of storage.26 The 10-MDP molecule also has the ability
to react with zirconia49 to obtain aging resistant adhesion.50 According to EDS microanalyses of the composite resin used, Filtek Z250, around a 30% of Zr a
32% of Zr was detected, regardless of the surface
treatment performed (alumina or silica-coated alumina
airborne-particle abrasion), which could allow a
chemical interaction between them. Moreover, RelyX
Ultimate resin cement incorporates a dark polymerization activator for Scotchbond Universal adhesive in the
catalyst paste that may have contributed to its better
performance; this would be especially true after aging as
this dual polymerization has been described as
Regarding the effect of silane application on composite resin luting, no clear benefit was detected in the
present study as previously reported.29,31,37,44 Specifically, a significant decrease in bond strength was
observed after 6 months of water storage when it was
included as a separate step, possibly related to the high
hydrophilicity of silane coupling agents.52
Finally, no failures occurred before testing for any of
the experimental groups evaluated, revealing a high
mTBS of the luted indirect composite resins.36 Regarding
the type of failure, higher numbers of cohesive fractures
were observed in groups with higher bond strength
Cura et al
September 2016
values, which is in agreement with observations of
Eliasson et al.25 For specimens tested 24 hours after the
luting procedure, cohesive failure in resin cement predominated for all groups. This indicated that the bond
strength after surface treatments approaches the fracture
strength of the resin cement evaluated. However, specimens after 6 months of water aging exhibited more
mixed failures (predominantly between cement and
composite resin onlay), which is compatible with a higher
hydrolytic degradation in the adhesive interface, except
in specimens treated with Scotchbond Universal, which
mostly showed cohesive failures in cement.
Within the limitations of this in vitro study, airborneparticle abrasion with alumina followed by Adper
Scotchbond 1XT or Scotchbond Universal adhesive
application obtained higher adhesive strength values after 24 hours of water storage. However, the selection of
the adhesive acquires relevance after 6 months of water
aging as airborne-particle abrasion with alumina particles, silica-coated or not, followed by Scotchbond Universal adhesive provided the highest bond strength
values and better aging stability.
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Corresponding author:
Dr Laura Ceballos
Health Sciences Faculty
Rey Juan Carlos University
Avda. Atenas s/n
28922, Alcorcón, Madrid
Email: [email protected]
The authors thank Roberto García-Quismondo Castro and Miguel A. Garrido for
their help with SEM and microroughness analyses, respectively.
Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.
Noteworthy Abstracts of the Current Literature
The concept of platform switching to preserve peri-implant bone level: Assessment
of methodologic quality of systematic reviews
Monje A, Pommer B
Int J Oral Maxillofac Implants 2015;30:1084-92
Purpose. To assess the methodologic quality of systematic reviews on the effect of platform switching upon
peri-implant marginal bone loss.
Materials and Methods. An electronic literature search of several databases was conducted by two reviewers.
Articles were considered for quality assessment if they met the following inclusion criterion: systematic reviews that
aimed at investigating the effect of platform switching/mismatch on marginal bone levels around dental implants. Two
independent examiners evaluated the review publications using two quality-ranking scales (assessment of multiple
systematic reviews [AMSTAR] and Glenny checklist). Descriptive statistics were used to summarize the results, and
Cohen’s kappa coefficients were calculated to appraise interrater agreement of each checklist.
Results. Overall, five systematic reviews (including three of them with meta-analysis) were evaluated. The mean
AMSTAR score ± standard deviation was 8.4 ± 2.6 (range, 4 to 11), and the mean Glenny score was 10.8 ± 2.9
(range, 6 to 14), showing high statistical correlation (rs = 0.98, P = .005). Cohen interexaminer test yielded values of
k = 0.88 and k = 0.86 for the AMSTAR and Glenny checklist, respectively. The AMSTAR items rated positive in 78%,
whereas 18% met the criteria for “no” and 4% were “not applicable.” Only one review article met all criteria. Items of
the Glenny checklist rated positive in 73% and negative in 27%. All but one study with the lowest quality scores
(finding no difference) demonstrated a clinical benefit of implant platform switching in preserving the peri-implant
marginal bone loss.
Conclusion. According to the quality-ranking scales appraised, substantial methodologic variability was found in
systematic assessment of benefits with the platform switching concept to preserve peri-implant bone level.
High-quality systematic reviews, however, generally favored platform switching over platform matching.
Reprinted with permission of Quintessence Publishing.
Cura et al