Limitations in bonding to dentin and experimental strategies to prevent bond degradation

Insight into the development of versatile dentin bonding agents to increase the durability of the bonding interface

Despite the huge improvements made in adhesive technology over the past 50 years, there are still some unresolved issues regarding the durability of the adhesive interface. A complete sealing of the interface between the resin and the dentin substrate remains difficult to achieve, and it is doubtful whether an optimal interdiffusion of the adhesive system within the demineralized collagen framework can be produced in a complete and homogeneous way. In fact, it is suggested that hydrolytic degradation, combined with the action of dentin matrix enzymes, destabilizes the tooth-adhesive bond and disrupts the unprotected collagen fibrils. While a sufficient resin-dentin adhesion is usually achieved immediately, bonding efficiency declines over time. Thus, here, a review will be carried out through a bibliographic survey of scientific articles published in the last few years to present strategies that have been proposed to improve and/or develop new adhesive systems that can help prevent degradation at the adhesive interface. It will specially focus on new clinical techniques or new materials with characteristics that contribute to increasing the durability of adhesive restorations and avoiding the recurrent replacement restorative cycle and the consequent increase in damage to the tooth.

Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to collect and interpret the randomized clinical trials (RCTs) that investigated the outcome of the self-adhesive luting resins (SA) compared to total-etch (TE), selective etch with dentin adhesives (Sle), selective etch without dentin adhesives (SleSA) or self-etch adhesives (SE).

DATA SOURCES

A thorough search of Internet databases was conducted without language restrictions, and the search ran up to and including April 2022. The illegible records citations were checked for more relevant clinical studies.

STUDY SELECTION/RESULTS

The inclusion criteria were randomized controlled trials (RCTs) that compared self-adhesive luting resins with total-etch, selective-etch, or self-etch adhesives regarding postoperative sensitivity, incidences of debonding, and survival rates of indirect restorations. From 1732 records, 9 RCTs met the eligibility criteria. Three RCTs compared total-etch adhesive to self-adhesive luting resin for intracoronal restorations, one RCT compared selective etch to self-adhesive luting resin for inlays, and 5 RCTs compared self-adhesive to other protocols for partial ceramic crowns. Postoperative sensitivity showed a non-statistically significant difference between SA and other adhesive protocols, SA revealed a non-statistically significant difference in debonding and survival to TE, but a lower statistically significant difference to Sle, SleSA, and SE.

CONCLUSIONS

Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, TE revealed comparable survival to SA for intracoronal restorations. SE and Sle exhibited the best clinical outcomes, followed by SleSA. Selective etch, and self-etch adhesives are preferable to self-adhesive resins.

CLINICAL SIGNIFICANCE

The significance of enamel etching and the superiority of self-etching adhesives over self-adhesive luting resins for reliable and durable bonding and improved clinical outcomes. However, long-term RCTs, particularly for total-etch comparison to self-adhesive luting resins, might be recommended to derive further evidence.

The Influence of Chlorhexidine Gluconate Dentine Pre-Treatment on Adhesive Interface and Marginal Sealing

Background and Objectives: The aim of this in vitro study was to evaluate the combined effect of a 2% chlorhexidine aqueous solution and a universal adhesive system applied in self-etch and etch-and-rinse strategies on the composite resin-dentin interface. Materials and Methods: Class V cavities were prepared on the facial and lingual surfaces of forty caries-free molars extracted for orthodontic reasons. The samples were randomly divided into two groups corresponding to the used etching protocol: I-etch-and-rinse; II-self-etch. In each tooth, one cavity was assigned for the control subgroups -IA (n = 20) and IIA (n = 20)-adhesive only, and the opposite cavity was pretreated with a 2% chlorhexidine solution-Gluco CHeX Cerkamed-subgroups IB (n = 20) and IIB (n = 20). Both sets of groups were restored using a universal adhesive system (Single Bond Universal Adhesive, 3M-ESPE) and a bulk-fill composite resin (Filtek One Bulk Fill Restorative, 3M-ESPE). The roots and the pulp tissue were then removed, and a needle connected to a perfusor with 100 mL saline solution was used for pulp pressure simulation with a hydrostatic pressure of 20 cm H₂O. Cariogenic attack was simulated using a demineralizing solution for 3 days at a constant temperature of 25 °C. The teeth were then sectioned in a facial-lingual direction and the microleakages at the occlusal and cervical margins were registered and scored using an optical Carl-Zeiss AXIO Imager A1m microscope (Carl-Zeiss). The composite resin-dentin interface was analyzed using a SEM Vega Tescan LMH II. Statistical analysis was performed using the Kruskal-Wallis test with a significance level of p < 0.05. Results: Microleakage evaluation showed no significant differences among the study groups (p > 0.05). In subgroup IA, significant differences were recorded between occlusal and cervical margins (p < 0.05). Conclusions: Application of chlorhexidine on tooth substrate before using a universal bonding system in total etch or self-etch mode has no influence on the adhesive interface in the condition of cariogenic attack. The thickness of the adhesive resin layer seems to be less uniform when using chlorhexidine, but the morphological differences at the adhesive interface have no influence on the sealing capacity of the universal bonding system, regardless of the etching strategy.

The inhibitory effects of various ions released from S-PRG fillers on dentin protease activity

This study investigates the effect of ions released from S-PRG fillers on host-derived enzymatic degradation of dentin collagen matrices. Dentin beams (n=80) were demineralized and distributed to eight groups following baseline dry mass and total MMP activity assessments. Each group treated with boron, fluoride, sodium, silicone, strontium, aluminium, or S-PRG eluate solutions for 5 min. Untreated beams served as control. After pre-treatment, MMP activity was reassessed, beams were incubated in complete medium for 1 week, dry mass was reassessed. Incubation media were analyzed for MMP and cathepsin-K-mediated degradation fragments. Data were analyzed with ANOVA and Tukey's test. All pretreatment groups showed significant reduction in total MMP activity (p<0.05) that was sustainable after incubation in all groups except for boron and silicone groups (p<0.05). Cathepsin-K activity did not differ between control or treatment groups. The results indicated that ions released from S-PRG fillers have the potential to partly inhibit MMP-mediated endogenous enzymatic activity.

Effect of Chlorhexidine-containing Etch-and-Rinse Adhesives on Dentin Microtensile Bond Strength after Biological Loading

PURPOSE

This study compared a 2%-CHX dentin pre-treatment with three CHX adhesives (experimentally admixed 0.1% CHX in primer or bonding agent, or industrially added 0.2% CHX in universal adhesive) by evaluating dentin bond strengths after biological loading in a fully automated artificial mouth model.

MATERIALS AND METHODS

The occlusal dentin of 50 freshly extracted human third molars was exposed, and the teeth were randomly assigned to 5 groups according to the adhesive protocol (n = 10): 1. control, Scotchbond Multipurpose (3M Oral Care; CTRL); 2. 2% CHX dentin pre-treatment (DENT); 3. 0.1% CHX experimentally admixed into the primer (PRIM); 4. 0.1% CHX experimentally admixed into the bonding agent (BOND); 5. Peak Universal Bond containing 0.2% CHX (Ultradent; PEAK). The teeth were restored with composite resin. Microtensile bond strength testing (bonding area 0.46 mm2 ± 0.04 mm2, crosshead speed 1 mm/min) was performed after 24-h storage in distilled water (baseline) or after 2-day biological loading with S. mutans (demineralization 1 h / remineralization 5 h). The mode of fracture was recorded and exemplary sticks were evaluated under SEM.

RESULTS

CTRL exhibited significantly higher μTBS at baseline in comparison to PRIM (p = 0.000), BOND (p = 0.002), and PEAK (p = 0.000). After undergoing the caries model, CTRL demonstrated significantly lower μTBS compared to DENT (p = 0.000), PRIM (p = 0.008), and PEAK (p = 0.000). The same behavior was observed for BOND vs DENT (p = 0.000), PRIM (p = 0.003), and PEAK (p = 0.001). After biological loading, DENT (p = 0.041), PRIM (p = 0.000), and BOND (p = 0.000) exhibited significantly fewer adhesive fractures than CTRL.

CONCLUSIONS

CHX addition to the primer protects dentin bond strength from declining after biological loading. Thus, it may offer some clinical advantage in terms of secondary caries inhibition around composite restorations. However, since loss of adhesion at baseline was less when 2% CHX was used as a dentin pre-treatment, it can be suggested as a safer option. so that bonding is not undermined by potential chemical interactions from CHX with the adhesives.

Construction of an antibacterial low-defect hybrid layer by facile PEI electrostatic assembly promotes dentin bonding

Dentin bonding is the most common form of human tissue repair among tissue-biomaterial adhesions, concerning billions of people's oral health worldwide. However, insufficient adhesive infiltration in the demineralized dentin matrix (DDM) always produces numerous defects in the bonding interface termed the hybrid layer, which causes high levels of bacteria-related secondary dental diseases, and less than 50% of the bonding lasts more than 5 years. Therefore, it is urgent and vital to construct an antibacterial low-defect hybrid layer to solve the durability-related problems. A DDM with a hydrogel-like surface formed by the hydration of highly-anionic non-collagenous proteins (NCPs) is firstly used as a template to electrostatically assemble polyethyleneimine (PEI). The formation of a stable antibacterial polyelectrolyte complex of PEI/NCPs rapidly eliminates NCP hydration capacity and significantly improves the infiltration of various adhesives. Simultaneously, both the PEI during the assembly and the PEI-assembled DDM can directly destroy a biofilm of S. Mutans on the DDM. Consequently, a long-term antibacterial and low-defect hybrid layer is successfully created, which greatly improves the bonding effectiveness. This helps to improve the clinical treatment of bacteria-based dental diseases and the tooth-restoration repair effect and prevent secondary dental diseases, having significance in clinical dentistry and providing insights for other tissue-biomaterial adhesions.

