Does operatory field isolation influence the performance of direct adhesive restorations?

J Adhes Dent. 2013 Feb;15(1):27-32. doi: 10.3290/j.jad.a28194.


Purpose: To evaluate the influence of different adhesive strategies (etch-and-rinse and self-etching adhesives) and type of field isolation (absolute or relative) on the clinical performance of restorations of noncervical carious lesions (NCCLs).

Materials and methods: One hundred forty NCCLs were selected from 38 patients, according to previously established inclusion/exclusion criteria, and assigned to one of four groups (n = 35): etch-and-rinse/rubber-dam (ERR), etch-and-rinse/cotton roll (ERC), self-etching/rubber-dam (SER) and self-etching/cotton roll (SEC). The adhesive systems used were: Adper Single Bond 2 (3M ESPE) and Adper SE Plus (3M ESPE), with restorations made using a composite resin (Z350, 3M ESPE). Using the USPHS modified criteria, 140 restorations were evaluated by two calibrated examiners at 5 different times: immediately after placement, at 7 days, and 2, 6, and 12 months. In order to evaluate the presence of gingival recession after the use of the #212 rubber-dam clamp, the clinical crowns of the teeth from groups ERR and SER were measured at six different periods (baseline, immediately, and at 7 days, 2, 6, and 12 months). Data were subjected to McNemar's, chi-square, and Student's t-tests.

Results: Both adhesive strategies reduced tooth sensitivity beyond the second period of evaluation (7 days); tooth sensitivity disappeared after the third period of evaluation (2 months). There were no statistically significant differences between the adhesive techniques or isolation techniques, except for a Bravo score for marginal discoloration in group SEC at 6 months, which was significantly different from the other groups. The rubber-dam isolation technique was more uncomfortable for the patient and resulted in short-term gingival recession.

Conclusion: No significant differences were found between the types of isolation or adhesive strategy in this clinical evaluation, with the exception of 2 restorations in group SEC that showed marginal discoloration, possibly due to inadequate enamel etching by the self-etching adhesive. Class V restorations perform equally well placed with or without rubber-dam.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chi-Square Distribution
  • Composite Resins*
  • Dental Cements
  • Dental Restoration, Permanent / adverse effects
  • Dental Restoration, Permanent / methods*
  • Dentin Sensitivity / etiology
  • Dentin Sensitivity / prevention & control
  • Female
  • Gingival Recession / etiology
  • Humans
  • Male
  • Middle Aged
  • Resin Cements*
  • Rubber Dams* / adverse effects
  • Statistics, Nonparametric
  • Tooth Cervix
  • Tooth Wear / therapy
  • Young Adult


  • Adper single bond 2
  • Composite Resins
  • Dental Cements
  • Resin Cements