Bond strength of universal adhesives: A systematic review and meta-analysis

Clinical outcome of bonded partial indirect posterior restorations on vital and non-vital teeth: a systematic review and meta-analysis

OBJECTIVES

The survival rate of indirect partial adhesive restorations on vital versus endodontically treated teeth is still controversial. The hypothesis is that there may be a difference in the survival rate of partial adhesive restorations performed on non-vital teeth compared to vital teeth.

MATERIALS AND METHODS

This systematic review was conducted following the PRISMA guidelines. The considered clinical studies investigated the outcomes of adhesive inlays, onlays, and overlays conducted over the past 40 years, focusing on Kaplan-Meier survival curves to calculate the hazard ratio (primary objective) and the survival rate (secondary objective) between vital and non-vital teeth. The risk of bias was assessed using the Newcastle-Ottawa Scale. Studies included in the review were identified through bibliographic research on electronic databases ("PubMed," "Scopus," "Cochrane Central Register of Controlled Trial," and "Embase"). The K agreement between the two screening reviewers was evaluated.

RESULTS

A total of 55,793 records were identified on PubMed, Scopus, and other bibliographic sources, and after the application of the eligibility and inclusion criteria, eight articles were included for qualitative analysis and six for quantitative analysis. The meta-analysis of the primary and secondary outcomes demonstrated that hazard ratios (HR = 8.41, 95% CI: [4.50, 15.72]) and survival rates (OR = 3.24, 95% CI: [1.76, 5.82]) seemed more favorable for indirect partial adhesive restorations on vital teeth than for those on endodontically treated teeth.

CONCLUSIONS

Within the limits of this study, these findings suggest that the risk of failure of indirect partial adhesive restorations on endodontically treated teeth is higher than on vital teeth.

CLINICAL RELEVANCE

The use of partial adhesive restorations on vital and endodontically treated teeth showed different long-term clinical outcomes.

Is the bond strength of zirconia-reinforced lithium silicate lower than that of lithium disilicate? A systematic review and metaanalysis

PURPOSE

This study systematically reviewed the literature to compare the bond strength of resin composites with that of zirconia-reinforced lithium silicate (ZLS) and lithium disilicate (LD).

STUDY SELECTION

This review was structured based on the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA 2020) statement. This study was registered at the International Prospective Register of Systematic Reviews (CRD42021256900). Studies were searched via PubMed, Web of Science, and Google Scholar databases without language or publication year limits. In vitro studies that evaluated the bond strength of the resin composites to ZLS and LD were included. The risk of bias in all the included articles was evaluated. Statistical analyses were performed using the Review Manager software (version 5.3, Cochrane Collaboration, Oxford, UK).

RESULTS

Of the 90 potentially related articles, the full texts of 16 articles were evaluated after screening. Finally, sevenstudies were included in the qualitative synthesis and meta-analysis. All the studies presented a medium risk of bias. The results showed no significant difference in bond strength between the ZLS and LD groups (P = 0.94, mean difference=0.08, and 95% confidence interval=-1.93 to 2.10). However, a significant difference was found in the subgroup analysis considering different types of aging treatments (P = 0.0008) and different types of bond strength tests (P < 0.00001).

CONCLUSION

The bond strength of resin composites was found to be similar to that of ZLS and LD, but different aging treatments and bond strength tests exhibited varying effects on the bond strength.

Impact of Immediate Dentin Sealing Using Universal Adhesive under Simulated Pulp Pressure on Microtensile Bond Strength of Indirect Resin Composite Restorations and Dentin Permeability

Objective  The aim of this study was to investigate the effect of immediate dentin sealing (IDS) technique using universal adhesive under simulated pulp pressure on microtensile bond strength (μTBS) of indirect resin composite restorations and dentin permeability.

Materials and Methods  Fifty extracted caries-free human third molars were used for specimens' preparation. Each molar's occlusal table was abraded flat and their roots were separated under continuous water cooling. Forty specimens were used for microtensile bond strength test (μTBST) evaluation. The μTBST specimens were randomly assigned to two groups according to the dentin sealing time; Immediate dentin sealing (IDS) and delayed dentin sealing (DDS). Each group was further subdivided into two subgroups according to the adhesive system used for dentin sealing: iBOND self-etch adhesive and GLUMA Bond Universal. All specimens were exposed to simulated pulp pressure for 1 week then restored using computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite blocks. The μTBS was evaluated for all tested subgroups after 24 hours and 6 months of water storage. The remaining 10 teeth were used for the preparation of dentin discs for dentin permeability evaluation. They were divided into two groups according to type of self-etch adhesive used. Fluid filtration rate was evaluated after etching, with smear layer and after adhesive application. Results obtained were statistically analyzed using Shapiro–Wilk test and Weibull analysis.

Results  Statistically significant difference was recorded between µTBS mean values of both IDS and DDS techniques at 24 hours and after 6 months of water storage. GLUMA Bond Universal adhesive had significantly higher bond strength compared with iBond at both IDS and DDS techniques, but both adhesives showed a significant reduction in the Weibull characteristic strength after 6 months of water storage. Significant reduction in dentin permeability was recorded by both adhesives without any significant difference between them.

Conclusions  The IDS technique using universal adhesive in self-etch mode is an effective strategy for improving the final bond strength of CAD/CAM resin composite restorations and reducing dentin permeability.

Effect of alumina particle morphology used for air abrasion on loss of enamel and luting composite resin

OBJECTIVE

To evaluate the volume loss after air abrasion with alumina particles with different morphology on bovine enamel and luting composite resin.

METHODS

Air abrasion was performed on 12 unscathed bovine teeth and 72 luting composite resin discs with 85 μm round-shaped and 50 μm sharp-edged alumina particles applied for 20 s, 40 s and 60 s (n = 12). Air abrasion was standardized by uniform areas of 2 mm diameter, a pressure of 0.25 MPa and a distance of 3 mm. The volume loss was determined by using a laboratory scanner.

RESULTS

Air abrasion with round-shaped alumina particles was mostly not measurable with the laboratory scanner, while sharp-edged alumina air abrasion resulted in significant loss of enamel. The median of volume loss by sharp-edged alumina particles ranged from 0.78 mm³ (20 s) to 2.52 mm³ (60 s). In contrast to round-shaped alumina the removal caused by sharp-edged alumina increased significantly with increasing application times (p ≤ 0.05). For air abrasion on luting composite resin the median of the removed volume ranged from 2.25 mm³ (20 s) to 6.18 mm³ (60 s), while round-shaped alumina showed a range from 0.45 mm³ (20 s) to 1.40mm³ (60 s). The round-shaped alumina produced a statistically significant lower volume loss than sharp-edged alumina for all three air abrasion times.

SIGNIFICANCE

The 85 μm round-shaped alumina particles removed less composite resin than 50 μm sharp-edged alumina particles but barely any enamel, making it an option for removing composite resin residues from enamel.

