Futurabond DC (single dose blister) will be applied as thickness to the enamel/dentine and rub into the tooth surface for 20s; FBDC drying layer for at least 5s with an air syringe; This adhesive layer will be light-cured with a light emitting diode unit (LED light), with an intensity of 1000mW/cm2, during 20s.

Etch with 36% phosphoric acid, during 30s in enamel structures. Remove the 36% phosphoric acid with water during 1 minute. The remove of water excess will be done with weak air spray, not to dry the dentine completely. The dentine surface must slightly remain wet. Application of Futurabond DC (FBDC) as self-etch mode simultaneously in dentin and enamel, and the light-cured (LED light; 1000mW/cm2), during 20s.

FuturabondU® (FBU) apply in enamel and dentin as etch-and-rinse (ER) mode. Etching of the dental hard tissue phosphoric acid (15s in dentin and 30s in enamel) and then rinse with water for 1 min. Dry off excess moisture with a gentle stream of air. Activating FBU SingleDose. FBU adhesive will be homogeneously applied to all cavity surfaces and rub in for 20s using the Single Tim; This adhesive layer will be light-cured with a light emitting diode unit, with an intensity of 1000mW/cm2 during 20s.

FuturabondU® (FBU) apply in enamel and dentin as SE mode. Activating FBU SingleDose. FBU adhesive will be homogeneously apply to all cavity surfaces and rub in for 20 s using the Single Tim; Dry off the adhesive layer with dry, oil-free air for at least 5 s in order to remove any solvents. This adhesive layer will be light-cured with a light emitting diode unit (LED light), with an intensity of 1000mW/cm2, during 20 seconds.

Adhese®Universal (ADU) apply by etch-and-rinse (ER) mode. Etching of the dental hard tissue phosphoric acid (15 seconds in dentin and 30 seconds in enamel); Etch agent rinse with water for 1 minute. Dry off excess moisture with a gentle stream of air. Keep dentin dry, do not over dry; Adhesive ADU will be scrubbed into the tooth surface (enamel and dentin) for at least 20 seconds. Adhesive will be dispersed with compressed air until a glossy, immobile film layer results.Light-curing for 10 s with a light emitting diode unit (LED light), with an intensity of 1000mW/cm2 for 20s.

Adhese®Universal (ADU)apply by self-etch (SE) mode. Starting with the enamel, thoroughly coat the tooth surfaces (enamel and dentin) to be treated with ADU; Adhesive will be scrubbed into the tooth surface for at least 20 seconds. Adhesive will be dispersed with compressed air until a glossy, immobile film layer results.Light-curing for 20 s with a light emitting diode unit (LED light), with an intensity of 1000mW/cm2.

Each participant is enrolled in several randomly allocated arms/groups (G1, G2, G3, G4, G5, G6) and received one to six NCCLs restorations in premolar/molar teeth.

All Participants

NCCLs restorations per arm/group distribution, according to the participant mean age.

Sex: Female, Male

Race and Ethnicity Not Collected

Systemic pathologies at baseline

Oral hygiene at baseline

Smoking habits at baseline

Daily cigarettes (NCCLs restorations in smoker participants) at baseline

NCCLs Tooth Type

Degree 1= No sclerosis present. Dentine is light yellow or whitish in colour with little discoloration; Dentine is opaque, with little translucency or transparency. Degree 2= More than category 1, but less than 50% of the difference between categories 1 and 4. Degree 3= Less than category 4, but more than 50% of the difference between categories 1 and 4. Degree 4= Significant sclerosis present. Dentine is dark yellow or even discoloured (brownish). Dentine appears glassy, with significant translucency or transparency evident.