Bonding strategies to deal with caries-affected dentin using cross-linking agents: Grape seed extract, green tea extract, and glutaraldehyde - An in vitro study

Aim

This study evaluated the effect of three collagen cross-linking agents - proanthocyanidins (grape seed extract [GSE] and green tea extract [GTE]) and glutaraldehyde [GA] on microshear bond strength (μSBS) of caries-affected dentin (CAD)-resin complex.

Materials and Methods

Freshly extracted 96 teeth with caries up to the middle third of dentin were sectioned through the deepest part of the occlusal fissure, perpendicular to the long axis of the crown. Caries was excavated with large round bur until firm dentin was obtained, confirmed by visual inspection and tactile examination. Flat occlusal dentin surfaces were treated as follows: Group-1 - 6.5% GSE (n = 30), Group-2 - 2% GTE (n = 30), Group-3 - 5% Glutaraldehyde (n = 30), Group-4 - control group (no agents) (n = 6). Each group was further divided into Subgroup A - Etch-N-Rinse 15s, Subgroup B - Etch-N-Rinse 45s, and Subgroup C - Self-etch. Two increments of 1.5-mm thick composite (Tetric-N-Ceram - Ivoclar Vivadent) with a 1-mm diameter were built-up. Each sample was subjected to μSBS test in Universal Testing Machine. Student's t-test was done for intragroup comparison and one-way ANOVA for intergroup comparison.

Results

Statistically significant difference was present in mean μSBS, with Group 1B showing the best results and Group 4C, the least.

Conclusions

Thus, the application of these collagen cross-linkers, to CAD, increases μSBS and promises a new approach to improve dentin bond strength.

Experimental two-step universal adhesives bond durably in a challenging high C-factor cavity model

OBJECTIVES

To determine the bonding effectiveness of experimental 2-step universal adhesives (UAs) to high C-factor class-I cavity-bottom dentin and to assess the potential bond-strength contribution of an additional flowable composite layer.

METHODS

Three experimental 2-step UA formulations, involving the application of a 10-MDP-based primer followed by a hydrophobic adhesive resin with a 15-to-20-µm film thickness and differing only for filler, referred to as BZF-21 (silica and bioglass filler), BZF-29 (silica filler) and BZF-29_hv (higher silica-filler loading resulting in a higher viscosity), all prepared by GC, along with three representative commercial adhesives, Clearfil SE Bond 2 (C-SE2, Kuraray Noritake), G-Premio Bond (G-PrB, GC) and OptiBond FL (Opti-FL, Kerr), were comparatively investigated for their 'immediate' and 'aged' (50,000 thermocycles) micro-tensile bond strength (μTBS), when applied either in etch-and-rinse (E&R) or self-etch (SE) mode, to high C-factor class-I cavity-bottom dentin (n = 10; 10 experimental groups). Four additional experimental groups involved the extra application of the flowable composite G-ænial Universal Flo (GC), employed as an intermediate liner in combination with the adhesives BZF-29 and G-PrB and again applied both in E&R or SE mode. Statistical analysis was performed using linear mixed-effects (LME) modelling and linear regression analysis (p < 0.05).

RESULTS

All 2-step UAs performed similarly when compared to the gold-standard E&R Opti-FL and SE C-SE2 adhesives, except for the aged μTBS of BZF-29_hv applied in E&R mode, and significantly outperformed the 1-step UA G-PrB. Significant reduction in μTBS upon aging was only recorded for 2-step UAs applied in E&R mode. The extra flowable composite layer significantly improved G-PrB's μTBS.

SIGNIFICANCE

The experimental 2-step UAs revealed favorable bonding performance in the challenging high C-factor class-I cavity model, comparable to that of the multi-step gold-standard E&R and SE adhesives and superior to that of the 1-step UA investigated. An additionally applied flowable composite layer compensated for the lower bonding effectiveness of the 1-step UA in the high C-factor cavity model.

The comparative evaluation of the effects of quercetin, α-tocopherol, and chlorhexidine dentin pretreatments on the durability of universal adhesives

OBJECTIVE

The aim of this study was to evaluate and compare the effects of chlorhexidine, quercetin, and α-tocopherol on the shear bond strength of universal adhesives in the short (24h) and long term (6 months).

MATERIAL AND METHODS

Ninety-six extracted sound molars were collected and divided randomly into four groups: control (no treatment), 2% chlorhexidine, 10% α-tocopherol, and 1% quercetin. The solutions were prepared and applied to the teeth for 60 s, followed by application of All-Bond universal adhesive and composite build-up. Half of the specimens in each group (n = 12) were tested for shear bond strength (SBS) after 24 h of storage and the other half were kept in distilled water for 6 months and then tested for shear bond strength. The shear bond strength test was performed and the failure modes were determined using a stereomicroscope. The data were analyzed using two-way analysis of variance and Tukey's post hoc tests with p ˂ .05 as the significance level.

RESULTS

The results of the two-way analysis of variance test showed that there was no significant difference in immediate SBS, and after 6 months, α-tocopherol had the lowest SBS in comparison to the control and CHX subgroups (p < .05). The t-test showed that the shear bond strength in the α-tocopherol and quercetin groups was significantly decreased after 6 months.

CONCLUSION

It can be concluded that the solutions used in this study had no adverse effect on immediate SBS. After 6 months, the CHX could preserve SBS in comparison to other groups.

Salivary esterases dramatically reduce biostability of dentin collagen treated with galloylated polyphenols

OBJECTIVE

To investigate the effects of salivary esterases on biostability of collagen treated by galloylated polyphenols.

METHODS

Human dentin was microtomed into 6-μm-thick films, which were demineralized and treated for 60 s using solutions containing 0.6% and 2% of one of the crosslinkers: tannic acid (TAC), epigallocatechin gallate (EGCG), epigallocatechin (EGC), and N-[3-dimethylaminopropyl]-N'-ethylcarbodiimide hydrochloride (EDC)/N-hydroxysuccinimide (NHS), and for 1 h using EDC/NHS. Half of the treated and untreated (control) films were subjected to human saliva incubation. Collagen biostability was assessed via exogenous protease biodegradation by weight loss and hydroxyproline release, and endogenous MMPs by in situ zymography. The degradation products of galloylated polyphenols (TAC and EGCG) by saliva were monitored using proton nuclear magnetic resonance (1H NMR) and gel permeation chromatography (GPC). The esterase activity of saliva induced by the crosslinkers was also assessed.

RESULTS

Collagen films treated with TAC and EGCG exhibited significantly improved biostability (p < 0.05); however, the enhanced biostability was severely reduced after saliva incubation (p < 0.001). For EDC/NHS treated collagen, saliva incubation showed negligible effect on the biostability. 1H NMR studies confirmed the esterase-catalyzed hydrolysis of the galloyl. GPC measurements showed decreased molecular weight of TAC in saliva indicating its chemical degradation. Both TAC and EGCG showed much higher esterase activity than other treatment groups.

SIGNIFICANCE

The galloyl group plays important role in collagen crosslinking, inducing higher biostability. However, galloylated polyphenols crosslinked on collagen are highly susceptible to metabolism of human saliva by salivary esterase, dramatically compromising the enhanced biostability.

Biochemical and Mechanical Analysis of Occlusal and Proximal Carious Lesions

A precise evaluation of caries excavation endpoint is essential in clinical and laboratory investigations. Caries invasion differentiates dentin into structurally altered layers. This study assessed these changes using Raman spectroscopy and Vickers microhardness. Ten permanent molars with occlusal and proximal carious lesions were assessed and compared at 130 points utilizing four Raman spectroscopic peaks: phosphate v1 at 960 cm^-1, amide I (1650 cm^-1), amide III (1235 cm^-1) and the C-H bond of the pyrrolidine ring (1450 cm^-1). The phosphate-to-amide I peak ratio and collagen integrity peak ratio (amide III: C-H bond) of carious zones were calculated and compared in both lesions. The former ratio was correlated to 130 Vickers microhardness indentations through lesions. The caries-infected dentin (CID) exhibited low phosphate peak, but higher amide I, III and C-H bond peaks than other zones in both lesions. The peaks in amide regions (I and III) varied in occlusal versus proximal lesions. A high correlation was found between mineral: matrix peak ratio and equivalent microhardness number within carious lesions, while the collagen integrity peak ratio was applied in proximal lesions only. Raman spectroscopy detected changes in the mineral and matrix contents within different carious zones and regions.