Effect of Stress Generated by Occlusal Cyclic Force on Class I Bulk-Fill Composite Restoration Microleakage

Objective  This study aimed to evaluate the effects of different types and restorative techniques of Class I composite restorations with a single loading force on stress distribution and cyclic loading force on microleakage formation.

Materials and Methods  Class I cavities were prepared in premolars with 4 mm depth and divided into six groups of different restorations with: (1) Filtek Z250; (2) a 3-mm-thick layer of Filtek Bulk Fill Flowable Restoration and covered with Z250; (3) a 1.5-mm-thick layer of flowable composite and covered with Z250; (4) lining all cavity with flowable composite and restored with Z250; (5) Filtek Bulk Fill Posterior Restoration; and (6) lining all cavity with flowable composite and restored with bulk-fill composite. The specimens with and without cyclic occlusal loading were subjected to microleakage observation. In addition, six different models of Class I restorations corresponding to the microleakage study were generated. Finite element analysis (FEA) was used to identify the stress distribution under a single loading force.

Statistical Analysis Data were statistically analyzed by two-way analysis of variance and multiple comparison. The significance level set at 0.05.

Results  Cavity lining or restoration with flowable composite underneath conventional composite reduced stress on composite resin based on FEA (groups 2 and 3). The cyclic stress on composite increased microleakage. Restoration with flowable composite underneath conventional composite reduced the microleakage in Class I restoration (groups 2, 3, and 4).

Conclusion  The most effective cavity lining with a flowable composite underneath conventional composite restoration was stress reduction under loading force resulting in microleakage reduction.

Randomized clinical split-mouth study on the performance of CAD/CAM-partial ceramic crowns luted with a self-adhesive resin cement or a universal adhesive and a conventional resin cement after 39 months

Objectives To determine the clinical performance of partial ceramic crowns (PCCs) luted with a conventional resin cement combined with a universal adhesive without or with selective enamel etching or luted with a self-adhesive resin cement. Methods In a split-mouth design, each three CAD/CAM-PCCs (Vita Mark II, Cerec) were placed in 50 patients. Two PCCs were luted with a conventional resin cement (RelyX Ultimate) combined with a universal adhesive (Scotchbond Universal) without (SB-E) or with (SB+E) selective enamel etching. The third PCC was luted with a self-adhesive resin cement (RelyX Unicem 2; RXU). Chi-square tests (α≤0.05) were applied. Based on clinical failures (complete debonding or need for replacement of the restorations), Kaplan-Meier survival analysis was performed. Results 31 patients were evaluated clinically using FDI criteria at 39 months. Clinically acceptable results were detected over time, except for "fracture of material and retention" (inacceptable fractures and debondings). Within materials, statistically significant differences (p ≤ 0.003) between baseline and 39 months were found for "marginal adaptation" and "marginal staining". At 39-month, SB+E and SB-E showed significantly better results compared to RXU in "marginal adaptation"(p ≤ 0.021) and "marginal staining"(p ≤ 0.013). Kaplan-Meier analysis showed higher survival rates after 39 months for SB+E (96%) and SB-E (88%) compared to RXU (69%) with statistically significant differences between RXU vs. SB-E (p = 0.022) and RXU vs. SB+E (p ≤ 0.001). Conclusions After 39-months, PCCs luted with the self-adhesive resin cement exhibited a statistically significant inferior survival rate compared to restorations luted with the conventional resin cement combined with a universal adhesive without or with selective enamel etching. Clinical significance Currently, self-adhesive resin cements cannot be recommended for luting partial ceramic crowns. However, the standard adhesive luting procedure comprising a universal adhesive and luting composite yielded good clinical results for more than 3 years irrespectively of application of a selective enamel etching step.

Effect of Time and Temperature of Air Jet on the Mechanical and Biological Behavior of a Universal Adhesive System

OBJECTIVES

To evaluate the influence of heat application on the degree of conversion (DC) of the 3M Single Bond Universal Adhesive System, as well as its transdentinal cytotoxicity and microtensile bond strength to dentin.

METHODS

Experimental groups were established according to the time and temperature of the air jet: G1: 5 seconds-25°C; G2: 10 seconds-25°C; G3: 20 seconds-25°C; G4: 5 seconds-50°C; G5: 10 seconds-50°C; G6: 20 seconds-50°C. In control group (G7), no treatment was performed. The DC was assessed using the Fourier transform infrared spectroscopy-attenuated total reflectance (FTIR-ATR) technique. For the transdentinal cytotoxicity test, dentin discs fitted in artificial pulp chambers (APC) received the application of the adhesive system and the air jets. For the microtensile bond strength, healthy molars were restored and submitted to the microtensile test after 24 hours and 6 months, respectively.

RESULTS

Significant reduction in viability of Mouse Dental Papilla Cell-23 (MDPC-23), which exhibited morphological changes, was observed in all experimental groups compared to control (p<0.05). Although all tested protocols resulted in transdentinal diffusion of 2-hydroxyethyl methacrylate (HEMA), the group G6 presented the highest degree of monomeric conversion and the lowest cytotoxic effect, with higher dentin bond strength values in comparison to group G1 (p<0.05).

CONCLUSIONS

Applying an air blast at 50°C for 20 seconds increases the DC and microtensile bond strength of the 3M Single Bond Universal Adhesive System to dentin, as well as reduces the transdentinal cytotoxicity of the material to pulp cells.

Anti-Demineralization Effects of Dental Adhesive-Composites on Enamel-Root Dentin Junction

Oral biofilm reactor (OBR) and pH cycling (pHC) artificial caries model were employed to evaluate the anti-demineralization effects of four composite filling systems on enamel-root dentin junction. Sixty-four enamel-root dentin blocks (6 mm × 6 mm × 2 mm) each with a cylindrical cavity were randomly assigned to the pHC and OBR group, then four subgroups (n = 8) and filled with either the Beautifil II (BEF, SPRG-filler-containing) or Estelite (EST) composite after the adhesive (either Single Bond Universal (SBU) or FL Bond II (FL, SPRG-filler-containing)). The demineralization lesions of filling interface were examined by micro-computerized tomography (μCT) and swept-source-optical coherence tomography (SS-OCT). According to the degree of interface damage, the caries lesions were sorted into four types: Type A and B (no attachment loss); Type C and D (attachment loss). EST/SBU showed the worst demineralization lesion and attachment loss (100% Type D), while BEF/FL exhibited the shallowest lesion depth (p < 0.05, 145 ± 45 μm on enamel, 275 ± 35 μm on root dentin) and no attachment loss (75% Type A and 25% Type B). Using FL adhesive alone does not effectively reduce enamel demineralization. BEF plays a leading role in acid resistance. The combination of BEF and FL showed a cumulative synergistic effect on anti-demineralization.

An in-vitro study investigating the effect of air-abrasion bioactive glasses on dental adhesion, cytotoxicity and odontogenic gene expression

OBJECTIVE

To assess the microtensile bond strength (MTBS) and interfacial characteristics of universal adhesives applied on dentine air-abraded using different powders. The analysis includes the cytotoxicity of the powders and their effect on odontogenic gene expression.