NCCLs Sclerotic Dentin Degree

NCCls Cavity Geometry (Internal angle shape, degree º)

Clinical Performance Acceptance was expressed as the number of NCCls restorations scored as "1-Clinically excellent/ very good", "2-Clinically good (after correction, very good)", "3-Clinically sufficient/ satisfactory (minor shortcomings with no adverse effects but not adjustable without damage to the tooth)", "4-Clinically unsatisfactory (repair for prophylactic reasons)". NCCls restorations with not acceptable performance were scored as "5-Clinically poor (replacement necessary)" for clinical properties. NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Futurabond®DC (FBDC) adhesive by self-etch (SE) mode in NCCls cavities randomly assigned to premolar or molar teeth: FBDC rubbered in enamel and dentine for 20s, then dryed for at least 5s with an air syringe and then light-cured.

FBDC-SE (G1; Control Group)

FBDC adhesive by self-etch mode with selective enamel etching (FBDC-SE-EE) in NCCls cavities randomly assigned to premolar or molar teeth: Enamel etched with 36% phosphoric acid for 30s and then removed with water during 1 minute; finally, FBDC applied by SE mode, simultaneously in dentin and enamel and light-cured.

FBDC-SE-EE (G2; Control Group)

FuturabondU® (FBU) adhesive by etch-and-rinse (ER) mode in NCCls cavities randomly assigned to premolar or molar teeth: Etching of dental tissues with 36% phosphoric acid (15s in dentin and 30s in enamel) and then rinse with water for 1 min; Dryed off the excess moisture with a gentle stream of air. FBU rubbered in enamel and dentine for 20s, then dyed for at least 5s and then light-cured.

FBU-ER (G3)

FBU adhesive by self-etch (SE) mode in NCCls cavities randomly assigned to premolar or molar teeth: FBU rubbered in enamel and dentine for 20s, then dyed for at least 5s and then, light-cured.

FBU-SE (G4)

Adhese®Universal (ADU) adhesive by etch-and-rinse (ER) mode in NCCls cavities randomly assigned to premolar or molar teeth: Etching of dental tissues with 36% phosphoric acid (15s in dentin and 30s in enamel) and then rinse with water for 1 min; Dryed off the excess moisture with a gentle stream of air. ADU scrubbled in enamel and dentine for 20s, then dyed for at least 5s and then light-cured.

ADU-ER (G5)

ADU adhesive by self-etch (SE) mode in NCCLs cavities randomly assigned to premolar or molar teeth: ADU scrubbled in enamel and dentine for 20s, then dyed for at least 5s and then light-cured.

ADU-SE (G6)

Esthetic, Functional and Biological Clinical Performance Adhesive/Adhesion Mode of NCCLs Restoration, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Clinical Performance Acceptance was expressed as the number of NCCls restorations scored as "Alfa" and "Bravo". NCCls restorations with not acceptable performance were scored as "Charlie" for Esthetic properties, for Retention criteria and for Biological properties, and also scored "Delta" for Marginal Adaptation criteria. NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

FBU adhesive by self-etch (SE) mode in NCCls cavities randomly assigned to premolar or molar teeth: FBU rubbered in enamel and dentine for 20s, then dyed for at least 5s and then light-cured.

Esthetic, Functional and Biological Clinical Performance Adhesive/Adhesion Mode of NCCLs Restoration, Graded on a 4-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

FDI or USPHS criteria evaluation outcomes for Esthetic, Functional and Biological parameters, at 24th month follow-up were expressed as the number os NCCLs With Clinical Acceptance for each parameter. NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

FBDC adhesive by self-etch mode with selective enamel etching (FBDC-SE-EE) in NCCls cavities randomly assigned to premolar or molar teeth: Enamel etched with 36% phosphoric acid for 30s and then removed with water during 1 minute; finally, FBDC applied by SE mode, simultaneously in dentin and enamel, and light-cured.

FDI or USPHS Criteria Evaluation Outcomes for Esthetic, Functional and Biological Parameters, at 24th Month Follow-up.

Surface Luster Clinical Acceptance was expressed as the number of NCCls restorations classified as "(11)-Luster comparable to enamel", "(12)-Slightly dull, not noticeable from speaking distance", "(13)-Dull surface but acceptable if covered with film of saliva", "(14)- Rough surface, cannot be masked by saliva film, simple polishing is not sufficient. Further intervention necessary". NCCls restorations with not acceptable Surface Luster were classified as "(15)-Quite rough, unacceptable plaque retentive surface". NCCLs restorations not observed due to retention lost were scored as "missing" for other categories.