The durability of resin-dentine bonds are enhanced by epigallocatechin-3-gallate-encapsulated nanohydroxyapatite/mesoporous silica

Biomimetic nanohydroxyapatite (nHAp) has long been used as a biocompatible material for bone repair, bone regeneration, and bone reconstruction due to its low toxicity to local or systemic tissues. Various cross-linkers have been employed to maintain the structure of collagen; these include epigallocatechin-3-gallate (EGCG), which can fortify the mechanical properties of collagen and withstand the degradation of collagenase. We hypothesized that EGCG combined with nHAp may promote resin-dentin bonding durability. Here, we examined the effect of epigallocatechin-3-gallate-encapsulated nanohydroxyapatite/mesoporous silica (EGCG@nHAp@MSN) on thermal stability and remineralization capability of dentin collagen. Dentin slices (2 × 2 × 1 mm³ ) were obtained and completely demineralized in a 10% phosphoric acid water solution. The resulting dentin collagen matrix was incubated with deionized water, EGCG, nHAp@MSN, and EGCG@nHAp@MSN. The collagen thermal degradation temperature was assessed utilizing differential scanning calorimetry analysis, which indicated that EGCG, nHAp@MSN, and EGCG@nHAp@MSN reinforced collagen's capability to resist thermal degradation. EGCG@nHAp@MSN resulted in the highest increase in denaturation temperature. Thermogravimetric analysis showed that both nHAp@MSN and EGCG@nHAp@MSN achieved a higher residual mass than the EGCG and control groups. Fourier transform infrared spectroscopy was performed to examine the interaction between EGCG@nHAp@MSN and dentin collagen. The EGCG@nHAp@MSN sample exhibited stronger dentin microhardness and uppermost bond strength after thermocycling. EGCG significantly enhanced collagen's capability to resist thermal degradation. In summary, EGCG and nHAp@MSN may work together to assist the exposed collagen to improve resistance to thermal cycling and promote remineralization while also strengthening the durability of resin-dentin bonds.

Hydroxyapatite Affects the Physicochemical Properties of Contemporary One-Step Self-Etch Adhesives

The study aimed to evaluate the influence of the manipulation surfaces on the physical properties of one-step self-etch adhesives (1-SEAs). Scotchbond Universal (SBU), Clearfil Universal Bond Quick ER (UBQ), and an experimental adhesive (UBQ_exp) were manipulated on different surfaces: manufacturer's Teflon-based dispensing dish (TD) or hydroxyapatite plate (HA). After manipulation of the adhesives, the pH of each 1-SEA was measured. Samples of each adhesive/manipulation surface were prepared and subjected to water sorption (WS)/solubility (SL) and flexural strength tests. The modulus of elasticity (E) was measured in dry and wet conditions before and after 24 h water storage, and the percentage of variation of E (ΔE) was calculated. Results were analyzed using the t-test with Bonferroni corrections (α = 0.05). When adhesives were manipulated on the HA plate, there was a significant increase in the adhesives' pH. WS and SL of all 1-SEAs decreased when the HA was used. Only SBU showed higher flexural strength when manipulated on the HA compared to the manipulation on TD under dry and wet conditions. For each 1-SEA, the use of HA resulted in significantly higher E in dry and wet conditions. ΔE of all adhesives was smaller with the manipulation on HA than on TD. It was concluded that the manipulation of 1-SEA on a hydroxyapatite plate considerably affected the adhesives' properties.

Comparative Assessment of Novel Collagen Cross-linking Agents on Push-out Bond Strength of Two Different Sealers: An In Vitro Study

AIM

To assess the push-out bond strength and tubular penetration of resin-based and bioceramic sealers after employing two collagen cross-linking agents, namely, cashew nut shell liquid (CNSL) and epigallocatechin-3-gallate (EGCG) on sodium hypochlorite treated root canal dentin.

MATERIALS AND METHODS

Fifty human permanent mandibular premolars selected were decoronated at CEJ, this was followed by cleaning and shaping protocols, root canals were enlarged up to 20 sizes with 6% taper and were randomly divided into the following 5 groups with 10 samples each based on the cross-linking agent and the sealer: • Group I: Irrigation with saline (control). • Group II: Irrigation with cashew nut shell liquid followed by bioceramic sealer obturation. • Group III: Irrigation with cashew nut shell liquid followed by resin-based sealer obturation. • Group IV: Irrigation with EGCG followed by bioceramic sealer obturation. • Group V: Irrigation with EGCG followed by resin-based sealer obturation. Five specimens in each group were evaluated for push-out bond strength with the universal testing machine while the remaining five specimens in each group were evaluated for depth of sealer penetration by a scanning electron microscope (SEM). The data was recorded, tabulated, and statistically analyzed.

RESULTS

The push-out bond strength was found to be maximum in the apical region in all the five groups followed by the middle third and coronal region. The maximum push-out bond strength was seen in group II followed by groups III and IV, and least in group V. The mean depth of tubular penetration of sealers was found to be effective in the coronal portion followed by the middle third while the apical third region showed the least depth penetration of sealers into the tubules. The maximum penetration of sealers was revealed in group V followed by groups III and IV, and least in group II.

CONCLUSION

Within the limitations of this study, it can be concluded that push-out bond strength was found to the maximum in specimens irrigated with cashew nut shell liquid and obturated with bioceramic sealer. The maximum push-out bond strength was seen in the apical third of all root canals followed by the middle and coronal region. The scanning microscopic analysis revealed maximum mean tubular penetration in the coronal portion followed by the middle third and apical third. A greater penetration was seen in specimens irrigated with EGCG and obturated with hybrid sealer.

CLINICAL SIGNIFICANCE

Selection of sealers plays a pivotal role in the success of endodontic therapy. Leakage-related issues can compromise the bond strength enhancing the bond strength can be achieved through the addition of cross-linking agents.

Evaluation of Bond Durability, Surface Morphology, and Remineralization at the Adhesive Interface with Dentin Bonding Agents Modified with Silica-doped Nanohydroxyapatite

Objectives

To compare and evaluate the bond durability, surface morphology, and remineralization of the adhesive layer with newer adhesive systems modified with novel bioactive nanoparticles.

Methodology

Bonding agents evaluated in this study include (a) Conventional dentin bonding agent (CN-DBA) (b) Nanohydroxyapatite (nanoHAP) incorporated dentin bonding agent (NH DBA); (c) Silica doped nanohydroxyapatite (Si nanoHAP) incorporated dentin bonding agent (Si NH DBA). A total of 104 human dentin discs (5 mm × 5 mm × 2 mm) were sectioned. Elemental analysis (Ca/P ratio) and surface morphology of the adhesive layer with different dentin adhesives were evaluated under scanning electron microscopy with energy-dispersive X-ray analysis after speculated storage time of 1 day and 6 months. Microshear bond strength of adhesive restorations with different dentin adhesives was evaluated under universal testing machine and fractographic analysis under scanning electron microscope after speculated storage time of 1 day and 6 months. The results were analyzed using analysis of variance and post hoc analysis.

Results

Si-NH-DBA showed highest mean microshear bond strength for both 1 day and 6 months, which was significantly higher compared to conventional nanofilled dentin bonding agent (CN-DBA) and NH-DBA. Si-NH-DBA group showed only 10% reduction in bond strength after 6 months, which was less compared to that of other groups. Similarly, Si-NH-DBA showed higher remineralization with stellate-shaped crystals at the adhesive layer after 6 months with hydrolytic resistant hybrid layer, compared to CN-DBA and NH-DBA.

Conclusion

Silica-doped nanohydroxyapatite proved its efficiency on bond stability, remineralization, and hydrolytic resistance when incorporated into dentin bonding agents because of its bioactivity and carbonate-containing apatite-forming ability.

Assessment of the remineralisation induced by contemporary ion-releasing materials in mineral-depleted dentine

OBJECTIVES

Evaluate the ability of current ion-releasing materials to remineralise bacteria-driven artificial caries lesions.

MATERIALS AND METHODS

Standardised class I cavities were obtained in 60 extracted human molars. Specimens underwent a microbiological cariogenic protocol (28 days) to generate artificial caries lesions and then were randomly divided into four restorative groups: adhesive + composite (negative control); glass ionomer cement (GIC); calcium silicate cement (MTA); and resin-modified calcium silicate cement (RMTA). Microhardness analysis (ΔKHN) was performed on 40 specimens (10/group, t = 30 days, 45 days, 60 days in artificial saliva, AS). Micro-CT scans were acquired (3/group, t = 0 days, 30 days, and 90 days in AS). Confocal microscopy was employed for interfacial ultra-morphology analysis (2/group, t = 0 days and 60 days in AS). Additional specimens were prepared and processed for scanning electron microscopy (SEM) and FTIR (n = 3/group + control) to analyse the ability of the tested materials to induce apatite formation on totally demineralised dentine discs (60 days in AS). Statistical analyses were performed with a significance level of 5%.

RESULTS

Adhesive + composite specimens showed the lowest ΔKHN values and the presence of gaps at the interface when assessed through micro-CT even after storage in AS. Conversely, all the tested ion-releasing materials presented an increase in ΔKHN after storage (p < 0.05), while MTA best reduced the demineralised artificial carious lesions gap at the interface. MTA and RMTA also showed apatite deposition on totally demineralised dentine surfaces (SEM and FTIR).

CONCLUSIONS

All tested ion-releasing materials expressed mineral precipitation in demineralised dentine. Additionally, calcium silicate-based materials induced apatite precipitation and hardness recovery of artificial carious dentine lesions over time.

CLINICAL RELEVANCE

Current ion-releasing materials can induce remineralisation of carious dentine. MTA shows enhanced ability of nucleation/precipitation of hydroxyapatite compared to RMTA and GIC, which may be more appropriate to recover severe mineral-depleted dentine.