METHODS

Sound human dentine specimens were air-abraded using bioglass 45S5 (BAG), polycarboxylated zinc-doped bioglass (SEL), alumina (AL) and submitted to SEM analysis. Resin composite was bonded to air-abraded or smear layer-covered dentine (SML) using an experimental (EXP) or a commercial adhesive (ABU) in etch&rinse (ER) or self-etch (SE) modes. Specimens were stored in artificial saliva (AS) and subjected to MTBS testing after 24 h and 10 months. Interfacial nanoleakage assessment was accomplished using confocal microscopy. The cytotoxicity of the powders was assessed, also the total RNA was extracted and the expression of odontogenic genes was evaluated through RT-PCR.

RESULTS

After prolonged AS storage, specimens in the control (SML) and AL groups showed a significant drop in MTBS (p > 0.05), with degradation evident within the bonding interface. Specimens in BAG or SEL air-abraded dentine groups showed no significant difference, with resin-dentine interfaces devoid of important degradation. The metabolic activity of pulp stem cells was not affected by the tested powders. SEL and BAG had no effect on the expression of odontoblast differentiation markers. However, AL particles interfered with the expression of the odontogenic markers.

SIGNIFICANCE

The use of bioactive glass air-abrasion may prevent severe degradation at the resin-dentine interface. Unlike alumina, bioactive glasses do not interfere with the normal metabolic activity of pulp stem cells and their differentiation to odontoblasts.

Marginal quality of a full-body bulk-fill composite placed with an universal adhesive system in etch-and-rinse and self-etch mode: An in vitrostudy

Background

Marginal seal of a nanohybrid bulk-fill composite compared to a nanohybrid conventional composite, using a universal adhesive (UA) applied in etch-and-rinse (ER) and self-etch (SE) mode was investigated.

Material and Methods

Thirty-six intact molars were selected and two standardized cavities in each tooth were prepared and allocated into four groups according to restorative material and etching strategy. All samples were placed in a 1% methylene blue solution for 24 h, then cut in the middle of the restorations obtaining two parts (n=144) and used for microscopic evaluation (50x) for dye penetration measurements.

Results

The data were analysed by ANOVA and Tukey post-hoc test (p<0.05). Marginal seal was influenced by adhesive strategy (p<0.05) but not from the composite used (p>0.05).

Conclusions

Simplified restorations with nanohybrid bulk-fill composite showed comparable marginal leakage to incrementally placed nanohybrid composite. The UA used with a ER technique resulted in better marginal seal irrespective of the restorative material used.

Key words:Bulk-fill composite, universal adhesive, self-etching, etch-and-rinse, marginal seal.

FISSURE SEALANT IN A NUTSHELL. EVIDENCE-BASED META-EVALUATION OF SEALANTS' EFFECTIVENESS IN CARIES PREVENTION AND ARREST

OBJECTIVE

This meta-evaluation aimed to summarize all available evidence regarding different fissure sealants on occlusal caries prevention, arrest, retention rate, adverse effect, and cost-effectiveness; when compared with no intervention, other preventive or minimally-invasive procedures.

MATERIALS AND METHODS

The systematic reviews and meta-analyses were identified via four electronic databases and manual searching. Two independent reviewers performed study selection, data extraction, quality assessment with AMSTAR-2.

RESULTS

Among the 366 records yielded, 38 systematic reviews were identified as eligible 24 of them included meta-analyses. Moderate evidence has supported the efficacies of resin-based sealants (RBS) in occlusal caries prevention, arrest and cost-effectiveness compared to no interventions. Low to very low certainty of evidence suggested similar effectiveness of glass-ionomer cements in caries prevention with RBS and more superior performance of resin infiltration in arresting non-cavitated occlusal lesions.

CONCLUSION

This meta-evaluation supports the use of RBS on permanent molars to reduce occlusal caries occurrence, arrest lesion progression and alleviate oral health inequalities between individuals of different socioeconomic status. This meta-evaluation also advocates further research on glass-ionomer cements and resin infiltration with respect to their efficacies in caries prevention and arrest.

Comparison of bond strength of universal adhesives using different etching modes: A systematic review and meta-analysis

This review aims to evaluate whether the etch-and-rinse or self-etch mode is the better protocol for dentin adhesion by universal adhesives. A total of 15 articles were included in the meta-analysis. Two reviewers performed a literature search up to October 2020in four databases: PubMed, Web of Science, Embase, and the Cochrane Library. Without considering the difference in aging mode, the analysis of the immediate and long-term bond strength of dentin showed that there was no statistical significance between the etch-and-rinse and self-etch mode of universal adhesive, and the long-term bond strength decreased relative to the immediate. In vitro studies suggest that prior acid etching did not improve bond performance. Whether from the perspective of long-term bonding performance or simplifying operating procedures, the self-etch mode is preferred.

Phenolic extract of Libidibia ferrea inhibits dentin endogenous enzymatic activity depending on the adhesive system strategy

This study evaluated the influence of Libidibia ferrea (Lf) extract used as dentin pretreatment on the resin-dentin bond strength stability and dentin endogenous enzymatic activity. The phytochemical profile (PP) of the Lf extract was evaluated by liquid chromatography; particle size, polydispersity index (PdI), and zeta potential (ZP) were evaluated by dynamic light scattering. The tested groups were ER-Scotchbond Universal (SBU) in the etch-and-rinse (ER) mode; ERLf-SBU in the ER mode + Lf after etching; SE- SBU in the self-etch (SE) mode; and LfSE-Lf before SBU in the SE mode. Sticks were obtained for microtensile bond strength tests and failure mode (24 hr and 12 months). The hybrid layer was evaluated using scanning electron microscopy. The endogenous enzymatic activity of the underlying dentin was analyzed by in situ zymography with the same treatments. The PP showed the presence of quercetin (2.6% w/w). Lf particles were considered large after the analysis of the PdI. The ZP remained stable over time. The ER and ERLf groups had lower bond strength after 12 months, but SE and LfSE remained stable. The predominant failure mode was adhesive for both times. ER and ERLf had longer resin tags and a thicker hybrid layer. The ER and LfSE groups showed higher enzymatic activity than the ERLf and SE groups after 12 months. The Lf extract may contribute to inhibit the dentin endogenous enzymatic activity when associated with an adhesive system in the ER mode.

