Effects of one versus two applications of an unfilled, all-in-one adhesive on dentine bonding

In vitro permeability of etch-and-rinse and self-etch adhesives used for immediate dentin sealing

To investigate the permeability of deep dentin following immediate sealing with different etch-and-rinse and self-etch adhesives (Single Bond 2, Adper Prompt L-Pop, Clearfil Protect Bond, Clearfil S3 Bond, G-Bond) and a dentin desensitizer (Gluma). Fluid-transport model was used to measure fluid conductance during and after application of adhesives. Polyvinylsiloxane impressions of bonded dentin were taken to monitor fluid transudation from the surface of the adhesives. The area and number of dentinal fluid droplets and/or blisters were calculated using image analysis. None of the adhesives were able to block fluid conductance completely. The fluid conductance values of the adhesives displayed the following statistical ranking (p<0.05): G-Bond≤Clearfil Protect Bond<Smear-layer-covered dentin<S3 Bond≤Single Bond 2≤Adper Prompt L-Pop<Gluma Desensitizer<Acid-etched dentin. Highly significant correlation was observed between the permeability of the tested adhesives and the area fraction of fluid droplets/blisters on the adhesive surfaces (r=0.99, p<0.01).

Effect of multiple coatings of one-step self-etching adhesive on microtensile bond strength to primary dentin

OBJECTIVE

To investigate the effect of multiple coatings of the one-step self-etching adhesive on immediate microtensile bond strength to primary dentin.

METHODS

Twelve caries-free human primary molars were randomly divided into 2 groups with 6 teeth each. In group 1, each tooth was hemisected into two halves. One half was assigned to control subgroup 1, which was bonded with a single-step self-etching adhesive according to the manufacturer's instructions; the other half was assigned to experimental subgroup 1 in which the adhesive was applied three times before light curing. In group 2, the teeth were also hemisected into two halves. One half was assigned to control subgroup 2, which was bonded with the single-step self-etching adhesive according to the manufacturer's instructions; the other half was assigned to experimental subgroup 2 in which three layers of adhesive were applied with light curing each successive layer. Microtensile bond strength was immediately tested after specimen preparation.

RESULTS

When the adhesive was applied three times before light curing, the bond strength of the experimental subgroup 1 (n=33, 57.49 +/-11.61 MPa) was higher than that of the control subgroup 1 (n=31, 49.71 +/-11.43 MPa, P<0.05). When using the technique of applying multiple layers of adhesive with light curing each successive layer, no difference of immediate bond strength was observed between the control subgroup 2 and the experimental subgroup 2 (P>0.05).

CONCLUSION

strength to primary dentin when using the technique of light-curing after applying three layers of adhesive.

Restoration of noncarious cervical lesions: when, why, and how

At this time, restoration of noncarious cervical lesions (NCCLs) is a common occurrence in clinics nowadays. Some reasons for this are the growth of the elderly population, a smaller rate of tooth loss, and possibly the increase of some etiologic factors. These factors include inadequate brushing techniques in gingival recession cases, corrosive food and drink consumption, and occlusal stress concentrating factors (occlusal interferences, premature contacts, habits of bruxism, and clenching). Unfortunately, Class V restorations also represent one of the less durable types of restorations and have a high index of loss of retention, marginal excess, and secondary caries. Some causes for these problems include difficulties in isolation, insertion, contouring, and finishing and polishing procedures. This work aims to help dentists in choosing the best treatment strategy, which necessarily involves steps of problem identification, diagnosis, etiological factor removal or treatment, and, if necessary, restoration. Finally, appropriate restorative techniques are suggested for each situation.

Clinical effectiveness of contemporary dentin bonding agents

Aim:

The purpose of this paper is to review the literature on the clinical effectiveness of contemporary resin-based dentin bonding agents primarily focussing on the longevity of restoration.

Materials and Methods:

The literature published from June 2004 up to September 2010 was reviewed for clinical trials that tested the effectiveness of dentin bonding agents in the longevity of noncarious class V restoration. Results of each study reported using the USPHS criteria for clinical assessment of restoration were included and tabulated. The American Dental Association guidelines for dentin and enamel adhesives were used as a reference to compare the performance of individual bonding agents. Kruskal–Wallis followed by Mann–Whitney U was done to compare the mean Alfa score percentage for the three categories of bonding systems [etch-and-rinse (ER), self-etch primer (SEP), and self-etch-adhesive (SEA)].

Results:

A comparison of the mean Alfa score percentages revealed no difference between the ER, SEP, and SEA categories of bonding systems except for marginal adaptation where ER was found to be superior to SEA.

Conclusion:

The clinical effectiveness of resin-based bonding agents is comparable among the three categories.

Marginal permeability of one step self-etch adhesives: Effects of double application or the application of hydrophobic layer

Aim:

The purpose of this in vitro investigation was to evaluate the influence of double application and application of hydrophobic layer on marginal adaptation of four self-etch adhesive systems (XENOIII, ALLBONDSE, CLEARFIL SE TRI BOND, FUTURA BOND).

Materials and Methods:

One hundred and twenty class V cavities were prepared on intact, extracted human premolars and were divided into three groups of ten teeth each for all four adhesives. Group 1: Application of bonding agents as per manufacturer directions. Group 2: Double application of bonding agents. Group 3: Application of hydrophobic layer. The specimens were restored with composite and light cured. After thermocycling and immersion in 2% Basic Fuchsin dye solution, the teeth were sectioned and dye penetration was observed under a stereomicroscope at 20× magnification. All the samples were scored and results were analyzed using Kruskal-Wallis and Mann-Whitney tests.