Dental Adhesives-Surface Modifications of Dentin Structure for Stable Bonding

The latest advancements in dentin bonding have focused on strategies to impair degradation mechanisms in order to extend the longevity of bonded interfaces. Protease inhibitors can reduce collagen degradation within the hybrid layer (HL). Collagen cross-linkers allow better adhesive infiltration and also inhibit proteases activity. Particles added to adhesive can promote mineral precipitation within the HL, reducing nanoleakage and micropermeability, besides possible antimicrobial and enzymatic inhibition effects. Most of these approaches are still experimental, and aspects of the adhesive under the clinician's control are still determinant for the long-term stability of adhesive restorations.

The impact of provisional intraradicular retainers cementation with temporary methacrylate-based resin in the bond strength of glass fiber posts to root dentin

Chemical composition of temporary cements interferes in the bond strength and quality of the bond interface of glass fiber posts to root dentin. The aim of the present study was to evaluate the influence of different temporary cements on the bond strength of fiberglass posts and resin cement. Thirty-two maxillary central incisor roots were standardized at 15 mm length. The root canals were prepared with Reciproc R50 and filled with a R50 single cone and AH Plus. Ten mm of filling material was removed with a heated Schilder condenser, leaving 5 mm of apical filling material. The roots were randomly distributed into 4 groups (n = 8). In the control group, the root canal was prepared with a standard drill according to the post diameter (DC #1, FGM, Joinville, Brazil), irrigated with 5 mL of distilled water and immediately received the fiberglass post cemented with self-adhesive resin cement. For the other groups, cores were made with temporary intraradicular retainers cemented with different temporary cements: methacrylate-based resin (Bifix Temp - Voco), calcium hydroxide-based (Provicol - Voco) and zinc oxide-based - eugenol-free (Relyx Temp NE - 3M). After 7 days, mechanical removal of the temporary retainers, preparation, irrigation of the root canal and cementation of the fiberglass post were performed, following the same protocol that had been performed in the control group. The roots were sectioned to obtain 3 slices per root third. The most cervical section of each third was used for the push-out test and failure pattern analysis, while the most apical section was subjected to analysis of the adhesive interface by scanning electron microscopy (SEM). The BS data were compared between groups using the two-way ANOVA and Tukey post-test. The failure pattern results were expressed in percentage and compared between groups using the chi-square test and the material adaptation data at the bond interface were evaluated using the Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner tests. The results showed higher BS in the cervical third, with a higher value in the control group (10.8 ± 0.94) and Bifix Temp group (9.78 ± 0.71), with no statistically significant difference between these groups (P > .05). The middle and apical thirds showed no statistically significant difference (P > .05). As regards the type of failure, a higher percentage of mixed adhesive failures was observed for all groups. Analysis of the adhesive interface by SEM showed that the temporary cement Bifix Temp showed greater adaptation at the bond interface. It was concluded that the methacrylate-based resin temporary cement showed the highest bond strength values and best adaptation to root dentin than the zinc oxide-based and calcium hydroxide-based temporary cements.

The stamp technique for direct restoration in a ICDAS 4 carious lesion: A 4-year follow-up

OBJECTIVE

This case report described the use of a stamping technique associated with a bulk fill composite to restore an ICDAS 4 carious lesion on a posterior tooth. The 4-year follow-up is also presented.

CLINICAL CONSIDERATIONS

A 32-year-old patient presented a carious lesion on tooth 36 with an underlying dark shadow at the dentin seen from the noncavitated enamel occlusal surface, which was compatible with an ICDAS 4 carious lesion. The lesion was radiographically detected and the caries disease was treated with dietary and hygiene habits orientations. Before accessing the lesion and selectively removing the carious tissue, an occlusal stamp was made by applying a flowable resin composite to copy the anatomy of the noncavitated enamel surface. The cavity was restored using a bulk fill resin composite (Opus Bulk Fill, FGM) with 4-mm-thick increments. Before curing the last increment, a Teflon band was adapted at the uncured bulk fill composite surface and the occlusal stamp made with the flowable composite was pressed against it to reproduce the natural characteristics and initial occlusal anatomy. The top surface was light-activated for 40 s. After 4 years, small wear could be seen in the restoration, but still within clinically acceptable levels.

CONCLUSION

The occlusal stamp technique allows reproduction of the natural anatomy of teeth affected by ICDAS 4 carious lesions with good clinical longevity over 4 years.

CLINICAL SIGNIFICANCE

This case report presents the use of the stamp technique to restore a tooth affected by an ICDAS 4 lesion, in which a carious process reached the dentin and the enamel anatomy was still preserved. The bulk fill resin composite associated with the occlusal stamp was chosen to quickly restore the cavity with clinical predictability. Bulk fill composites allow the insertion of up to 4-mm-thick increments and offer lower shrinkage stress, good clinical longevity and a less time-consuming procedure in cases of posterior teeth, especially if associated with the stamp technique.

Role of Natural Cross Linkers in Resin-Dentin Bond Durability: A Systematic Review and Meta-Analysis

BACKGROUND

The role of endogenous Matrix Metallo Proteinases in resin dentin bond deterioration over time has been well documented. The present study aimed to systematically review the literature; in vitro and ex vivo studies that assessed the outcomes of natural cross-linkers for immediate and long-term tensile bond strength were included.

METHODS

The manuscript search was carried out in six electronic databases-PubMed/MEDLINE, LILACS, SciELO, Cochrane, Web of Science and DOAJ, without publication year limits. Only manuscripts in English (including the translated articles) were selected, and the last search was performed in December 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed.

RESULTS

From the 128 potentially eligible studies, 48 full-text articles were assessed for eligibility. After eligibility assessment and exclusions, 14 studies were considered for systematic review and seven studies for meta-analysis. Amongst the selected studies for meta-analysis, three had a medium and four had a low risk of bias.

CONCLUSIONS

It was evidenced by the available data that Proanthocyanidin is the most efficient natural cross-linker to date, in preserving the bond strength even after ageing.

Effects of the Combined Application of Trimethylated Chitosan and Carbodiimide on the Biostability and Antibacterial Activity of Dentin Collagen Matrix

The structural integrity of a dentin matrix that has been demineralized by the clinical use of etchants or calcium-depleting endodontic irrigants, such as endodontic ethylenediaminetetraacetic acid (EDTA), is often deteriorated due to the collagenolytic activities of reactivated endogenous enzymes as well as the infiltration of extrinsic bacteria. Therefore, the biomodification of dentin collagen with improved stability and antibacterial activity holds great promise in conservative dentistry. The purpose of this study was to evaluate the effects of the combined application of trimethylated chitosan (TMC) and 1-ethyl-3-[3-dimethylaminopropyl]carbodiimide hydrochloride (EDC) on the biostability and antibacterial activity of the demineralized dentin collagen matrix. The morphological changes in the collagen matrix were observed by scanning electron microscopy (SEM), the amount of TMC adsorbed on the collagen surface was detected by X-ray photoelectron spectroscopy, and the elastic modulus was measured by a three-point bending device. Dry weight loss and amino acid release were detected to evaluate its anti-collagenase degradation performance. The antibacterial performance was detected by confocal microscopy. The TMC-treated group had less collagen space and a more compact collagen arrangement, while the untreated group had a looser collagen arrangement. The combined application of TMC and EDC can increase the elastic modulus, reduce the loss of elastic modulus, and result in good antibacterial performance. The current study proved that a dentin collagen matrix biomodified by TMC and EDC showed improved biodegradation resistance and antibacterial activities.

Effect of pretreatment with matrix metalloproteinase inhibitors on the durability of bond strength of fiber posts to radicular dentin

Objectives

Application of matrix metalloproteinases inhibitors has been suggested to improve the durability of resin–dentin bonding. The purpose of this study was to evaluate the effect of dimethyl sulfoxide (DMSO), carbodiimide (EDC), and chlorhexidine (CHX) treatment on the push‐out bond strength of fiber posts to radicular dentin.

Materials and Methods

24 extracted premolars were assigned randomly to 4 groups after root canal treatment and post space preparation (n = 6). In the first, second, and third groups, radicular dentin was treated with 1 ml of 5% DMSO, 0.3 M EDC, and 2% CHX, respectively. The fourth group (control) received no treatment. The root canals were primed with ED primer II, and the fiber posts were cemented with Panavia F2.0. In each group, half of the specimens were subjected to the push‐out test and the other half to 3000 thermal cycles before testing. Data were analyzed using two‐way analysis of variance via SPSS version 20 (p < .05).

Results

Among the nonthermocycled specimens, the values of push‐out bond strength were observed in the control, EDC, CHX, and DMSO groups, in decreasing order. Among the thermocycled specimens, the values were observed in the control, EDC, DMSO, and CHX groups in decreasing order. Thermocycling had a significant adverse effect on the push‐out bond strength (p = .015), but the effect of material (p = .375), and the interaction effect of material and thermocycling (p = .998) were not significant.

Conclusions

Application of CHX, DMSO, and EDC had no significant effect on the bond strength of fiber posts to radicular dentin.