Surface Luster, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Staining Margin Clinical Acceptance was expressed as the number of NCCls restorations classified as "(21)-No surface staining", "(22)-Minor staining, easily removable", "(23)-Moderate surface staining, also present on other teeth, not aesthetically unacceptable", "(24)-Surface staining present on the restoration and is unacceptable; major intervention necessary for improvement". NCCls restorations with not acceptable Staining Margin were classified as "(25)-Severe staining and/or subsurface staining (generalized or localized); not accessible for intervention". NCCLs restorations not observed due to retention lost were scored as "missing" for other categories.

Staining Margin, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Colour Stability and Translucency Clinical Acceptance was expressed as the number of NCCls restorations classified as "(31)-Good colour match no difference in shade and translucency", "(32)-Minor deviations", "(33)-Clear deviation but acceptable. Does not affect aesthetics", "(34)-(Localised) clinically unsatisfactory but can be corrected by repair". NCCls restorations with not acceptable Colour Stability and Translucency were classified as "(35)-Unacceptable. Replacement necessary". NCCLs restorations not observed due to retention lost were scored as "missing" for other categories.

Colour Stability and Translucency, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Fractures and Retention Clinical Acceptance was expressed as the number of NCCls restorations classified as "(41)-Restoration retained, no fractures/cracks", "(42)-Small hairline crack", "(43)-Two or more or larger hairline cracks and/or chipping (not affecting the marginal integrity or proximal contact", "(44)-Chipping fractures which damage marginal quality or proximal contacts; bulk fractures with or without partial loss(less than half of the restoration)". NCCls restorations with not acceptable Fractures and Retention were classified "(45)-Partial or complete loss of restoration".

Fractures and Retention, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Marginal Adaptation Clinical Acceptance was expressed as the number of NCCls restorations classified as "(51)-Harmonious outline, no gaps, no discoloration", "(52)-Marginal gap (50 µm) or Small marginal fracture removable by polishing", "(53)-Gap< 150 µm not removable or Severe small enamel or dentin fractures", "(54)- Gap> 250 µm or dentine exposed or Chip fracture damaging margins or Notable enamel or dentine wall fracture", "(55)-Filling is loose but in situ". NCCLs restorations not observed due to retention lost were scored as "missing" for other categories.

Marginal Adaptation, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Postoperative Hypersensibility, Tooth Vitality Clinical Acceptance was expressed as the number of NCCls restorations classified as "(61)-No hypersensitivity, normal vitality", "(62)-Low hypersensitivity for a limited period of time, normal vitality", "(63)-Premature/slightly more intense or Delayed/weak sensitivity; no subjective complaints, no treatment needed", "(64)-Premature/very intense or Extremely delayed/weak with subjective complaints or Negative sensitivity intervention necessary but not replacement". NCCls restorations with not acceptable Postoperative Hypersensibility, Tooth Vitality criteria were classified as (65)-Very intense, acute pulpitis or no vital; Endodontic treatment is necessary and restoration has to be replaced".NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Postoperative Hypersensibility, Tooth Vitality, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Recurrence of Caries, Erosion, Abfraction Clinical Acceptance was expressed as the number of NCCls restorations classified as "(71)-No secondary or primary caries", "(72)-Very small and localized. No operative treatment required", "(73)-Larger areas of: Demineralisation or Erosion or Abrasion/abfraction in dentine, localized and accessible and can be repaired", "(74)-Caries with cavitation or Erosion in dentine or Abrasion/abfraction in dentine Localized and accessible and can be repaired". NCCls restorations with not acceptable Recurrence of Caries, Erosion, Abfraction criteria were classified as "(75)-Deep secondary caries or exposed dentine that is not accessible for repair of restoration". NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Recurrence of Caries, Erosion, Abfraction, Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Tooth Integrity (enamel cracks) Clinical Acceptance was expressed as the number of NCCls restorations classified as "(81)-Complete integrity", "(82)-Small margin enamel(<150 µm) or Hairline crack in enamel (<150 µm not probable)", "(83)-Enamel split(<250 µm) or Crack< 250 µm, no adverse effects", "(84)-Major enamel split (gap>250 µm or dentine or base exposed) or Crack>250 µm (probe penetrates)". NCCls restorations with not acceptable Tooth Integrity (enamel cracks) criteria were classified as "(85)-Cusp or tooth fracture". NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Tooth Integrity (Enamel Cracks), Graded on a 5-point Scale, Using FDI Criteria at 24 Month Follow-up Recall