Results:

Group 3, in which the adhesive systems were coated with hydrophobic layer, showed significantly decreased microleakage, followed by Group 1 and Group 2 for all the adhesive systems. And there is no significant different between Group 1 and Group 2.

Conclusion:

Marginal permeability of one-step adhesives can be minimized by the application of more hydrophobic resin layer, and the double application of one-step self-etch system can be safely performed without jeopardizing the performance of adhesives.

Influence of hydrophobic layer and delayed placement of composite on the marginal adaptation of two self-etch adhesives

AIM

The purpose of this in vitro investigation was to evaluate the influence of hydrophobic layer and delay in placement of composite on marginal adaptation of two self-etch adhesive systems (XENO-III and ALL-BOND SE).

MATERIALS AND METHODS

Eighty class V cavities were prepared on intact, extracted human premolars and were divided into 4 groups of 10 teeth each. Group 1: Application of bonding agents as per manufacturer directions and immediate placement of composite; Group 2: Application of bonding agent and composite similar to group1, with hydrophobic layer curing before composite placement; Group 3: Application of bonding agent similar to group 1, with 2 min delay in composite placement; and Group 4: Application similar to group 2 with 2-min delay in composite placement. The specimens were restored and light cured. After thermocycling and immersion in 2% basic Fuchsin dye solution, the teeth were sectioned and dye penetration was observed under a stereomicroscope at 20x magnification. All the samples were scored and results were analyzed using Kruskal-Wallis and Mann-Whitney tests.

RESULTS

In group 1, the microleakage along the both enamel and dentin margin was significantly higher than the other groups for both the adhesive systems. There is no significant difference between groups 2, 3 and 4.

CONCLUSION

The addition of a more hydrophobic resin layer and delay in composite placement significantly improves the marginal adaptation of self-etch adhesive resin systems.

Effect of 3-year water storage on the performance of one-step self-etch adhesives applied actively on dentine

OBJECTIVES

To evaluate the effect of the application method on the immediate and 3-year resin-dentine bond strength (μTBS) and nanoleakage (NL) for 3 one-step self-etch adhesives (Adper Prompt L-Pop; Clearfil S(3) Bond and Xeno III).

METHODS

The occlusal enamel of 42 human molars were removed to expose a flat dentine surface. The adhesives were applied under inactive or active application. After light-curing (600mW/cm(2) for 10s), composite buildups were constructed incrementally and sectioned to obtain bonded sticks (0.8mm(2)) to be tested in tension immediately or after 3 years of water storage of water storage. For NL, 2 bonded sticks from each tooth at each time were coated with nail varnish, placed in silver nitrate and polished down with SiC paper. The μTBS data was submitted to a two-way repetead mesures ANOVA and Tukey's test for each adhesive (α=0.05).

RESULTS

The active application showed higher immediate and 3-year μTBS than the inactive application (p<0.05). An increase in the silver nitrate deposition was seen for all conditions after 3 years; however this was more pronounced for all materials under inactive application (p<0.05).

CONCLUSIONS

The active application improves the immediate bonding performance of the adhesive systems. Reductions of the bond strength were observed for all materials after 3 years, however reduced degradation rate was observed when the materials are applied actively in dentine.

Adhesive systems: important aspects related to their composition and clinical use

This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-andrinse systems require a specific acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and deficiencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplified ones due to some chemical associations and interactions. The SeM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

Dentin bond durability and water sorption/solubility of one-step self-etch adhesives

The purpose of this study was to evaluate the dentin bonding durability of three HEMA-containing one-step self-etch adhesives after one-year water storage and to measure the amounts of their water sorption/solubility. OptiBond All-In-One (OP), Bond Force (BF) and Clearfil S³Bond (S³) were applied to the dentin surfaces according to manufacturers' instructions. Bond strengths to dentin were determined using µTBS test after water storage for 24 hours, six months, and one year. In addition, water sorption and solubility of the polymerized adhesives were measured. The µTBS of S³ and OP significantly decreased after one year. On the other hand, for BF there were no significant differences in µTBS between all storage periods. There were significant differences in water sorption and solubility among the adhesives (BF>S³>OP). The initial amounts of water sorption and solubility of the three adhesives did not affect their bonding durability to dentin.

Effect of dentine smear layer on the performance of self-etching adhesive systems: A micro-tensile bond strength study

This study aimed to evaluate the effect of the smear layer on the micro-tensile bond strength when two self-etching adhesives were used with different techniques. Flat dentine surfaces were prepared using either medium grit diamond burs or tungsten carbide burs. Ten specimens from each prepared surfaces were subjected for smear layer evaluation under SEM. Forty specimens from each of the prepared surfaces were further divided into two groups, bonded with either Clearfil SE Bond (SE) or Clearfil S(3) Bond (S3) using one of four applications (as manufacturer's instructions, agitation, reapplication, and increased application time), restored with composites and subjected to a micro-tensile bond strength test. Smear layers created with diamond burs were thicker than those created with tungsten carbide burs. Surfaces prepared with tungsten carbide burs produced a higher bond strength than those prepared with diamond burs and the same type of adhesive resin. SE demonstrated a higher bond strength than S3 for all surfaces. S3 applied with the agitation technique demonstrated a higher bond strength to dentine prepared with tungsten carbide and diamond burs than that applied with other techniques. SE applied with increased time on dentine treated with carbide burs produced the highest bond strength. In conclusion, a thick smear layer decreased bond strength to dentine, and this might be improved by modification of application technique.