Degradation and Stabilization of Resin-Dentine Interfaces in Polymeric Dental Adhesives: An Updated Review

Instability of the dentine-resin interface is owed to the partial/incomplete penetration of the resin adhesives in the collagen fibrils. However, interfacial hydrolysis of the resin-matrix hybrid layer complex activates the collagenolytic and esterase enzymes that cause the degradation of the hybrid layer. Adequate hybridization is often prevented due to the water trapped between the interfibrillar spaces of the collagen network. Cyclic fatigue rupture and denaturation of the exposed collagen fibrils have been observed on repeated application of masticatory forces. To prevent interfacial microstructure, various approaches have been explored. Techniques that stabilize the resin–dentine bond have utilized endogenous proteases inhibitors, cross linking agents’ incorporation in the exposed collagen fibrils, an adhesive system free of water, and methods to increase the monomer penetration into the adhesives interface. Therefore, it is important to discover and analyze the causes of interfacial degradation and discover methods to stabilize the hybrid layer to execute new technique and materials. To achieve a predictable and durable adhesive resin, restoration is a solution to the many clinical problems arising due to microleakage, loss of integrity of the restoration, secondary caries, and postoperative sensitivity. To enhance the longevity of the resin-dentine bond strength, several experimental strategies have been carried out to improve the resistance to enzymatic degradation by inhibiting intrinsic collagenolytic activity. In addition, biomimetic remineralization research has advanced considerably to contemporary approaches of both intrafibrillar and extrafibrillar remineralization of dental hard tissues. Thus, in the presence of biomimetic analog complete remineralization of collagen, fibers are identified.

Dual-functional adhesive containing amorphous calcium phosphate nanoparticles and dimethylaminohexadecyl methacrylate promoted enamel remineralization in a biofilm-challenged environment

OBJECTIVE

The cariogenic biofilm on enamel, restoration, and bonding interface is closely related to dental caries and composite restoration failure. Enamel remineralization at adhesive interface is conducive to protecting bonding interface and inhibiting secondary caries. This study intended to assess the remineralization efficiency of adhesive with dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) on initial caries lesion of biofilm-coated enamel.

METHODS

Artificial initial carious lesion was created via 72-hour immersion in demineralization solution and cariogenic biofilm was formed after 24-hour culture of Streptococcus mutans (S. mutans). Specimens were then divided into 4 groups: enamel control, enamel treated with NACP, DMAHDM and NACP+DMAHDM respectively. Samples next underwent 7-day cycling, 4 h in BHIS (brain heart infusion broth containing 1 % sucrose) and 20 h in AS (artificial saliva) per day. The pH of BHIS was tested daily. So did the concentration of calcium and phosphate in BHIS and AS. Live/dead staining, colony-forming unit (CFU) count, and lactic acid production of biofilms were measured 7 days later. The enamel remineralization efficiency was evaluated by microhardness testing and transverse microradiography (TMR) quantitatively.

RESULTS

Enamel of NACP+DMAHDM group demonstrated excellent remineralization effectiveness. And the NACP+DMAHDM adhesive released a great number of Ca²⁺ and PO₄^3- ions, increased pH to 5.81 via acid neutralization, decreased production of lactic acid, and reduced CFU count of S. mutans (P < 0.05).

SIGNIFICANCE

The NACP+DMAHDM adhesive would be applicable to preventing secondary caries, strengthening enamel-adhesive interface, and extending the lifespan of composite restoration.

Novel bioactive adhesive containing dimethylaminohexadecyl methacrylate and calcium phosphate nanoparticles to inhibit metalloproteinases and nanoleakage with three months of aging in artificial saliva

OBJECTIVES

The objectives of this study were to: (1) develop a multifunctional adhesive via dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP); and (2) investigate its ability to provide metalloproteinases (MMPs) deactivation and remineralization for long-term dentin bonding durability.

METHODS

DMAHDM and NACP were incorporated into Adper™ Single Bond 2 Adhesive (SB2) at mass fractions of 5% and 20%, respectively. Degree of conversion and contact angle were measured. Endogenous MMP activity of the demineralized dentin beams, Masson's trichrome staining, nano-indentation, microtensile bond strength and interfacial nanoleakage analyses were investigated after 24 h and 3 months of storage aging in artificial saliva.

RESULTS

Adding DMAHDM and NACP did not compromise the degree of conversion and contact angle of SB2 (p > 0.05). DMAHDM and NACP incorporation reduced the endogenous MMP activity by 53 %, facilitated remineralization, and increased the Young's modulus of hybrid layer by 49 % after 3 months of aging in artificial saliva, compared to control. For SB2 Control, the dentin bond strength decreased by 38 %, with greater nanoleakage expression, after 3 months of aging (p < 0.05). However, DMAHDM+NACP group showed no loss in bond strength, with much less nanoleakage, after 3 months of aging (p > 0.05).

SIGNIFICANCE

DMAHDM+NACP adhesive greatly reduced MMP-degradation activity in demineralized dentin, induced remineralization at adhesive-dentin interface, and maintained the dentin bond strength after aging, without adversely affecting polymerization and dentin wettability. This new adhesive has great potential to help eliminate secondary caries, prevent hybrid layer degradation, and increase the resin-dentin bond longevity.

The roles of 10-methacryloyloxydecyl dihydrogen phosphate and its calcium salt in preserving the adhesive-dentin hybrid layer

OBJECTIVES

10-Methacryloyloxydecyl dihydrogen phosphate (MDP) has been regarded as the most effective dentin-bonding monomer for more than 20 years. Although the dentin-bonding promoting effect of MDP has been well demonstrated, the mechanisms by which it benefits the stably of collagen within the adhesive-dentin hybrid layer are not currently fully understood. The objective of this study was to investigate the roles of MDP and its calcium salt in preserving the adhesive-dentin hybrid layer.

METHODS

MDP-conditioned collagen was investigated by Fourier-transform infrared spectroscopy, Ultraviolet-visible spectroscopy, and molecular docking. The structural changes to the dentin surface upon acid-etching and MDP-conditioning were observed by SEM. X-ray diffraction and nuclear magnetic resonance were used to investigate the chemical interactions between MDP and HAp. The collagen-protecting effects of MDP and its Ca salt were investigated using in-situ zymography, rhMMP-9 colorimetric assay, hydroxyproline assay, and molecular docking.

RESULTS

MDP forms a stable collagen-phosphate complex through hydrogen bonding with the collagen in dentin. Furthermore, it generates MDP-Ca salts that are deposited on the dentin collagen scaffold, protecting it from degradation. Moreover, both free MDP and the MDP-Ca salt inhibit matrix metallopeptidase and exogenous proteases, with the inhibitory effect of the calcium salt being significantly stronger than that of the free form.

SIGNIFICANCE

MDP-based adhesives preserve the collagen within the hybrid layer by simultaneously improving collagen's resistance to exogenous enzymes and inhibiting MMP activity, both of which contribute to the longevity of dentin-resin bonding.

Evaluation of the Bond Strength of Self-Etching Adhesive Systems Containing HEMA and 10-MDP Monomers: Bond Strength of Adhesives Containing HEMA and 10-MDP

The aim of this in vitro study was to assess the bond strength of self-etching adhesives containing HEMA and 10-MDP monomers. Twenty-four bovine teeth were divided into three groups. Two cylinders of composite resin were made in each tooth (n = 16): G1-Prime and Bond Universal (control); G2-OptiBond All-in-One (HEMA); and G3-Clearfil SE (10-MDP and HEMA). After 24-hour storage in distilled water, the specimens were fixed to a universal testing machine (Kratos Equipamentos Ltda.) for the microshear test at a speed of 0.5 mm/min. A qualitative analysis of the fracture pattern was also performed using scanning electron microscopy (500× magnification). The normality of sample data distribution was determined using the Shapiro–Wilk test. The results were assessed using the Kruskal–Wallis test, and α level of 5% was used for the analysis. The results indicated a statistical difference (p > 0.05) between G3 (15.6080 MPa) and G2 (11.2180 MPa). No statistical difference was observed when G1 (14,6325 MPa) was compared with the other two groups. It was also observed that a mixed fracture pattern was predominant in all groups. The self-etching adhesive containing HEMA and 10-MDP monomers showed to be promising in increasing the bond strength between the dental substrate and the composite resin, whereas the adhesive containing only HEMA exhibited lower bond strength to dentin.

Comparison the Effect of Bromelain Enzyme, Phosphoric Acid, and Polyacrylic Acid Treatment on Microleakage of Composite and Glass Ionomer Restorations

Statement of the Problem

Resin modified glass-ionomer cement (RMGIC) shows low microleakage values. Bromelain enzyme is a deproteinizing agent with an anti-inflammatory effect in human body.Efective cavity treatment is an important factor in reduction of microleakage.

Purpose

The aim of this study was to determine the effectiveness of the deproteinizing aspect of 10% bromelain enzyme on the microleakage of RMGIC and composite restorations.

Materials and Method

In this experimental study, 40 non-carious extracted human molar teeth were categorized in eight experimental groups (n=5). Standard class V cavities were prepared on the buccal and lingual surfaces of the teeth (n=10). The specimen were classified as Group 1, in which 20% polyacrylic acid (PAA) was applied on the teeth then treated with 10% bromelain enzyme; Group 2: 10% bromelain enzyme was applied; Group 3: 10% bromelain enzyme was applied and then treated with polyacrylic acid; Group 4: 20% polyacrylic acid was applied. Groups1 to 4 were restored with RMGIC (Fuji II LC, GC, Japan). Group 5: etched by 37% phosphoric acid and then treated by 10% bromelain; Group 6: 10% bromelain enzyme was applied without etching; Group 7: teeth were deproteinized with 10% bromelain enzyme and then etched with 37% phosphoric acid; and Group 8: cavities were etched with 37% phosphoric acid. In the groups 5 to 8, Adper single bond (3M, ESPE, USA) and filled with composite resin Z350 (3M, ESPE, USA). After thermocycling, the teeth were sectioned. Microleakage scores were measured using stereomicroscope (40×). Kruskal-Wallis and Mann-Whitney tests were used for data analysis. (p< 0.05).