The Toxicity of Universal Dental Adhesives: An In Vitro Study

There is no consensus in the literature regarding the potential toxicity of universal dental adhesives (UDA). Being used in close proximity to the pulp, their biocompatibility should be an important factor in dental research. The aim of the present study was to evaluate the biocompatibility of UDA in an in vitro model. The study was performed using a monocyte/macrophage peripheral blood SC cell line (ATCC CRL-9855) on four specific UDA, namely: All-Bond Universal (Bisco); CLEARFIL Universal Bond Quick (Kuraray); G-Premio BOND (GC); Single Bond Universal (3M ESPE). The cytotoxicity of the investigated UDA was measured using the XTT colorimetric assay. The genotoxicity of the analyzed compounds was evaluated using an alkaline version of the comet assay. Furthermore, flow cytometry (FC) apoptosis detection was performed using the FITC Annexin V Apoptosis Detection Kit I. FC cell-cycle arrest assessment was performed using propidium iodide staining. The study observed significant differences in the toxicity of the UDA that were tested, as G-Premio BOND showed significant in vitro toxicity in all of the tests performed, while All-Bond Universal, CLEARFIL Universal Bond Quick and Single Bond Universal did not present any significant toxic effects toward SC cell line. The in vitro toxicity of UDA should be taken into consideration prior to in vivo and clinical studies. The flow cytometry could improve the accuracy of dental materials research and should be incorporated into the standardization criteria.

Cryoprotectant agents for ovarian tissue vitrification: Systematic review

Studies on the cryopreservation of ovarian tissue usually compare slow freezing versus vitrification and aim to optimize protocols, evaluate combinations or concentrations of cryoprotectant agents (CPAs), exposure time, and the addition of synthetic polymers. This systematic review aimed to identify the different CPAs used for the vitrification of human or primate ovarian tissue and to compare their results in terms of follicular survival and functional preservation. We searched Pubmed and EMBASE for randomized clinical trials or cohort studies comparing CPAs for human and/or primate ovarian vitrification. The highest rate of morphologically normal follicles after cryopreservation was 98% and was obtained with a combination of 27% ethylene glycol (EG) plus 27% glycerol, in addition to non-permeable synthetic polymers. The use of dimethyl sulfoxide (DMSO) in relatively low concentrations combined with EG and other CPAs yielded more than 90% of intact follicles after vitrification. The methods and outcomes varied largely among studies, making it difficult to combine their results. While there is no definite answer to what is the best combination of CPAs for vitrification of human ovarian tissue, the data reviewed here suggest that current vitrification techniques are able to preserve the integrity of most follicles.

Effects of non-thermal atmospheric plasma on dentin wetting and adhesive bonding efficiency: Systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis evaluated the effects of non-thermal atmospheric plasma (NTAP) treatment on dentin wetting and adhesive-dentin bond strength.

DATA/SOURCES

This report followed the PRISMA 2020 statement. Two reviewers conducted literature search of MEDLINE, Web of Science and Scopus databases up to the end of November 2020. Included in vitro studies compared the effect of NTAP on treated dentin of non-carious, intact, extracted human third molar teeth with different control groups. Studies with no adequate methods, missing data, lack of control group, or those using animal teeth were excluded. The random effects model was used to summarize the treatment effect with standardized mean difference (SMD) and 95% CI. Risk of bias was assessed using the custom Cochrane Collaboration's tool.

STUDY SELECTION/RESULTS

Seventeen studies met inclusion criteria. The effects on dentin wetting were reported in favor of NTAP (SMD -5.38; 95% CI [-6.97, -3.78]; p<0.00001; I2=81%). Regarding adhesive-dentin bond strength, statistically significant differences between the NTAP and control group were in favor of NTAP in the short-term (SMD 1.92; 95%CI [1.35, 2.50]; p<0.00001; I2=97%), and long-term (SMD 3.28; 95%CI [2.46, 4.09]; p<0.00001; I2=97%). A limitation of meta-analysis is moderate heterogeneity caused by methodological differences and lack of data, which was evaluated through risk of bias and sensitivity analysis.

CONCLUSIONS

NTAP substantially improves dentin wetting and adhesive-dentin bond strength with 30 seconds exposure time and up to 10 mm tip-to-surface distances being sufficient for positive NTAP effects on bonding efficiency.

FUNDING

ON172207 and III41008 from the Ministry of Education, Science and Technological Development, Republic of Serbia. NP is funded by MESTD grant number 451-03-68/2020-14/200024.

CLINICAL SIGNIFICANCE

This systematic review and meta-analysis substantiate potential applicability of NTAP treatment of dentin in improving adhesive bonding clinically. Further research should be based on the optimized parameters such as time and distance with additional refinement of NTAP power.

Universal adhesive: the effect of different simulated pulpal pressure fluids and bonding modes to dentin

The aim of this study was to evaluate the effect of SPP with either fetal bovine serum (FBS) or deionized water (DW) on the bond strength (μTBS) of a Universal adhesive to dentin, in both etch-and-rinse (ER) and self-etch (SE) modes. The kinematic viscosity (cSt) of FBS and DW was measured at 25 °C ± 0.1 ºC. Seventy-two sound human molars were sectioned and randomly divided into three groups according to the SPP conditions: (1) Control (0 cm H₂O), (2) SPP (15 cm H₂O) with FBS, (3) SPP (15 cm H₂O) with DW. Each group was subdivided (n = 10) based on the bonding modes: ER (37% phosphoric acid + ScothBond Universal Adhesive) or SE (ScothBond Universal Adhesive). Samples were then submitted to μTBS. Data were analyzed by Student's t test, two-way ANOVA and Tukey tests (p < 0.05). The cSt results showed that DW (23.59 ± 0.39) had significantly higher values than FBS (22.33 ± 0.06). With regard to SPP, the control group (36.1 MPa) had significantly higher values of μTBS when compared to the SPP using FBS (31.06 MPa) and SPP with DW (26.55 MPa). According to ANOVA, the bonding modes and the interaction of simulated pulpal pressure (SPP) did not statistically influence the results (p < 0.05). The presence of SPP reduced the bond strength of Universal adhesive to dentin. DW during SPP had significantly reduced bonding values when compared to FBS. Bonding strategies were not affected by SPP when evaluated in a short period of time (24 h).

Update on Enamel Bonding Strategies

Optimal strategies for the application of an adhesive differ between enamel and dentin because of the differences in their composition. The development of adhesive systems has mainly focused on the bonding of dentin, rather than on the enamel, by etching with phosphoric acid (PA). Dental adhesive technologies continue to rapidly advance, and various adhesive systems have been developed since the study of Buonocore in 1955. He introduced the enamel acid-etch technique. Then, the etch-and-rinse (ER) system was developed, and subsequently, the self-etch (SE) system. Universal adhesives are a new generation of one-bottle SE adhesives that can be applied with either ER mode or SE mode, or a combined system involving selective enamel etching mode. Since the combination of PA etching and the SE system differs from conventional ER systems, the enamel bonding strategy should be carefully considered. This concise review of the literature on reliable enamel bonding strategies should prove helpful to clinicians to choose an appropriate adhesive system to achieve optimal clinical outcomes.

One-year results of a novel self-adhesive bulk-fill restorative and a conventional bulk-fill composite in class II cavities-a randomized clinical split-mouth study

Objectives

In the context of the phase-down of amalgam, development of easily applicable, permanent restorative materials is of high clinical interest. Aim of this study was to evaluate the clinical performance of a novel, tooth-colored, self-adhesive bulk-fill restorative (SABF, 3M Oral Care) and a conventional bulk-fill composite (Filtek One, 3M Oral Care; FOBF) for restoring class II cavities. The null-hypothesis tested was that both materials perform similar regarding clinical performance.