Bond Strength and Quality of the Hybrid Layer of One-step Self-etch Adhesives Applied with Agitation on Dentin

Vigorous application on the dentin surface is an excellent tool capable of improving the immediate performance of simplified self-etch adhesive systems.

Effect of Configuration Factor on Shear Bond Strengths of Self-etch Adhesive Systems to Ground Enamel and Dentin

Despite recent improvements in self-etch bonding systems, a two-step etch and rinse system gave consistently higher shear bond strengths to both ground enamel and dentin and would be the best system to use clinically.

Improving clinical retention of one-step self-etching adhesive systems with an additional hydrophobic adhesive layer

BACKGROUND

The durability of restorations bonded with one-step self-etching (OSSE) adhesive systems is inferior compared with that of restorations bonded with conventional adhesives. The authors conducted an 18-month randomized clinical study to evaluate the clinical performance of two OSSE systems in noncarious cervical lesions applied as recommended or with an extra layer of hydrophobic adhesive layer after 18 months of clinical service.

METHODS

Thirty participants, each of whom had at least two pairs of similar-sized noncarious cervical lesions, took part in this study. The authors placed 120 restorations, 30 in each of four groups: Clearfil S3 Bond (Kuraray, Osaka, Japan) (CS) and iBond Gluma inside (Heraeus Kulzer, Hanau, Germany) (IB), and Clearfil S3 Bond (CSB) and iBond Gluma inside (IBB) with an extra layer of hydrophobic adhesive applied on top of them. They placed the restorations incrementally, using a resin-based composite. The authors evaluated the restorations at baseline and at 18 months following modified U.S. Public Health Service criteria.

RESULTS

At 18 months, the retention rate for the IB group was statistically lower than those for the CS, IBB and CSB groups. Marginal discoloration occurred in all groups and was statistically worse in the IB group.

CONCLUSIONS

The conversion of the iBond Gluma inside and Clearfil S3 Bond adhesive systems into two-step systems by means of applying an extra hydrophobic adhesive layer improved the clinical performance of these materials after 18 months of clinical service.

CLINICAL IMPLICATIONS

The application of an extra hydrophobic adhesive layer over OSSE adhesive systems, layers improved the OSSE systems clinical performance, mainly in terms of retention rate.

Effect of Double Layering and Prolonged Application Time on MTBS of Water/Ethanol-based Self-etch Adhesives to Dentin

Problems related to the chemical formulation and/or chemical dispersion of hydrophilic/hydrophobic components in one-step self-etch adhesives limit their efficacy and are not easily solved by changing the different bonding application parameters.

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan-Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 +/- 3.4%; ART with Carisolv, 46.0 +/- 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth.

Effect of the Number of Applications of Acetone-based Adhesives on Microtensile Bond Strength and the Hybrid Layer

The application technique of total- and self-etching bonding resins affects their bonding strength to dentin.

In vitro bonding performance of self-etch adhesives: II--ultramorphological evaluation

OBJECTIVE

To study the interfacial ultra-morphology formed by "all-in-one" self-etch adhesives.

METHODS

Forty-nine extracted molars were assigned to one of five all-in-one adhesives: Adper Prompt L-Pop (AP, 3M ESPE); Clearfil S3 Bond (S3, Kuraray); G-Bond (GB, GC America); iBond (iB, Heraeus Kulzer) and Xeno IV (XE, Dentsply Caulk). Adper Single Bond Plus (SB, 3M ESPE), a two-step etch&rinse adhesive, and Clearfil SE Bond (SE, Kuraray), a two-step self-etch adhesive, were used as controls. Dentin, unground enamel and ground enamel were used as bonding substrates. Dentin specimens were processed for FESEM and TEM analyses. Enamel specimens were processed for FESEM.

RESULTS

Dentin: GB, iB, S3, SE and XE resulted in a submicron-thick hybrid layer (0.2-0.7 microm), but only S3 and SE did not result in interfacial gaps. AP resulted in the thickest hybrid layer (1.7-2.9 microm) among the self-etch adhesives. SB resulted in a 3.4-5.2 pm thick hybrid layer. Unground enamel-GB, iB and SE resulted in a mostly featureless morphology resembling that of untreated enamel with areas in which the superficial enamel layer was removed without dissolving the subsurface enamel. XE resulted in areas of intra-prismatic etching and areas without any etching pattern. S3 resulted in frequent shallow intra-prismatic etching, while AP was able to unveil the enamel crystallites across the entire enamel surface. Phosphoric acid in SB resulted in the deepest intra- and inter-prismatic demineralization. Ground enamel--AP resulted in a well-defined inter-prismatic etching pattern. iB, GB, SE and S3 resulted in islands of superficially dissolved enamel within areas without evidence of enamel dissolution. XE resulted in etched enamel areas with mild intraprismatic exposure of crystallites. Phosphoric acid in SB resulted in deep enamel etching.

CONCLUSIONS

Only AP, an aggressive self-etch adhesive, showed enamel morphological features that resemble those created by etch & rinse adhesives. S3 and SE were the only self-etch adhesives that did not result in dentin interfacial debonding.