Surface Staining Clinical Acceptance was expressed as the number of NCCls restorations classified as "(Alfa)- No staining in the restoration and/or the tooth" or "(Bravo)-Slight staining in the restoration and/or the tooth". NCCls restorations with not acceptable Surface Staining were classified as "(Charlie)-The staining penetrated in the restoration and/or the tooth in a pulpal direction". NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Surface Staining, Graded on a 3-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Marginal Discoloration Clinical Acceptance was expressed as the number of NCCls restorations classified as "(Alfa)-No discoloration along the margin between the restoration and adjacent tooth" or "(Bravo)-Slight discoloration along the margin between the restoration and the adjacent tooth (removable, usually localized)". NCCls restorations with not acceptable Marginal Discoloration were classified as "(Charlie)-Deep staining cannot be polished away". NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Marginal Discoloration, Graded on a 3-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Color Match Clinical Acceptance was expressed as the number of NCCls restorations classified as "(Alfa)-Restoration matches the adjacent tooth structure in color and translucency" or "(Bravo)-Light mismatch in color, shade or translucency between the restoration and the adjacent tooth". NCCls restorations with not acceptable Color Match were classified as "(Charlie)-The mismatch in color and translucency is outside the acceptable range of tooth color and translucency". NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Color Match, Graded on a 3-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Retention Clinical Acceptance was expressed as the number of NCCls restorations classified as "(Alfa)-Retained" or "(Bravo)-Partially retained". NCCls restorations with not acceptable Retention were classified as "(Charlie)-Missing".

Retention, Graded on a 3-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Marginal Integrity Clinical Acceptance was expressed as the number of NCCls restorations classified as "(Alfa)-No visible evidence of crevice along the margin", "(Bravo)-Visible evidence of a crevice along the margin into which the explorer will penetrate"or "(Charlie)-Dentin or the base is exposed". NCCls restorations with not acceptable Marginal Integrity were classified as "(Delta)-Restoration is fractured, mobile or missing".

Marginal Integrity, Graded on a 4-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Postoperative Sensitivity Clinical Acceptance was expressed as the number of NCCls restorations classified as "(A)-No evidence of postoperative sensitivity". NCCls restorations with not acceptable Postoperative Sensitivity were classified as "(B)-Experience of postoperative sensitivity. NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Postoperative Sensitivity, Graded on a 2-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Secondary Caries Clinical Acceptance was expressed as the number of NCCls restorations classified as "(A)-No evidence of caries". NCCls restorations with not acceptable Secondary Caries criteria were classified as "(B)-Evidence of caries along the margin of the restoration. NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Secondary Caries, Graded on a 2-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Gingival Bleeding Clinical Acceptance was expressed as the number of NCCls restorations classified as "(A)-No evidence of gingival bleeding adjacent to Class II restoration". NCCls restorations with not acceptable Gingival Bleeding criteria were classified as "(B)-Evidence of gingival bleeding adjacent to Class II restoration". NCCLs restorations not observed due to retention/marginal integrity lost were scored as "missing" for other categories.

Gingival Bleeding, Graded on a 2-point Scale, Using USPHS Criteria at 24 Month Follow-up Recall

Each participant is enrolled in several randomly allocated arms/groups (G1, G2, G3, G4, G5, G6) and received one to six NCCLs restorations in Premolar/molar teeth.