Materials and methods

In this randomized split-mouth study, 30 patients received one SABF and one FOBF restoration each. Scotchbond Universal (3M Oral Care) was used as adhesive for FOBF (self-etch mode), while SABF was applied directly without adhesive. Restorations were evaluated by two blinded examiners at baseline, 6 months and 12 months employing FDI criteria. Non-parametric statistical analyses and χ²-tests (α = 0.05) were applied.

Results

Thirty patients (60 restorations) were available for the 6- and 12-month recalls exhibiting 100% restoration survival. All restorations revealed clinically acceptable FDI scores at all time points and for all criteria. Only regarding esthetic properties, FOBF performed significantly better than SABF regarding surface lustre (A1) and color match and translucency (A3) at all time points and marginal staining (A2b) at 12 months.

Conclusions

The null-hypothesis could not be rejected. Both materials performed similarly regarding clinical performance within the first year of clinical service. SABF exhibited slightly inferior, but clinically fully acceptable esthetic properties as compared to FOBF.

Clinical relevance

Within the limitations of this study, the self-adhesive bulk-fill restorative showed promising results and may be recommended for clinical use.

Influence of Low-Level Laser Modification and Adhesive Application Mode on the Bonding Efficiency of Universal Adhesives to Er:YAG Laser-Ablated Dentin

Introduction: Erbium laser ablation as a method of tooth preparation and conditioning has shown promising results. Although previous studies have adopted various combinations of different laser parameters and several dentin adhesive systems, very few have investigated combining high-level and low-level ER:YAG lasers with Universal adhesives. This study aimed to assess the impact of using low-energy irradiation on the surface micro-topography and shear bond strength (SBS) of universal adhesive (UA) to the erbium:yttrium-aluminum-garnet (Er:YAG) laser-ablated dentin substrate, bonded in etch-and-rinse or self-etch adhesive mode. Methods: Eighty-seven extracted molars were sectioned to expose flat occlusal dentin surface; 60 teeth were divided equally into three groups according to the surface treatment; bur-cutting (B), Er:YAG high-energy laser cutting (L₁ - 200 mJ, 20 Hz, 50 μs pulse), or L₁ followed by low-energy laser modification (L₁ /L₂ - 80 mJ, 10 Hz, 50 μs pulse). Then each group was equally divided into two groups (n=10) according to the mode of application of the universal adhesive; either etch-and-rinse (ER) or self-etching (SE). The samples were subjected to thermocycling (5000 cycle between 5°C and 55°C), and SBS was tested. Two-way ANOVA and Tukey post hoc test were used to analyze the results. The remaining 27 samples were used to investigate the effect of the treatment on the topography of the treated dentin surfaces using a scanning electron microscope (SEM). Results: B/SE recorded the highest SBS (25.48 ± 2.6 MPa) followed by B/ER (23.20 ± 6.8 MPa) and L₁ /L₂ /SE (22.94 ± 4.1 MPa) and with no statistically significant difference between these groups (P >0.05). The lowest SBS results (P <0.05) were recorded for L₁/SE (12.22 ± 3 MPa). No statistical differences were found between the SBS of L₁ /L₂ /ER and L₁ /ER groups or between the SBS of L₁ /L₂ / ER and L₁ /L₂ /SE groups. Conclusion: A subsequent treatment of the Er:YAG laser-ablated dentin with low-energy laser modification mode (LMM) enhances the SBS of the tested UA when applied in SE mode.

Chemical interaction between 10-methacryloyloxydecyl dihydrogen phosphate and methacryloxypropyltrimethoxysilane in one-bottle dental primer and its effect on dentine bonding

In the present study, we investigated the chemical interaction between 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and methacryloxypropyltrimethoxysilane (gamma-MPS) in one-bottle primer solutions and its effect on dentine bonding performance. Solutions containing 10 wt% 10-MDP and/or gamma-MPS at 0, 1, 5, 10, or 15 wt% were prepared, providing 10 experimental groups (labeled MDP/MPSxx or MPSxx, where MDP indicates the presence of 10 wt% MDP and xx is the wt% of gamma-MPS in the solution). Phosphoric-acid-etched dentine blocks were prepared from human molars and conditioned in the solutions before being used to build resin-dentine-bonded specimens, which were subsequently subjected to microtensile bond strength (μTBS) testing after 24-h or six-months water storage. Interfacial nanoleakage was evaluated by SEM observation. All the primer-conditioned samples showed significantly higher initial μTBS values than that of the control group, and six-months water storage significantly lowered the μTBS for all the groups; however, the decreases for MDP/MPS10 and MDP/MPS15 were significantly greater than those for MDP/MPS1 and the control solution. Furthermore, MDP/MPS10 and MDP/MPS15 groups also showed more serious nanoleakage. Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, and X-ray diffraction analyses were used to investigate the chemical affinity between 10-MDP and hydroxyapatite (HAp). In XRD analysis, the intensities of peaks assigned to 10-MDP-calcium salts were lower for the solutions containing gamma-MPS. Overall, the results indicate that the copresence of gamma-MPS (above 10 wt%) and 10-MDP in one-bottle primer solutions inhibit the formation of 10-MDP-calcium salts, leading to increased long-term nanoleakage and decreased bonding durability.

The influence of the operator's experience on the microleakage of two universal adhesives

Objectives

This study aimed to investigate the influence of the operator's experience on the microleakage of two universal adhesives applied in self‐etch (SE) and etch‐and‐rinse (E&R) modes.

Materials and methods

Two class V cavities were prepared on the buccal and lingual surfaces of 112 caries‐free extracted human molars and were divided into eight groups based on the combination of the factors “adhesive system” (Tetric N‐Bond Universal Adhesive [TNU]; Scotchbond Universal Adhesive [SBU]), “adhesive strategy” (SE or E&R), and “the operators performing the procedures” (specialists in operative dentistry or intern students). After 24 h of water storage and thermocycling, the marginal microleakage was evaluated using the dye penetration technique and the data were analyzed.

Results

In the SE mode, microleakage at the enamel margin for both adhesives was higher in the student group than in the specialist group (p values < 0.05). The operator's skill did not affect the microleakage scores of both adhesives applied in the E&R mode at the dentin and enamel margins or in the SE mode at the dentin margins (p > 0.05). The microleakage score was significantly higher at the dentin margins than the enamel margins for both universal adhesives applied in the E&R mode (p values <0.05).

Conclusion

The microleakage values of the universal adhesives applied in the SE mode at the enamel margins were affected by the operator's skill. However, the operator's experience did not affect the microleakage scores of the two universal adhesives applied in the E&R mode at the enamel and dentin margins or in the SE mode at the dentin margins.