Effects of root dentin surface coating with all-in-one adhesive materials on biofilm adherence

OBJECTIVES

Sealing of exposed root dentinal surfaces with adhesive materials is expected to be a promising approach for preventing root dentin caries. The aim of this study was to evaluate the effects of surface coating with all-in-one adhesives on inhibiting Streptococcus mutans biofilm attachment.

MATERIALS AND METHODS

Bovine root dentin was cut and ground with #600-grit SiC paper. Each of the three all-in-one adhesives, Hybrid Bond (HB), Reactmer Bond (RB) or Shake One (SO) was single-coated on the dentin surfaces according to the manufacturers' instructions. The dentin surface without coating served as the control. The surface roughness of the coated and non-coated dentin surfaces was recorded by means of laser microscope measurements. S. mutans artificial biofilms were then grown on the surface of each specimen in a microcosm for 20h. The amounts of bacteria and water insoluble glucan in the retained biofilm on the surface of the specimens were measured. All numerical data were statistically analyzed using one-way ANOVA & Tukey's HSD (p<0.05).

RESULTS

All of the coated groups showed significantly lower susceptibility to biofilm attachment compared with the non-coated root dentin (p<0.05). Among the coated groups, SO showed the lowest susceptibility for biofilm formation.

CONCLUSIONS

Three all-in-one adhesive materials could be effective for root surface coating. A fluoride-releasing adhesive, SO demonstrated the strongest potentiality in resisting biofilm formation.

Bonding durability of HEMA-free and HEMA-containing one-step adhesives to dentine surrounded by bonded enamel

OBJECTIVE

To evaluate the bonding durability of HEMA-free and HEMA-containing one-step adhesives to dentine surrounded by bonded enamel after 1-year storage in water.

MATERIAL AND METHOD

Flat coronal dentine surfaces of extracted human molars were prepared, leaving the surrounding enamel. Two one-step self-etch adhesive systems: HEMA-containing Tri-S Bond (TSB; Kuraray Medical Inc., Tokyo, Japan) and HEMA-free G Bond (GB; GC Co., Tokyo, Japan), were applied to both dentine and the surrounding enamel surfaces according to manufacturers' instructions. Following resin composite crown (Clearfil AP-X, Kuraray Medical Inc., Tokyo, Japan) build-ups, the bonded specimens were stored in 37 degrees C water for 24h (control group), 3 months, 6 months and 1 year. After the designated periods of water storage, the specimens were serially sectioned perpendicular to the adhesive interface into 0.7 mm thick slabs, and then trimmed to form hour-glass configurations with a 1mm2 cross-sectional area. The micro-tensile bond strength (muTBS) test was carried out at a crosshead speed of 1.0mm/min. The muTBS data were statistically analyzed using two-way ANOVA, t test, and Tukey's HSD post hoc multiple comparison tests (alpha=0.05).

RESULTS

After 1 year water of storage, the bond strength of TSB to dentine was significantly lower compared with the 1-day, 3-month and 6-month groups (p<0.05). On the other hand, the muTBS of GB decreased over time, but there was no significant difference between the experimental periods (p>0.05).

CLINICAL SIGNIFICANCE

Bonded enamel margins may not maintain the integrity of the resin-dentine interface created by HEMA-free and HEMA-containing one-step adhesives.

Influence of differently oriented dentin surfaces and the regional variation of specimens on adhesive layer thickness and bond strength

STATEMENT OF THE PROBLEM

Adhesive systems can spread differently onto a substrate and, consequently, influence bonding.

PURPOSE

The purpose of this study was to evaluate the effect of differently oriented dentin surfaces and the regional variation of specimens on adhesive layer thickness and microtensile bond strength (MTBS).

MATERIALS AND METHODS

Twenty-four molars were sectioned mesiodistally to expose flat buccal and lingual halves. Standardized drop volumes of adhesive systems (Single Bond [SB] and Prime & Bond 2.1 [PB2.1]) were applied to dentin according to the manufacturer's instructions. Teeth halves were randomly divided into groups: 1A-SB/parallel to gravity; 1B-SB/perpendicular to gravity; 2A-PB2.1/parallel to gravity; and 2B-PB2.1/perpendicular to gravity. The bonded assemblies were stored in 37 degrees C distilled water for 24 hours and then sectioned to obtain dentin sticks (0.8 mm2). The adhesive layer thickness was determined in a light microscope (x200), and after 48 hours the specimens were subjected to MTBS test. Data were analyzed by one-way and two-way analysis of variance and Student-Newman-Keuls tests.

RESULTS

Mean values (MPa +/- SD) of MTBS were: 39.1 +/- 12.9 (1A); 32.9 +/- 12.4 (1B); 52.9 +/- 15.2 (2A); and 52.3 +/- 16.5 (2B). The adhesive systems' thicknesses (microm +/- SD) were: 11.2 +/- 2.9 (1A); 18.1 +/- 7.3 (1B); 4.2 +/- 1.8 (2A); and 3.9 +/- 1.3 (2B). No correlation between bond strength and adhesive layer thickness for both SB and PB2.1 (r = -0.224, p = 0.112 and r = 0.099, p = 0.491, respectively) was observed.