Results

Statistical analysis did not show any significant difference in occlusal and gingival margin microleakage in glass ionomer groups (1-4) (occlusal p= 0.218, gingival p= 0.192). Kruskal-Wallis revealed significant difference in occlusal and gingival margin microleakage of Groups 5 to 8 (occlusal p= 0.006 and gingival p= 0.00). Group 5 demonstrated the lowest occlusal microleakage (occlusal mean=0.00).

Conclusion

Applying bromelain or polyacrylic acid did not affect the microleakage of glass ionomer filling. Due to the antinflamatory effects of bromelain, we suggest using it instead of PAA. Pretreatment of 10% bromelain enzyme after phosphoric acid significantly decreased microleakage in the occlusal and gingival margin of composite filling.

Influence of chlorhexidine, propolis, pulpal pressure simulation, and aging on dentin bond strength

The present study evaluated the bond strength (μTBS) of dentin treated with chlorhexidine and propolis subjected to simulated pulpal pressure (SPP) and thermocycle aging. One hundred and twenty healthy human molars were sectioned to obtain 2 mm of dentin thickness and were divided into two groups (n = 60): SPP (15 cm H₂ O) and no SPP (Control group). Dentin surfaces were conditioned with 37% phosphoric acid for 15 s and were divided according to the dentin treatment (n = 20): Control; Chlorhexidine gluconate (0.2% for 30 s) and Propolis (aqueous propolis extract for 30 s). Half of the specimens were submitted to 15,000 thermocycle aging (5 ± 2°C and 55 ± 2°C). The samples were sectioned into beams and submitted to μTBS. Data were analyzed by three-way ANOVA (SPP × Dentin treatment × Thermocycle aging) and the Tukey's tests (p < .001). With regard to the SPP, ANOVA revealed that the Control group (32.98 MPa) had significantly higher values of μTBS when compared to the SPP (29.19 MPa). With regard to Thermocycle aging, no aging (34.05 MPa) had significantly higher values of μTBS when compared to the aging (28.12 MPa). With regard to the dentin treatment, Propolis and Chlorhexidine did not statistically influence the results (p > .05). The SPP and thermocycle aging negatively influenced the bond strength between the dentin and resin; the 0.2% chlorhexidine digluconate and aqueous propolis extract solutions did not interfere in the bond strength between the resin and dentin. The use of chlorhexidine and propolis as a dental treatment may not influence the dentin bond strength, but SPP and thermocycle aging may damage the longitudinal dentin bond strength.

Interactions of two phosphate ester monomers with hydroxyapatite and collagen fibers and their contributions to dentine bond performance

OBJECTIVES

To evaluate the interactions of two phosphate ester monomers [10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and dipentaerythritol penta-acrylate phosphate (PENTA)] with hydroxyapatite and collagen and understand their influence on dentine bonding.

METHODS

Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, nuclear magnetic resonance, ultraviolet-visible, and molecular docking were applied for separately evaluating the interactions of two monomers with hydroxyapatite and collagen. Hydrophilicity tests and morphological observation were employed to characterize pretreated dentine. Microtensile bond strength (μTBS) and nanoleakage were investigated to evaluate the bonding performance. Hydroxyproline assay, in situ zymography, and matrix metalloproteinase-9 (MMP-9) activity assay were used to confirm the MMP inhibition.

RESULTS

Chemoanalytic characterization confirmed the interactions of 10-MDP and PENTA with hydroxyapatite and collagen. The interactions of PENTA were weaker than 10-MDP. PENTA possessed better dentine tubule sealing after etching than 10-MDP. Dentine treated with PENTA was more hydrophilic than 10-MDP. 10-MDP and PENTA treating significantly increased the initial μTBS than the control group without primer conditioning. μTBS decreased significantly during aging, and the decrease was more severe in the PENTA group than 10-MDP. The 10-MDP and PENTA groups exhibited relatively less fluorescence than the control. The relative inhibition percentages of MMP-9 decreased in the order of 10-MDP-Ca salt, 10-MDP and PENTA. The 10-MDP, PENTA, and 10-MDP-Ca salt groups showed significantly lower hydroxyproline contents than the control.

CONCLUSIONS

Although PENTA adsorbed on hydroxyapatite, it did not form a stable calcium salt. The interactions of 10-MDP with hydroxyapatite and collagen are different than those of PENTA.

CLINICAL SIGNIFICANCE

The sealing of dentinal tubules by PENTA and the inhibition of MMP by 10-MDP and its calcium salts contribute to improving the dentine bonding durability.

A multi-functional dentine bonding system combining a phosphate monomer with eugenyl methacrylate

OBJECTIVE

The tooth-resin composite interface is frequently associated with failure because of microbial contamination, hydrolytic and collagenolytic degradation. Thus, designing a dentine bonding system (DBS) with an intrinsically antimicrobial polymerisable monomer is of significance especially if it can be used with self-etching primers enabling resistance to degradation of the interface.

METHODS

Experimental adhesives were developed incorporating eugenyl methacrylate (EgMA) at concentrations of 0,10 or 20 wt%, designated as EgMA0, EgMA10 and EgMA20, respectively, for use as a two-step self-etch DBS with the functional monomer bis[2-(methacryloyloxy) ethyl] phosphate (BMEP) in the primer. The curing, thermal and wettability properties of the adhesives were determined, and hybrid layer formation was characterised by confocal laser scanning microscopy, microtensile bond strengths (µTBS) and nanoleakage by back-scattered SEM. In situ zymography was used to assess MMP inhibitory activity of the BMEP-EgMA DBS.

RESULTS

EgMA in the adhesives lowered the polymerisation exotherm and resulted in higher Tg, without negatively affecting degree of conversion. Water sorption and solubility were significantly lower with higher concentrations of EgMA in the adhesive. The formation of a distinct hybrid layer was evident from confocal images with the different adhesives, whilst EgMA20 yielded the highest µTBS post water storage challenges and lowest nanoleakage after 6 months. The experimental DBS exhibited minimal to no MMP activity at 3 months.

SIGNIFICANCE

The hydrophobic nature of EgMA and high cross-link density exerts considerable benefits in lowering water uptake and polymerisation exotherm. The application of EgMA, adhesives in conjunction with BMEP in a multi-functional self-etching DBS can resist MMP activity, hence, enhance longevity of the dentine-resin composite interface.

Chlorhexidine-loaded poly (amido amine) dendrimer and a dental adhesive containing amorphous calcium phosphate nanofillers for enhancing bonding durability

OBJECTIVE

A novel method of combining chlorhexidine (CHX) loaded poly (amido amine) (PAMAM) dendrimers with a dental adhesive containing amorphous calcium phosphate (ACP) nanofillers are proposed for etch-and-rinse bonding system to enhance resin-dentin bonding durability.

METHODS

The CHX-loaded PAMAM and ACP nanofillers were synthesized and characterized. Their effects on the cytotoxicity were tested by MTT assay. Micro-tensile bond strength (μTBS) before and after thermomechanical challenges were used to evaluate the bonding durability. Anti-matrix metalloproteinase (MMPs) property was examined using in-situ zymography. A double-fluorescence technique was used to examine interfacial permeability after bonding. Dentin remineralization in Ca/P lacking solution was observed under scanning electron microscopy.

RESULTS

Compared with a 0.2 wt% CHX solution, the PAMAM loaded CHX had less cytotoxicity, while the in situ zymography showed it could still inhibit MMPs activity within the hybrid layer after released from PAMAM. The application of the novel method maintained the μTBS better than the control group after thermomechanical challenges, and it did not negatively affect water permeability of the bonding interfaces. CHX-loaded PAMAM regulated the calcium (Ca) and phosphate (P) ions provided by the ACP-containing adhesives to remineralize the demineralized dentin surfaces without initial Ca/P in the environment.

SIGNIFICANCE

The novel method can reduce the cytotoxicity of CHX, inhibit MMPs activities, maintain μTBS, and induce dentin remineralization, which are crucial factors for enhancing bonding durability.

Improving Properties of an Experimental Universal Adhesive by Adding a Multifunctional Dendrimer (G-IEMA): Bond Strength and Nanoleakage Evaluation

A vast number of adhesive formulations exist currently. However, available adhesives still have several drawbacks such as increased hydrophilicity, polymerization deficiency, potential cytotoxicity and limited monomer interdiffusion within dentin. To improve material properties, a Bisphenol A-free adhesive containing a novel dendrimer G(2)-isocyanatoethyl methacrylate (G-IEMA) in replacement of Bis-GMA was made and tested. Sound human molars were sectioned to expose mid-coronal dentin, which was bonded using four adhesives—Futurabond, Scotchbond Universal and experimentals EM1 and EM2. The experimental adhesive EM2 contained G-IEMA, while EM1 had Bis-GMA. Groups were further allocated to two different adhesive strategies: etch-and-rinse (20 s etching) or self-etch. Immediate (24 h) microtensile bond strength to dentin (n = 5) was tested using a universal testing machine (1 mm/min, 5 kN; Shimadzu AGS-X Autograph, Tokyo, Japan), while the ultrastructure of the interface (n = 2) was assessed using scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). Nanoleakage expression was evaluated using silver nitrate penetration and posterior SEM-EDS analysis (n = 3). Linear mixed models/Generalized models were used for inferential statistics (5% significance level). Bond strength results did not depend on the adhesive choice, although differences were found between strategies (p < 0.001). Regarding nanoleakage, when applied in an etch-and-rinse mode, experimental adhesives scored lower nanoleakage means than Futurabond and Scotchbond Universal. The novel adhesive shows interesting interfacial properties, with favorable nanoleakage results and a bond strength to dentin that matches current commercial adhesives.