Effects of Phosphoric Acid Pre-Etching on Chemisorption between Enamel and MDP-Containing Universal Adhesives: Chemical and Morphological Characterization, and Evaluation of Its Potential

This study aimed to provide evidence that phosphoric acid pre-etching is necessary for the chemisorption between enamel and 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing universal adhesives. Three MDP-containing universal adhesives: Single Bond Universal (SBU), All Bond Universal (ABU), and Clearfil Universal Bond Quick (CBQ), as well as an experimental MDP-containing adhesive (EX) were investigated. Clearfil SE Bond (CSE) was a control and untreated enamel (UE) was another control. Self-etch (SE) and etch-and-rinse (ER) bonding modes were employed for universal adhesives. The enamel surfaces with different treatments were observed with a scanning electron microscope (SEM). The chemical bonds in the enamel reactants were determined using Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), and nuclear magnetic resonance (NMR). The charge changes with phosphoric acid pre-etching or without were characterized by ζ-potential. FTIR confirmed the chemisorption between enamel and MDP-containing adhesives. XPS and ³¹P NMR studies detected improved chemical affinity to the phosphoric acid etching + MDP-containing universal adhesives applied with enamel. The ζ-potential of MDP-containing universal adhesives absorbed with enamel, with or without etching became more negative compared with that of UE (P < 0.05). Furthermore, single etching created a negative ζ-potential with a higher absolute value (P = 0.009). Phosphoric acid pre-etching can increase the negative charge on the enamel surface and facilitate the chemical reactions of MDP and hydroxyapatite (HAp) to produce more calcium salts, thus improving the chemisorption between enamel and MDP-containing universal adhesives.

Effect of 9.3 μm CO2 and 2.94 μm Er:YAG Laser vs. Bur Preparations on Marginal Adaptation in Enamel and Dentin of Mixed Class V Cavities Restored With Different Restorative Systems

This study aimed to compare marginal adaptation in enamel and dentin before and after aging of laser vs. bur-prepared mixed class V cavities restored by different restorative systems. Seventy two caries-free human molars were distributed to nine experimental groups; cavities were prepared using two different lasers: a handpiece -integrated 2.94 μm Er:YAG laser at 4.5 W, 300 mJ, and 0.75 W, 50 mJ with 15 Hz (LiteTouch, Light Instruments, Israel) and a novel CO2 laser at 12.95 W, 19.3 mJ, and 4.1 W, 6.11 mJ with 671 Hz (Solea 9.3 μm, Convergent Dental, USA). Cavities prepared with conventional diamond burs (Intensiv, Switzerland) in a red contra angle at high speed under maximal water cooling served as control. Cavities were prepared under simulation of dentinal fluid and restored using three different self-etching universal adhesives in combination with three nanohybrid composites, applied in two layers: Scotchbond Universal with Filtek Supreme XTE (3M, USA), G-Premio BOND with Essentia Universal (GC, Japan), and OptiBond Universal with Harmonize Universal (Kerr, USA). After restorations' polishing and simultaneous thermal (5–50°C, 2 min each) and mechanical loading (max. 49 N; 200,000 cycles), replicas of restoration margins were examined under SEM at × 200 magnification. Percentages of continuous margins (CMs) were quantified before and after the fatigue test and statistically compared (two-way ANOVA with Fisher's least significant difference [LSD] post hoc test). Significant differences were found in almost all groups between the results before and after the fatigue test, as well as between the different preparation tools and restorative materials (p &lt; 0.05). Traditional bur preparations are confirmed as gold standard in enamel and dentin, as all three tested restorative systems provide results of marginal adaptation of more than 80% CM after loading. Er:YAG laser preparations can be equally effective in combination with SBU/Filtek Supreme XTE. CO2 laser ablation could not provide convincing results with the tested self-etching restorative systems. Marginal adaptation has been highly dependent on the substrate and showed impaired adhesion, especially in enamel. Scotchbond Universal/Filtek Supreme XTE showed the highest and most stable values of CM. The other two restorative systems were highly dependent on the preparation device of the substrate.

Quality assessment tools used in systematic reviews of in vitro studies: A systematic review

BACKGROUND

Systematic reviews (SRs) and meta-analyses (MAs) are commonly conducted to evaluate and summarize medical literature. This is especially useful in assessing in vitro studies for consistency. Our study aims to systematically review all available quality assessment (QA) tools employed on in vitro SRs/MAs.

METHOD

A search on four databases, including PubMed, Scopus, Virtual Health Library and Web of Science, was conducted from 2006 to 2020. The available SRs/MAs of in vitro studies were evaluated. DARE tool was applied to assess the risk of bias of included articles. Our protocol was developed and uploaded to ResearchGate in June 2016.

RESULTS

Our findings reported an increasing trend in publication of in vitro SRs/MAs from 2007 to 2020. Among the 244 included SRs/MAs, 126 articles (51.6%) had conducted the QA procedure. Overall, 51 QA tools were identified; 26 of them (51%) were developed by the authors specifically, whereas 25 (49%) were pre-constructed tools. SRs/MAs in dentistry frequently had their own QA tool developed by the authors, while SRs/MAs in other topics applied various QA tools. Many pre-structured tools in these in vitro SRs/MAs were modified from QA tools of in vivo or clinical trials, therefore, they had various criteria.

CONCLUSION

Many different QA tools currently exist in the literature; however, none cover all critical aspects of in vitro SRs/MAs. There is a need for a comprehensive guideline to ensure the quality of SR/MA due to their precise nature.

Influence of reduced application time on bonding durability of universal adhesives to demineralized enamel

OBJECTIVES

This study aimed to assess the effect of application time on the microshear bond strength (μSBS) of three universal adhesives in demineralized and sound enamel before and after aging.

MATERIALS AND METHODS

Bovine teeth (192) were prepared where buccal surfaces were ground and divided into two groups (sound enamel and demineralized enamel). The specimens in each group were divided into 12 subgroups by combining 3 adhesive agents (All-Bond Universal, Scotchbond Universal, and Tokuyama Universal Bond) × 4 adhesion strategy. Each adhesive was applied with either prolonged (PA) or reduced (RA) application time in etch-and-rinse or self-etch mode. Bonded composites were subjected to μSBS testing after 24-h or 2-year water storage. The results were evaluated using four-way ANOVA and Tukey's post-hoc test (α = 0.05).

RESULTS

The μSBS of adhesives to sound enamel in both etching modes was mostly similar to demineralized enamel, regardless of application time and aging time. At 24-h, all adhesives with PA in self-etch mode showed higher μSBS when compared with RA, except Tokuyama Universal Bond, but after 2-year aging, no significant difference was found in μSBS between RA and PA. The μSBS of adhesives with PA in etch-and-rinse mode depended on used adhesive and enamel condition compared to RA, regardless of μSBS testing time.

CONCLUSIONS

PA of adhesives did not reveal a significant difference in μSBS to enamel, regardless of substrate type and etching mode.

CLINICAL RELEVANCE

After 2-year aging, the bond strength of universal adhesives presented no significant difference between PA and RA treatments.