CONCLUSIONS

The differently oriented dentin surfaces and the regional variation of specimens on the adhesive layer thickness are material-dependent. These variables do not influence the adhesive systems' bond strength to dentin. CLINICAL SIGNIFICANCE Adhesive systems have different viscosities and spread differently onto a substrate, influencing the bond strength and also the adhesive layer thickness. Adhesive thickness does not influence dentin bond strength, but it may impair adequate solvent evaporation, polymer conversion, and may also determine water sorption and adhesive degradation over time. In the literature, many studies have shown that the adhesive layer is a permeable membrane and can fail over time because of its continuous plasticizing and degradation when in contact with water. Therefore, avoiding thick adhesive layers may minimize these problems and provide long-term success for adhesive restorations.

Dental adhesion review: Aging and stability of the bonded interface

OBJECTIVE

Most of current dental adhesive systems show favorable immediate results in terms of retention and sealing of bonded interface, thereby counteracting polymerization shrinkage that affects resin-based restorative materials. Despite immediate efficacy, there are major concerns when dentin bonded interfaces are tested after aging even for short time period, i.e. 6 months.

METHODS

This study critically discusses the latest peer-reviewed reports related to formation, aging and stability of resin bonding, focusing on the micro and nano-phenomena related to adhesive interface degradation.

RESULTS

Most simplified one-step adhesives were shown to be the least durable, while three-step etch-and-rinse and two-step self-etch adhesives continue to show the highest performances, as reported in the overwhelming majority of studies. In other words, a simplification of clinical application procedures is done to the detriment of bonding efficacy. Among the different aging phenomena occurring at the dentin bonded interfaces, some are considered pivotal in degrading the hybrid layer, particularly if simplified adhesives are used. Insufficient resin impregnation of dentin, high permeability of the bonded interface, sub-optimal polymerization, phase separation and activation of endogenous collagenolytic enzymes are some of the recently reported factors that reduce the longevity of the bonded interface.

SIGNIFICANCE

In order to overcome these problems, recent studies indicated that (1) resin impregnation techniques should be improved, particularly for two-step etch-and-rinse adhesives; (2) the use of conventional multi-step adhesives is recommended, since they involve the use of a hydrophobic coating of nonsolvated resin; (3) extended curing time should be considered to reduce permeability and allow a better polymerization of the adhesive film; (4) proteases inhibitors as additional primer should be used to increase the stability of the collagens fibrils within the hybrid layer inhibiting the intrinsic collagenolytic activity of human dentin.

Effect of Double-application or the Application of a Hydrophobic Layer for Improved Efficacy of One-step Self-etch Systems in Enamel and Dentin

The double-application and placement of a hydrophobic resin coat can improve the performance (μTBS) of one-step self-etch systems to tooth substrates, mainly in dentin.

A 36-month evaluation of self-etch and etch-and-rinse adhesives in noncarious cervical lesions

BACKGROUND

There are two bonding strategies for composite restorations: the etch-and-rinse (ER) approach and the self-etch (SE) approach. Few clinical trials have evaluated the SE approach in Class V restorations for a 36-month period. The authors conducted a study to evaluate whether the SE system can provide retention rates and marginal discoloration similar to that of the ER system.

METHODS

Twenty-five patients, each having at least two pairs of equivalent noncarious cervical lesions under occlusion, were enrolled in this study. Two calibrated operators placed 78 restorations, one-half for ER and one-half for SE. Two independent examiners evaluated the restorations at baseline and after six-, 12-, 18- and 36-month periods according to the slightly modified U.S. Public Health Service criteria. Statistical analysis between materials in each period was conducted using a Fisher exact test (alpha = .05), and the performance of the materials at baseline in comparison with each period was evaluated by a McNemar test (alpha = .05).

RESULTS

Five SE restorations and one ER restoration were lost after 36 months. After 36 months, 10 SE and five ER restorations were rated Bravo in marginal adaptation (P > .05). Fourteen SE and five ER restorations were rated Bravo in marginal discoloration (P < .05).

CONCLUSIONS

Although a significantly increased marginal discoloration was observed with SE, both adhesives showed retention rates in noncarious cervical lesions that were not statistically different after 36 months.

CLINICAL IMPLICATIONS

The ER and SE adhesive systems can be used with confidence; however, SE adhesive showed a faster and more progressive enamel marginal degradation.

Pulpal responses after application of current adhesive systems to deep cavities

The aim of the present study was to evaluate comparatively the pulpal tissue reactions of four adhesive systems placed in experimental cavities of healthy dog's teeth. Class V cavities with a mean value of remaining dentin thickness (RDT) ranging between 0.55 +/- 0.30-0.68 +/- 0.38 mm were prepared. The cavities were treated with the following adhesive systems: Etch and Prime 3.0 (EP), Single Bond (SB), Clearfil SE Bond (CSE), and Prompt L-Pop (PLP). The pulpal tissue responses to dentin adhesives were assessed histopathologically at postoperative periods of 7, 21, and 65 days, and the results were subjected to statistical analysis. A significantly greater adverse inflammatory response was observed with the materials EP and PLP, while a significantly lesser degree of disorganization in the odontoblastic zone was found with the materials SB and CSE, in the postoperative period of 65 days. In addition, a thicker predentin zone was observed where SB material was applied. Application of the selected adhesive systems to non-exposed cavities, with an RDT, which ranged between the above-mentioned rates, was correlated with slight to moderate inflammation and odontoblast reduction depending on the materials used as well as upon the RDT.