Effect of Active Bonding Application after Selective Dentin Etching on the Immediate and Long-Term Bond Strength of Two Universal Adhesives to Dentin

The objective was to evaluate the influence of active bonding applications (ABA) for different time intervals after selective dentin etching (SDE) for 3 s on the microtensile bond strength (μTBS) to dentin of two universal adhesive systems (UAs): one containing 2-hydroxyethyl methacrylate (HEMA) (Scotchbond Universal, SBU), and one that was HEMA-free (Prime&Bond Universal, PBU). Dentin bovine specimens were divided into four groups: self-etch as control (SE), SDE + ABA for 15 s (SDE15), SDE + ABA for 20 s (SDE20), and SDE + ABA for 25 s (SDE25). The μTBS test was performed after a water storage of 24 h and 6 months. Scanning electron microscopy (SEM) was used in order to examine the resin−dentin interface. For the PBU, the µTBS was significantly influenced only by the aging factor (p < 0.026). A statistically significant decrease in the µTBS after 6 months of aging was observed only for the SDE15 group. For SBU, µTBS was significantly influenced by the protocol application and the aging time (p ≤ 0.041). The groups SDE15, SDE20, and SDE25 achieved statistically significant higher values (after 24 h and 6 months). No considerable variances were noticed in the homogeneity and continuity of the hybrid layer (HL) among the groups. In conclusion, SDE and ABA improved the µTBS only of a HEMA-containing universal adhesive.

A Novel Chemical Binding Primer to Improve Dentin Bonding Durability

The dentin collagen matrix that is not completely enveloped by resin adhesive is vulnerable to degradation by intrinsic collagenases during the etch-and-rinse process, which contributes to the deterioration of the bonding interface. Current commercial adhesives have no functional components that can form covalent bonds to the dentin collagen matrix. In this study, a photocurable aldehyde, 4-formylphenyl acrylate (FA), was synthesized and for the first time applied as a primer in adhesive dentistry to covalently bind to collagen. Experimental groups with different concentrations of FA (1%, 3%, 5%, 7%, 9%) were prepared as primers. The cytotoxicity was evaluated by live/dead-cell staining and thiazolyl blue tetrazolium bromide assay. The interaction of FA with collagen was examined by attenuated total reflection Fourier transform infrared spectroscopy, hydroxyproline release under the degradation of type I collagenase, and thermogravimetric analysis. An optimal group was selected based on the degree of conversion of 2 universal adhesives and further divided depending on the treatment time (20 s, 30 s, 1 min, 2 min). The bonding performances were evaluated by microtensile strength before and after aging. Finally, the bonding interface was observed under confocal laser scanning microscopy and scanning electron microscope. The results indicated that FA demonstrated good biocompatibility, dentin modification capability, and infiltration. It not only effectively cross-linked dentin collagen to improve its stability against enzymatic hydrolysis and modify the adhesive interface but also potentially acted as a diluting monomer to induce deep penetration of adhesive resin monomers into the dentin. The bonding strength after aging was improved without jeopardizing the degree of conversion of 2 commercial adhesives. Such prominent advantages of using FA to improve the bonding performance promotes its further application in adhesive dentistry.

Synthesis, characterization and evaluation of azobenzene nanogels for their antibacterial properties in adhesive dentistry

The presence of cariogenic bacteria within the prepared tooth cavity at the adhesive resin-dentin interface is detrimental to the long-term stability and function of composite restorations. Here, we report the synthesis and incorporation of methacrylated azobenzene nanogels within bisphenol A-glycidyl methacrylate/hydroxyethyl methacrylate/ethanol (B/H/E) adhesive resins and evaluate their ability to reduce the bacterial invasion of cariogenic Streptococcus mutans biofilms while preserving the mechanical strength and structural integrity of the critical interfacial connection between the restoration and the tooth. The azobenzene nanogel, with a hydrodynamic radius of < 2 nm and a molecular weight of 12,000 Da, was polymerized within B/H/E adhesive formulations at concentrations of 0.5 wt.%, 1.5 wt.%, and 2.5 wt.%. While the double-bond conversion, cytocompatibility, water solubility, and sorption of the adhesive networks were comparable, azobenzene nanogel networks showed improved hydrophobicity with a ≥ 25° increase in water contact angle. The polymerized adhesive surfaces formulated with azobenzene nanogels showed a 66% reduction in bacterial biofilms relative to the control while maintaining the mechanical properties and micro-tensile bond strength of the adhesive networks. The increased hydrophobicity and antibacterial activity are promising indicators that azobenzene nanogel additives have the potential to increase the durability and longevity of adhesive resins.

Tannic acid induces dentin biomineralization by crosslinking and surface modification

It is currently known that crosslinking agents can effectively improve the mechanical properties of dentin by crosslinking type I collagen. However, few scholars have focused on the influence of crosslinking agents on the collagen-mineral interface after crosslinking. Analysis of the Fourier transform infrared spectroscopy (FTIR) results showed that hydrogen bonding occurs between the tannic acid (TA) molecule and the collagen. The crosslinking degree of TA to collagen reached a maximum 41.28 ± 1.52. This study used TA crosslinked collagen fibers to successfully induce dentin biomineralization, and the complete remineralization was achieved within 4 days. The crosslinking effect of TA can improve the mechanical properties and anti-enzyme properties of dentin. The elastic modulus (mean and standard deviation) and hardness values of the remineralized dentin pretreated with TA reached 19.1 ± 1.12 GPa and 0.68 ± 0.06 GPa, respectively, which were close to those of healthy dentin measurements, but significantly higher than those of dentin without crosslinking (8.91 ± 1.82 GPa and 0.16 ± 0.01 GPa). The interface energy between the surface of collagen fibers and minerals decreased from 10.59 mJ m^-2 to 4.19 mJ m^-2 with the influence of TA. The current work reveals the importance of tannic acid crosslinking for dentin remineralization while providing profound insights into the interfacial control of biomolecules in collagen mineralization.

Simulating the Intraoral Aging of Dental Bonding Agents: A Narrative Review

Despite their popularity, resin composite restorations fail earlier and at higher rates than comparable amalgam restorations. One of the reasons for these rates of failure are the properties of current dental bonding agents. Modern bonding agents are vulnerable to gradual chemical and mechanical degradation from a number of avenues such as daily use in chewing, catalytic hydrolysis facilitated by salivary or bacterial enzymes, and thermal fluctuations. These stressors have been found to work synergistically, all contributing to the deterioration and eventual failure of the hybrid layer. Due to the expense and difficulty in conducting in vivo experiments, in vitro protocols meant to accurately simulate the oral environment’s stressors are important in the development of bonding agents and materials that are more resistant to these processes of degradation. This narrative review serves to summarize the currently employed methods of aging dental materials and critically appraise them in the context of our knowledge of the oral environment’s parameters.

Riboflavin and Its Effect on Dentin Bond Strength: Considerations for Clinical Applicability-An In Vitro Study

Bioactive collagen crosslinkers propose to render the dentin hybrid layer less perceptive to hydrolytic challenge. This study aims to evaluate whether bond strength of dental resin composite to dentin benefits from riboflavin (RB)-sensitized crosslinking when used in a clinically applicable protocol. A total of 300 human dentin specimens were prepared consistent with the requirements for a macro-shear bond test. RB was applied on dentin, either incorporated in the primer (RBp) of a two-step self-etch adhesive or as an aqueous solution (RBs) before applying the adhesive, and blue light from a commercial polymerization device was used for RB photoactivation. Bonding protocol executed according to the manufacturer's information served as control. Groups (n = 20) were tested after 1 week, 1 month, 3 months, 6 months or 1 year immersion times (37 °C, distilled water). The different application methods of RB significantly influenced bond strength (p < 0.001) with a medium impact (η2p = 0.119). After 1 year immersion, post hoc analysis identified a significant advantage for RB groups compared to RBp (p = 0.018), which is attributed to a pH-/solvent-dependent efficiency of RB-sensitized crosslinking, stressing the importance of formulation adjustments. We developed an application protocol for RB-sensitized crosslinking with emphasis on clinical applicability to test its performance against a gold-standard adhesive, and are confident that, with a few adjustments to the application solution, RB-sensitized crosslinking can improve the longevity of adhesive restorations in clinics.