Airborne-particle Abrasion and Dentin Bonding: Systematic Review and Meta-analysis

CLINICAL RELEVANCE

The literature reviewed suggests that airborne particle abrasion has no negative effects on the bond strength of resin-based materials to dentin and that a positive influence on dentin bond strength was only achieved in specific air-abrasion conditions.

SUMMARY

In this systematic review the authors investigated how airborne-particle abrasion (APA) using aluminum oxide affects the bond strength of resin-based materials to dentin. The search was performed in three databases. In vitro studies (Type of study) comparing the bond strength of resin-based materials (Outcome) to air-abraded (Intervention) compared with non-air-abraded (Comparison) human dentin (Population) were included (the PICOT elements are given parenthetically). From 5437 unique articles, 65 were read in full, 33 were included in the qualitative synthesis, and 32 were included in the meta-analysis. Methodologic quality and risk of bias were assessed. Comparisons were performed between air-abraded and control dentin groups by adopting a random-effects model (α=0.05). Additional analyses were carried out for the different parameters used in APA: type of surface treatment in the control group, particle size, air pressure, and APA duration. The bond strength to air-abraded dentin was favored only when the control surface was treated with a hand excavator. For particle size, APA was favored when the particle size was >30 μm and the controls were no treatment or hand excavator or when the particle size was ≤30 μm and the control was bur. In addition, the results favored air-abraded groups only when the pressure was > 5 bar and bur was used in the control group. No significant differences were observed for duration of APA. No comparison on bond strength considering the presence of aging conditions was possible in the included studies due to the low number of studies that aged the specimens. In conclusion, APA had no negative effects on the bond strength of resin-based materials to dentin and was able to improve the dentin bond strength only when the particle size was > 30 μm and air pressure was > 5 bar. PROSPERO registration protocol: CRD42018096128.

Influence of primer contamination on the bonding interface of enamel pre-etched with phosphoric acid

In this study, the influence of primer contamination on enamel bonding was analyzed. Adper Scotchbond Multi-Purpose (SMP), CLEARFIL SE Bond 2 (SE2), Scotchbond Universal (SBU) Adhesive, and Scotchbond Etchant (35% phosphoric acid; PA) were used. Ground bovine enamels were divided into eight groups based on the bonding protocols. The bonding interfaces after an acid-base challenge were observed via scanning electron microscopy to determine the acid-base resistant zone (ABRZ). Moreover, the bonding interfaces after the nanoleakage challenge were analyzed via energy-dispersive X-ray spectroscopy. ABRZ was observed in all the samples except PA_ONLY (applied PA etching, No primer and No adhesive resin). The funnel-shaped erosion was detected only in X_SBU (applied SBU without PA etching). The nanoleakage test revealed silver patterns in some groups. The nanoleakage, i.e., the penetration of the silver ions, was detected in the groups wherein primer was applied on PA-pre-etched enamel.

To etch or not to etch, Part I: On the fatigue strength and dentin bonding performance of universal adhesives

OBJECTIVE

To characterize whether the bonding performance and fatigue strength of resin-dentin interfaces created by a universal adhesive would be affected by different H₃PO₄-application times to more accurately assess long-term durability.

METHODS

Mid-coronal flat dentin surfaces with standardized smear-layers were produced on sound third molars, etched with 32% H₃PO₄ for 0, 3 and 15 s, bonded with a mild universal adhesive (3M-ESPE) and restored with a nanofilled composite. Bonded specimens (0.9 × 0.9 mm) were stored in deionized water for 24 h and sectioned into beams for microtensile testing (n = 10). Resin-dentin beams were tested under tension until failure (0.5 mm/min) after 24 h or 6 month storage in artificial saliva at 37 ̊C. Bar-shaped resin-dentin beams (0.9 × 0.9 × 12 mm) were tested under 4-point-flexure initially at quasi-static loads (n = 22) and then under cyclic loads (n > 50). The stress-life fatigue behavior was evaluated using the twin-bonded interface approach by the staircase method at 4 Hz. Fractured interfaces and the tension side of unfractured beams were evaluated under SEM, along with the micro-morphology of the etched dentin surfaces and hybrid layers. Data were analyzed by ANOVA and Tukey test and Wilcoxon Rank Sum Test (α = 0.05).

RESULTS

Quasi-static loads were limited to discriminate the bonding performance of resin-dentin interfaces. Application modes significantly affected etching patterns, fatigue strength, endurance limits and hybrid layer morphology (p < 0.001).

SIGNIFICANCE

Reductions in fatigue strength of self-etched bonded interfaces raise concerns about the true ability of universal adhesives to properly bond to dentin.

Universal Adhesive for Fixed Retainer Bonding: In Vitro Evaluation and Randomized Clinical Trial

This study aims to assess the efficacy of a universal adhesive (Scotchbond Universal, 3M ESPE) (SB) in total-etch mode, compared to a traditional orthodontic primer (Transbond XT Primer, 3M ESPE) (XT Primer), to perform bonding of orthodontic fixed retainers along with the Transbond XT Light Cure Adhesive Paste (3M ESPE). For the in vitro study, a round section wire (Ortosmail Krugg) was bonded using XT Primer for 20 bovine incisors (Group 1) and SB for other 20 (Group 2). Samples were debonded in a universal testing machine applying a tangential force to specimens (crosshead speed of 1 millimeter per minute). Shear bond strength (SBS) and adhesive remnant index (ARI) scores were calculated. For the in vivo study, 100 patients needing upper and lower canine-to-canine fixed retainers after orthodontic treatment were randomly assigned to two groups of 50 participants each, i.e., group 1 (retainer bonding with XT Primer) and group 2 (retainer bonding with SB). Over two years, examinations were carried out monthly, and detachments were registered by considering the teeth and arches affected. In vitro, no statistically significant differences in SBS and ARI scores were demonstrated between the two groups, both showing a mean bond strength of about 12 MPa and major frequency of ARI "2" (>50% remnant adhesive on the enamel). Conversely, a significantly lower failure rate over 2 years was assessed clinically for group 2 in both arches. Independently of the adhesive and arch, incisors reported a significantly higher failure rate than canines. Scotchbond Universal used in total-etch mode could be a valid alternative to the traditional orthodontic Transbond XT Primer.

Microtensile Bond Strength of Etch-and-Rinse Adhesives in Different Hydroabrasion Conditionings

The aim of the present study was to in vitro evaluate the effect of dentin conditioning with hydroabrasion on the microtensile bond strengths of three adhesive systems, compared to the standard etch-and-rinse technique. Sixty extracted human third molars were collected, and their midcoronal occlusal dentin was used for the microtensile bond strength test. Teeth were randomly assigned to three groups according to the adhesive system used: ExciTE F DSC, ENA Bond, and Scotchbond Universal. Specimens from each group were further divided into four subgroups: control specimens were treated with standard adhesive procedures; hydroabraded (HA) specimens were subjected to preventive hydroabrasion with three different intensity levels. After bonding procedures, composite crowns were incrementally built up. After thermocycling, specimens were subsequently sectioned into 1 × 1 mm sticks, and microtensile bond strengths were measured. Data were statistically analyzed. Failure mode analysis was performed. There were no significant differences in terms of bond strength between standard adhesion protocols and adhesion with HA preconditionings. On the other hand, the type of adhesive used had a significant effect on the tensile bond strength. Subgroups treated with hydroabrasion at higher intensity showed a slightly increased frequency of cohesive fractures. In conclusion, hydroabrasion can be used for dentin cavity preparation or finishing, since it does not seem to affect the bonding effectiveness.