Systematic review of the chemical composition of contemporary dental adhesives

Dental adhesives are designed to bond composite resins to enamel and dentin. Their chemical formulation determines to a large extent their adhesive performance in clinic. Irrespective of the number of bottles, an adhesive system typically contains resin monomers, curing initiators, inhibitors or stabilizers, solvents and sometimes inorganic filler. Each one of these components has a specific function. The aim of this article is to systematically review the ingredients commonly used in current dental adhesives as well as the properties of these ingredients. This paper includes an extensive table with the chemical formulation of contemporary dental adhesives.

Relationship between water status in dentin and interfacial morphology in all-in-one adhesives

OBJECTIVES

All-in-one adhesive systems have been recently developed to simplify bonding procedures. The adhesives containing acidic resin monomers generate a relatively thin bonding zone between dentin and composite. This zone may be left acidic and permeable when polymerization is poor. In this study, the effect of water contained in dentin on the quality of the bonding interface was morphologically investigated for all-in-one adhesives.

METHODS

Intact coronal dentin (hydrated dentin), desiccated coronal dentin (dehydrated dentin), caries-affected dentin (CAD) and resin composites were used for adherends to assess the effects of water contained in dentin on the ultra-structures of bonding interfaces created with two all-in-one adhesives and a resin composite.

RESULTS

The bonding interfaces were observed under TEM without demineralization. Voids of various sizes were found at the bottom of the adhesive resin layers along the bonding interface of hydrated dentin, while dehydrated dentin, CAD and resin composites did not generate voids. The results showed that the voids were possibly formed by water that had penetrated from the underlying dentin.

CONCLUSION

When the adherend contains little water, the formation of voids will not occur. It was verified that a phenomenon of void formation would not occur in a clinical situation in which caries-affected dentin is mainly subjected to adhesive practices.

Microleakage of porcelain veneer restorations bonded to enamel and dentin with a new self-adhesive resin-based dental cement

Cementation technique of bonded ceramic restorations is a time-consuming and technique-sensitive procedure critical to long-term success.

OBJECTIVE

Evaluate the performance of a self-adhesive, modified-resin dental cement (Rely-X UniCem, 3M-ESPE) for the cementation of ceramic veneer restorations without previous conditioning of the tooth surface, and in combination with a one-bottle adhesive and a self-etching adhesive.

METHODS

Thirty-six premolars received a veneer preparation that extended into dentin. Leucite-reinforced pressed glass ceramic (Empress 1) veneers were cemented following manufacturers' instructions, according to the following treatment groups (n=9): (1) Variolink-Excite Ivoclar-Vivadent (V+E control), (2) Unicem+Single Bond 3M-ESPE (U+SB), (3) Unicem+Adper Prompt L-Pop 3M-ESPE (U+AP), (4) Unicem 3M-ESPE (U). After 24h storage at 37 degrees C, teeth were thermocycled (2000 cycles) at 5 and 55 degrees C, immersed in ammoniacal silver nitrate for 24h, placed in a developer solution overnight and sectioned using a slow-speed saw. Three 1mm longitudinal sections were obtained from each tooth and evaluated for leakage with a microscope (1x to 4x). Imaging software was used to measure stain penetration along the dentin and enamel surfaces.

RESULTS

ANOVA with SNK (alpha=0.05) revealed that on dentin, U had significantly less leakage than U+SB and U+AP, but no different than V+E; on enamel U had leakage values that were significantly greater than the groups with adhesives.

SIGNIFICANCE

The self-adhesive cement U gave low leakage on dentin that was comparable to the cement that employed an adhesive for sealing dentin, whereas this cement benefits from use of an adhesive when cementing to enamel.

Increases in Dentin-bond Strength If Doubling Application Time of an Acetone-containing One-step Adhesive

When treating dentin surfaces with Futurabond one-step self-etch bonding agent, in order to obtain higher microtensile bond strength, doubling the application time of the adhesive should be considered.

Interfacial and surface characterization of two self-etching adhesive systems and a total-etch adhesive after bonding to ground and unground bovine enamel—a qualitative study

The purpose of the study was to evaluate the enamel surface and interface morphology of two self-etching adhesive systems (SAS) vs a total-etch control, after bonding to ground and unground enamel using field emission scanning electron microscopy (FESEM). Thirty bovine incisors were used in this study. The buccal enamel surface of 15 teeth was ground flat to resemble freshly cut enamel. The rest of the teeth were left intact. Two SAS, Clearfil SE Bond (CSE, Kuraray) and Prompt L-Pop (3M-ESPE), and a conventional adhesive system, Scotchbond Multipurpose (3M-ESPE, control), were used to condition the surface of unground and ground enamel on 12 teeth. A composite button was bonded to the remaining 18 teeth; a cross-section (1 mm thick) was obtained from each and the bonded interface was polished. All specimens were dehydrated in ascending grades of ethanol, gold-sputter-coated, and observed under FESEM (Hitachi S-4000) to evaluate the ultrastructural morphology of the enamel surface and the enamel-dentin interface. The etching patterns and adhesive penetration varied according to the aggressiveness of the SAS, with CSE being the mildest and H3PO4 being the most aggressive. There were no significant differences on the ultrastructural morphology of the enamel surface between unground and ground specimens. It appears that microporosities within enamel prisms provide sufficient enamel-resin hybridization in unground enamel. The enamel dissolution pattern and depth of infiltration depend on the type of SAS used, with no significant differences in unground and ground enamel.