Clinical Evaluation of Bioactive Restorative Material versus Resin Modified Glass Ionomer in Cervical Restorations: A Randomized Controlled Clinical Trial

Abstract: Objective: In the context of great attention given to fluoride containing restorative material and development of easily applied and reliable material for different clinical situations. This current study aimed to compare Bioactive resin-based composite (ACTIVA) to Resin modified glass ionomer (RMGI) in cervical restorations. Materials and methods:  Fuji II LC® capsules (conventional resin modified glass ionmer), or ACTIVA™ BioACTIVE-RESTORATIVE™ (enhanced resin-modified glass-ionmer) with using Etch-Rite™ and Prime&Bond universal (universal adhesive system) were applied randomly in thirty anterior teeth and six premolars with class V cavities; all materials were applied according to manufacturers’ instructions. Restorations were evaluated at baseline (one week), after six months, and after 12 months by two blinded assessors using modified USPHS criteria. Results:  The results in this study were ordinal data, so Mann-Whitney test was used to compare between tested materials. Freidman test was used to test the effect of time within tested materials. Kruskal Wallis test used to compare the interaction between variables for all tested parameters. The results were statistically significant when p≤0.05. There was no significant difference between interaction of both restorations and time in marginal discoloration (p=0.051), recurrent caries (p=1.00) and retention analysis (p=1.00), but there was a significant change in marginal adaptation (p=0.001), surface roughness (p=0.017), color change (p= 0.004) and surface luster (p=0.017) with 100 % survival rate in this study. Conclusions: Both conventional resin-modified glass ionmer and enhanced resin-modified glass ionomer are acceptable as intermediate restoration. Bioactive restorations proved to retain its esthetic characteristics over the conventional one. Bioactive restorations with an adhesive system can be used as long-term restoration in small-defined cavities, not in stress-bearing areas.   Clinical relevance: Within the limitations of this study, ACTIVA BIO-ACTIVE Restorative showed similar results to FUJI II LC in class V cavity restorations.  

Effect of Chlorhexidine on Immediate and Delayed Bond Strength between Resin and Dentin of Primary Teeth: A Systematic Review and Meta-Analysis

Objectives: The purpose of this study was to systematically review the literature and use meta-analysis to investigate whether chlorhexidine (CHX) application after acid etching as an adjunct treatment has any influence on the immediate and delayed bond strength to primary dentin. Materials and Methods: In this review, PubMed, ISI (all data bases), Scopus and Cochrane were searched according to the selected keywords up to April 30, 2018. The full texts of all published articles that met our primary inclusion criteria were obtained. The studies were analyzed in two parts: in vitro studies that evaluated the effect of CHX application during the bonding procedures (application after acid etching) on immediate and delay dentin bond strength of resin-dentin interface. Results: The initial search yielded 214 publications, of which 8 were selected after thorough methodological assessment. None of the clinical studies fulfilled the eligibility criteria. Our results indicated that in comparison to the control group, CHX significantly reduced immediate resin-dentin bond strength (P=0.043). These values were increased after aging (P<0.001). Conclusion: Based on this invitro Meta-analysis CHX application, improve resin-dentin bond strength durability in primary teeth.

Effect of an extrafibrillar dentin demineralization strategy on the durability of the resin-dentin bond

OBJECTIVES

This study aimed to evaluate the potential of the extrafibrillar dentin demineralization strategy on the long-term dentin bond strength of an etch-and-rinse adhesive.

METHODS

A water-soluble glycol chitosan-EDTA (GCE), a chelating conditioner, was synthesized and subjected to size-exclusion dialysis to obtain molecules >40 kDa. The conjugation of EDTA to glycol chitosan was analyzed by Fourier transform infrared (FTIR) spectroscopy. Mid-coronal dentin surfaces of 80 teeth were either acid-etched with 35% phosphoric acid or conditioned with 25 mg/mL GCE (n = 40) and thoroughly water-sprayed before applying the etch-and-rinse adhesive Adper Single Bond Plus and placing Z250 composite resin (3 M Oral Care; St Paul, MN, USA). Resin-bonded specimens were prepared into beams with a cross-sectional area of about 0.9 mm² vertically through the resin-dentin interfaces before the microtensile bond strengths (MTBS) were determined immediately or after 3, 6, or 12 months of water storage. The resin-dentin interfaces were analyzed using transmission electron microscopy (TEM). The MTBS data were analyzed using two-way ANOVA followed by the LSD post-hoc multiple comparisons (P < 0.05).

RESULTS

FTIR spectra showed that EDTA was successfully conjugated to glycol chitosan. The phosphoric acid-etching group and GCE-conditioning group showed similar bond strength values after 24 h of water storage. The bond strength of the phosphoric acid-etching group after 12-month water aging was significantly reduced from 51.61 ± 3.30 MPa to 38.57 ± 4.81 MPa, while the bond strength of the GCE-conditioning group was not significantly reduced from 50.28 ± 3.62 MPa to 46.40 ± 4.71 MPa.The degradation of the hybrid layer could be detected in the phosphoric acid-etching group after 12 months of water aging, but not in the GCE-conditioning group.

CONCLUSION

The extrafibrillar dentin demineralization strategy using GCE conditioner could defy the hybrid layer degradation of the dentin bond after 12 months of water aging and enhance the dentin bond durability of the etch-and-rinse adhesive Adper Single Bond Plus.

Silanization of nanographene platelets improves interaction with the dentin bonding resin matrix and enhances interfacial bond integrity to dentin

This study synthesized and characterized graphene nanoplatelets silanized with 3-(trimethoxysilyl)propyl methacrylate (MPS-GNP) for morphological and chemical characteristics. In addition, we modified a dentin bonding agent using different concentrations of MPS-GNP to study its interaction within the resin matrix of the adhesive, degree of conversion (DC), biological, and mechanical properties after bonding to tooth. Both 0.25% and 0.5% MPS-GNP-modified bonding agents showed comparable DC values to the unmodified control adhesive (range: 41%-43%). However, a statistically significant reduction in the DC was found when 0.25% and 0.5% non-silanized GNP was doped with the adhesive (<38%) (p < 0.05). On day 30, the bacterial viability of 0.5% GNP and MPS-GNP groups remained very low under 22% with the highest dead cell count (p < 0.05). GNP incorporated within the resin matrix of the dentin bonding agent showed clear evidence of several interfacial gap formations and non-union between the GNP surface and resin matrix, while the MPS-GNP modified dentin bonding agent showed MPS-GNP with no gap formation with complete union between the graphene surface and resin matrix. The decrease in the μTBS was least pronounced for 0.25% and 0.5% MPS-GNP groups. After 12 months of ageing, the groups 0.25% and 0.5% MPS-GNP also showed the highest BS as compared to the rest of the groups. Statistically significant reduction was seen in nanohardness at the hybrid layer and adhesive layer for GNP groups after 4 months of storage. The addition of up to 0.5% MPS-GNP showed optimized DC, antibiofilm activity, and micro-tensile bond strength without affecting the standard adhesion characteristics as compared to GNP alone.

Long-term effect of curcuminoid treatment on resin-to-dentin bond strength

Endogenous dentin proteases contribute to the degradation of collagen fibrils in the hybrid layer. Recently, inhibition of host-derived proteases by curcuminoids has shown promising results. The aim of this study was to evaluate the effect of curcuminoid treatment on the microtensile bond strength (μTBS) after 24 h or 12 months of storage. Fifty-four extracted sound human molars were flattened to mid-coronal dentin and divided into nine groups. After phosphoric acid-etching for 15 s, the dentin was experimentally treated for 60 s using 100 μM or 200 μM of curcumin, diflourobenzocurcumin, or demethoxycurcumin dissolved in 1% and 2% dimethyl sulfoxide (DMSO)/water solutions. Untreated and DMSO-treated groups served as controls. After bonding agent application, each tooth was restored with dental composite. The molars were sectioned into 0.9 × 0.9 × 6 mm beams. The μTBS testing was performed after 24 h and 12 months of storage in artificial saliva. Data were analyzed using regression analyses. Failure patterns were evaluated using scanning electron microscopy. Dentin treatment with curcuminoids did not adversely affect 24-h μTBS compared to controls. After 12 months, the μTBS of curcuminoid groups was statistically significantly higher than the controls. This study indicates the feasibility of using curcuminoids as protease inhibitors.

Placement of Posterior Composite Restorations: A Cross-Sectional Study of Dental Practitioners in Al-Kharj, Saudi Arabia

Dental practitioner-related factors can affect the quality of composite restorations. This study aimed to investigate the clinical techniques used by dental practitioners (DPs) while placing direct posterior composite restorations. Methods: A questionnaire survey that sought information related to the placement of posterior composite restorations was delivered to 161 DPs working in the Al-Kharj area, Saudi Arabia. The collected data were statistically analyzed using Pearson’s Chi-square test and Fisher’s exact test considering the DP’s working sector and the answered questions. Results: A total of 123 DPs completed the survey (76.4% response rate). There was a statistically significant difference between DPs working in the private sector and those working in the governmental sector in 7 out of 17 questionnaire items namely: preparing a minimum depth of 2 mm, (p = 0.001); mechanical means of retention, (p = 0.003); operative field isolation, (p = 0.004); adhesive strategy, (p < 0.001); light-curing unit used, (p = 0.013); the use of radiometer, (p = 0.023), and dental matrix selection, (p < 0.001). Conclusion: The clinical techniques applied by DPs working in the private sector in Al-Kharj, Saudi Arabia when placing posterior composite restorations, including the specifications of cavity preparation, operative field isolation, and selection of the dental matrix system, may be substandard compared to those applied by DPs working in the governmental sector.