All Participants Flow

FBDC-SE (G1; Control) Arm/Group Flow

FBDC-SE-EE (G2; Control ) Arm/Group Flow

FBU-ER (G3) Arm/Group Flow

FBU-SE (G4) Arm/Group Flow

ADU-ER (G5) Arm/Group Flow

ADU-SE (G6) Arm/Group Flow

Prof. Patricia Manarte-Monteiro; Associate Professor

Dental Adhesives/Restorations Performance

Futurabond®DC (FBDC) adhesive by self-etch (SE) mode bonding in NCCls restorations, was randomly assigned to premolar or molar teeth ensuring that this adhesive/mode is only apllied once in each participant.

G1-Control: Futurabond®DC-SE (FBDC_SE)

Futurabond®DC adhesive by self-etch mode with selective enamel etching (FBDC-SE-EE) bonding in NCCls restorations, was randomly assigned to premolar or molar teeth ensuring that this adhesive/mode is only apllied once in each participant.

G2-Control: Futurabond®DC_SE_EE

FuturabondU® (FBU) adhesive by etch-and-rinse (ER) mode, bonding in NCCls restorations, was randomly assigned to premolar or molar teeth ensuring that this adhesive/mode is only apllied once in each participant.

G3: Futurabond® U - ER (FBU_ER)

FuturabondU® (FBU) adhesive by self-etch (SE) mode, bonding in NCCls restorations, was randomly assigned to premolar or molar teeth ensuring that this adhesive/mode is only apllied once in each participant.

G4: Futurabond® U - SE (FBU_SE)

Adhese®Universal (ADU) adhesive by etch-and-rinse (ER) mode, bonding in NCCls restorations, was randomly assigned to premolar or molar teeth ensuring that this adhesive/mode is only apllied once in each participant.

G5: Adhese® Universal - ER (ADU_ER)

Adhese®Universal (ADU) adhesive by self-etch (SE) mode, bonding in NCCls restorations, was randomly assigned to premolar or molar teeth ensuring that this adhesive/mode is only apllied once in each participant.

G6: Adhese® Universal - SE (ADU_SE)

National Authority of Medicines and Health Products, IP is a Government agency accountable to the Health Ministry of Portugal

National Ethics Committee for Clinical Research

University Fernando Pessoa

NCCL Direct Composite Restoration Performance With Self-Etch and Multimode Adhesives

NCCL Direct Composite Restoration Performance With Self-Etch and Multimode Adhesives Clinical Trial

Patrícia Manarte Monteiro

Associate Professor

Daily Juice Plus+ with 2 vegetable & 2 fruit & 2 berry capsule (test group 1)

Juice Plus+ with 2 vegetable & 2 fruit & 2 placebo capsule (test group 2)

Daily Placebo in the form of 6 capsules (control group)

Periodontitis

Daily Juice Plus+ with 2 vegetable & 2 fruit & 2 berry capsule

Daily Juice Plus+ with vegetable & fruit & berry capsule

Daily Juice Plus+ with vegetable & fruit & placebo capsule

Daily Juice Plus+ vegetable & fruit & placebo capsule

Placebo in the form of 6 capsules

Birmingham Dental Hospital & Scool

Effect of Dietary Intake of Dried Whole Food Concentrates (Juice Plus) on Clinical Outcomes Following Periodontal Therapy: A Pilot Study

The Effect of Daily Dietary Intake of Dried Whole Food Concentrates of Fruit, Vegetables and Berries (Juice Plus+) in Improving Clinical Outcomes Following Non-surgical Periodontal Therapy: a Pilot Study.

carboxylic acid/karies

NCCL Direct Composite Restoration Performance With Self-Etch and Multimode Adhesives

Effect of Dietary Intake of Dried Whole Food Concentrates (Juice Plus) on Clinical Outcomes Following Periodontal Therapy: A Pilot Study

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