Polymerization kinetics of dental adhesives cured with LED: correlation between extent of conversion and permeability

OBJECTIVES

The aim of this study was to analyze the polymerization kinetics of different adhesive films in relation to their permeability after exposure to different LED curing units.

METHODS

One adhesive from each class was analyzed: a three-step etch-and-rinse (OptiBond FL; Sybron-Kerr), a two-step etch-and-rinse (One-Step, Bisco), a two-step self-etch (Clearfil Protect Bond, Kuraray) and a one-step self-etch adhesive (Xeno III; Dentsply DeTrey). Adhesive films were prepared and cured with SmartLite IQ (Dentsply) or L.E. Demetron I (Demetron Kerr) up to complete curing. Polymerization kinetic curves of the tested adhesives were obtained with differential scanning calorimetry (DSC). In particular, total reaction time and extent of polymerization (Ep) at 20, 40 or 60s were compared. Permeability of the adhesive films was evaluated on flat dentin surfaces of human extracted teeth connected to a permeability device and statistically analyzed.

RESULTS

Total reaction time differed among the adhesives tested: OptiBond FL<Clearfil Protect Bond<One-Step<Xeno III with both curing units (p<0.05). At 20s OptiBond FL showed the highest Ep, while the lowest values were obtained with One-Step and Xeno III (p<0.05). E(p) increased when curing time was prolonged (40 and 60s) for all adhesives tested (p<0.05), however, on simplified adhesives, incomplete polymerization took place even after prolonged exposure intervals. An inverse correlation was found between Ep of the adhesives and their permeability using LED curing units.

SIGNIFICANCE

This study supports the hypothesis that, longer curing times than those recommended by the respective manufacturer decrease permeability of the bonded interfaces.

Effect of simulated pulpal pressure on all-in-one adhesive bond strengths to dentine

OBJECTIVES

To evaluate the durability of all-in-one adhesive systems bonded to dentine with and without simulated hydrostatic pulpal pressure (PP).

METHODS

Flat dentine surfaces of extracted human molars were prepared. Two all-in-one adhesive systems, One-Up Bond F (OBF) (Tokuyama Corp., Tokyo, Japan), and Fluoro Bond Shake One (FBS) (Shofu Co., Kyoto, Japan) were applied to the dentine surfaces under either a PP of 0 or 15cm H(2)O. Then, resin composite build-ups were made. The specimens bonded under pressure were stored in 37 degrees C water for 24h, 1 and 3 months under 15cm H(2)O PP. Specimens not bonded under pressure were stored under zero PP. After storage, the specimens were sectioned into slabs that were trimmed to hourglass shapes and subjected to micro-tensile bond testing (muTBS). The data were analysed using two-way ANOVA and Holm-Sidak HSD multiple comparison tests (alpha=0.05).

RESULTS

The muTBS of OBF fell significantly (p<0.05) when PP was applied during bonding and storage, regardless of storage time. In contrast, although the muTBS of OBF specimens bonded and stored without hydrostatic pressure storage fell significantly over the 3 months period, the decrease was less than half as much as specimens stored under PP. In FBS bonded specimens, although there was no significant difference between the muTBS with and without hydrostatic pulpal pressure at 24h, by 1 and 3 months of storage under PP, significant reductions were seen compared with the control group without PP.

CONCLUSION

The muTBS of OBF bonded specimens was lowered more by simulated PP than by storage time; specimens bonded with FBS were not sensitive to storage time in the absence of PP, but showed lower bond strengths at 1 and 3 months in the presence of PP.

Influence of Additional Adhesive Application on the Microtensile Bond Strength of Adhesive Systems

Applying an additional layer of solvent-free adhesive systems increased adhesive thickness and did not affect bond strength. This thicker adhesive layer may help to preserve the integrity of the restoration by acting as a stress-absorbing layer.

Effect of Dentin Conditioning Time on Nanoleakage

Increasing dentin conditioning time did not affect nanoleakage for any of the dentin adhesives used in this study.

Quantitative Comparison of the Water Permeable Zone Among Four Types of Dental Adhesives Used with a Dual-cured Composite

When placing a dual-cured composite, variation in the permeability of adhesive interfaces may affect bonding quality and longevity.

Conditioning effect on dentin, resin tags and hybrid layer of different acidity self-etch adhesives applied to thick and thin smear layer

OBJECTIVES

to assess the conditioning effect (CE) of self-etch adhesives of different acidity applied to thick and thin smear layer (SL), the corresponding resin tags (RT) and hybrid layer (HL).

METHODS

Twenty-seven molars had their occlusal dentin exposed and were sectioned into two halves. Each of them was ground with a 60 or 600-grit SiC paper, respectively for thick and thin SL production. Three self-etch adhesives: a mild (Clearfil SE Bond), an intermediary (Optibond Solo SE and Solo Plus) and a strong (Tyrian Self Priming Etchant+One Step Plus) and an etch-&-rinse system (Scotchbond Multi Purpose Plus) were used. For CE evaluation, the self-etch primers were applied and rinsed off with acetone and alcohol prior to SEM preparation. For RT and HL specimens self-etch adhesives were applied and restored with Z-250. For RT specimens, dentin was removed with HCl (6N) and NaClO (1%) baths. The HL specimens were fixed, dehydrated, dried with HMDS, embedded, polished and slightly demineralized (6N HCl) and deproteinized (1% NaClO). After gold sputtering they were observed by SEM.

RESULTS

The thick smear layer was clearly not totally removed by the mild self-etch primer. RT varied in density and shape among the self-etch adhesives. Thicker HL was observed for the strong self-etch and etch-&-rinse adhesives.

CONCLUSIONS

The etch-&-rinse adhesive presented the thickest HL and was the only adhesive to produce RT in high density and uniform distribution along the whole dentin surface, independently of the SL thickness.

Contraction stress and bond strength to dentinfor compatible and incompatible combinations of bonding systems and chemical and light-cured core build-up resin composites

OBJECTIVE

Recent studies have shown that adhesives containing acidic monomers combined with composites can adversely effect the polymerization reaction producing low bond strengths. This phenomenon may also occur in making composite build-ups, jeopardizing one of the key factors for a successful core build-up restoration. The aim of this study was to investigate the contraction stress development and bond strength to dentin of core build-up resin composites combined with adhesives of various acidities. In addition the hypothesis tested was that light irradiation through chemical-cured composites during curing does not influence contraction stress or bond strength to dentin.

METHODS

The chemical-cured (Clearfil Core) and light-cured (Clearfil Photo Core) core build-up resin composites were combined with two light-cured adhesives, Clearfil SE Bond (pH=1.8) and One-Step Bond (pH=4.3) and two dual-cured adhesives, Clearfil Photo Bond (pH=2.5) and All-Bond 2 (pH=6.1). Contraction stress development (at C=3) was determined for a period of 30 min in a universal testing machine where the opposing bonding surfaces were glass and dentin. After the 30 min period, the specimens were loaded in tension to determine the bond strength to dentin. To test the hypothesis, the combinations of the chemical-cured composites with the four bonding systems were also light irradiated for 40s right at the start of curing.

RESULTS

For all composite-adhesive combinations tested, the adhesion to dentin resisted the developing polymerization contraction stresses. Both, dentin as a substrate to bond at and the use of adhesives, were showed to play an important role in keeping the contraction stresses low. The chemical-cured composite (Clearfil Core) combined with the light-cured adhesive SE Bond (pH=1.8) showed for both contraction stress and bond strength significant lower values than the other combinations. The hypothesis was accepted for combinations of the chemical-cured composite with All-Bond 2 and One-Step Bond, but was not supported by combinations with Clearfil SE Bond or Clearfil Photo Bond, as a significant increase in contraction stress was found. The higher values found for bond strength were not significant.

SIGNIFICANCE

Besides combinations of chemical-cured core build-up composites with light or dual-cured adhesives as recommended by the manufacturer, also combinations with adhesives of other manufacturers are compatible, provided that the pH is higher than approximately 4.3. Chemical-cured core build-up composites combined with light-cured adhesives with a pH as low as 1.8 lead to a significantly lower stress and bond strength compared to other combinations. Light irradiation during curing through a combination of a chemical-cured composite and a low pH adhesive reactivates polymerization.

A novel method to obtain microtensile specimens minimizing cut flaws

Cutting procedures conventionally used for microtensile specimens' preparation induce mechanical stress and attrition, leading to cracks in dental structure. Enamel is mainly affected due to its high module of elasticity and brittleness. As an alternative to the conventional diamond saw, a diamond wire was used for cutting. The two techniques were compared in efficacy in the preparation of two different sample shapes. Forty human molars, flattened in dentin or enamel, were used for sample preparation. After bonding procedures, resin block was built incrementally. Half of the teeth were cut using a diamond disc and the other half using a diamond wire, obtaining slabs and stick-shaped specimens. Slabs were then shaped to obtain hourglass samples. Five samples from each subgroup were randomly selected for Scanning electron microscopy (SEM) analysis. Remaining samples underwent microtensile test and the results were analyzed, including/excluding premature failures (pf), with three-way ANOVA and Tukey test, performed separately, by substrate. On dentin, only the exclusion of pf showed a significant higher bond strength values than when pf were included (p < 0.05); however, on enamel, all factors (equipment, shape and including/excluding pf) had a significant effect on bond strength (p<0.05). The most remarkable finding from SEM was the incidence of specimens' cracks and defects when diamond blade was used. Scratches and cracks in the hourglass-shaped specimens were also detected. In both cases, enamel was more affected than dentin.

Effect of Air-blowing Variables on Bond Strength of All-in-one Adhesives to Bovine Dentin

This study evaluated the effect of air-blowing variables on the microtensile bond strength (microTBS) of two all-in-one adhesives. A bonding agent was applied to the flat dentin surface of extracted bovine teeth, and the surface left undisturbed for 20 seconds. Gentle or intensive air-blowing was applied for five seconds, and the adhesive photopolymerized for 10 seconds. Resin composite paste was placed and cured after each bonding treatment. Specimens were subjected to microTBS test with a crosshead speed of 1.0 mm/min. Data were statistically analyzed using ANOVA, followed by Bonferroni post hoc test. When Clearfil tri-S Bond was bonded to dentin, the microTBS value of specimens applied with intensive air-blowing was significantly higher than that applied with gentle air-blowing (p<0.01). On the other hand, with Fluoro Bond Shake One, the microTBS value of specimens applied with intensive air-blowing was significantly lower than that applied with gentle air-blowing (p<0.01).