Degree of conversion and dentin bond strength of light-cured multi-mode adhesives pretreated or mixed with sulfinate agents

The influence of sulfinate agents applied as a dentin pretreatment or a mixture with multi-mode one-step self-etch adhesives (1-SEAs) on the degree of conversion (DC) and micro-tensile bond strength (μTBS) of light-cured 1-SEAs was investigated. 1-SEAs Clearfil Universal Bond Quick (UBQ) or Scotchbond Universal Adhesive (SBU) were applied to dentin in etch&rinse or self-etch mode using various application strategies: 1) no pretreatment, 2) pretreatment with 90 wt% ethanol, 3) pretreatment with a sulfinate agent Clearfil DC Activator (UDC) or Scotchbond Universal DCA (SDC), or 4) a mixture of UBQ+UDC or SBU+SDC. μTBS was measured after 24 h. Additionally, DC was measured using attenuated total reflectance Fourier-transform infrared spectroscopy. Pretreatment with sulfinate agents resulted in the highest μTBS and DC, significantly improving them especially in etch&rinse mode. The mixture of sulfinate agents with 1-SEAs was less effective. Pretreatment with ethanol significantly improved μTBS in etch&rinse mode but compromised μTBS in self-etch mode.

Bond durability of universal adhesives to intact enamel surface in different etching modes

This study aimed at determining the enamel bond durability of universal adhesives to intact enamel (IE) and ground enamel (GE) in different etching modes under thermal cycling (TC) and fatigue stresses. Two universal adhesives and a two-step self-etch adhesive were used. Enamel specimens were divided into four groups by treatment: (i) GE in etch-and-rinse, (ii) IE in etch-and-rinse, (iii) GE in self-etch, and (iv) IE in self-etch. Bonded specimens were subjected to TC, and then shear bond strengths (SBS) were conducted. SBS tests were also conducted after storage in 37°C water for 24 h (baseline). For shear fatigue strength (SFS) testing, bonded specimens were subjected to fatigue stress at a frequency of 10 Hz for 50,000 cycles. At baseline, all adhesives showed significantly higher SBS values with GE than IE in self-etch mode in contrast to in etch-and-rinse mode. After TC, the universal adhesives with IE showed lower SBS values than the baseline, regardless of the etching mode. Universal adhesives showed significantly lower SFS values with IE in etch-and-rinse, but not in self-etch mode. Phosphoric acid pre-etching or grinding of the aprismatic enamel may be helpful in establishing reliable initial and long-term bonds to enamel when using universal adhesives in self-etch mode.

Effect of Cavity Disinfection with Chlorhexidine on Marginal Gap of Class V Composite Restorations Bonded with a Universal Adhesive Using Self-Etch and Etch-and-Rinse Bonding Strategy

Objectives:

This in-vitro study aimed to evaluate the effect of cavity disinfection with chlorhexidine (CHX) on marginal gaps of Class V composite resin restorations bonded with a universal adhesive using self-etch and etch-and-rinse bonding strategy.

Materials and Methods:

Sixty sound human premolars were randomly assigned to two groups (n=30): group 1 (CHX) and group 2 (no CHX). Each group was divided into two subgroups (n=15) according to the bonding strategy of the universal adhesive (self-etch or etch-and-rinse). Class V cavities were prepared on the buccal surfaces of the teeth. The occlusal and gingival margins of the cavities were placed in enamel and dentin, respectively. In the first and second subgroups of both groups, the All-Bond Universal adhesive was applied with self-etch and etch-and-rinse bonding strategy, respectively. After restoration and thermocycling, the samples were sectioned, and marginal gaps at the gingival margins were measured in micrometer (μm) under a stereomicroscope. Two-way analysis of variance (ANOVA) was used to compare marginal gaps between the groups and the subgroups.

Results:

The mean marginal gap size was significantly affected by cavity disinfection (P=0.001) and bonding strategy (P=0.002). However, the interaction effect of these two factors on the mean marginal gap size was not significant (P=0.79).

Conclusion:

The use of CHX resulted in larger marginal gaps at the gingival margins of Class V composite resin restorations. Irrespective of disinfection, the self-etch bonding strategy resulted in larger marginal gaps compared to the etch-and-rinse bonding strategy.

Effect of Non-Thermal Atmospheric Plasma on Micro-Tensile Bond Strength at Adhesive/Dentin Interface: A Systematic Review

Objective: The objective of this review was to evaluate the effect of non-thermal atmospheric plasma (NTAP) on adhesives resin–dentin micro-tensile bond strength (μTBS) in previously published studies. Methods: Electronic search was conducted using the Medline, Cochrane library, and Scopus databases. The included studies were laboratory studies that investigated the effect of NTAP on adhesives μTBS to coronal dentin. Studies that evaluated the effect of NTAP on bond strength to indirect substrates, enamel or root dentin, were excluded. The methodological quality of included studies was assessed. Results: Thirteen studies were included in this systematic review. All the included studies were considered to have a medium risk of bias. NTAP significantly improved μTBS at 24 h or after short-term aging in five studies (38.5%) and both immediate and after long-term aging in 5 studies (38.5%). In two studies (15.4%), NTAP resulted in a short-term material-dependent effect that was not stable after long-term aging. Interestingly, in one study (7.7%), NTAP had a positive effect only in the etch-and-rinse (ER) mode after long-term aging. Conclusion: Within the limitations of this systematic review, NTAP application could enhance resin–dentin μTBS of ER adhesives or universal adhesives (UAs) applied in the ER mode. In the ER mode, the rewetting step after NTAP seems to be unnecessary. Because of the limited information currently available in the literature, further studies are required to evaluate the effect of the NTAP application on self-etch (SE) adhesives or UAs applied in the SE mode.

On the synergistic effect of sulfonic functionalization and acidic adhesive conditioning to enhance the adhesion of PEEK to resin-matrix composites

OBJECTIVE

The objective of this study was to evaluate the combined effect of the sulfuric acid etching and an acidic adhesive conditioning on the shear bond strength of PEEK to a resin-matrix composite.

MATERIALS AND METHODS

Forty PEEK specimens were assigned randomly to 4 groups for H₂SO₄ etching followed by universal adhesive (pH at 2.5) conditioning for 0, 1, 3, and 5 min. Thirty PEEK specimens were divided into 3 groups for only acidic adhesive conditioning for 0, 1, 3, and 5 min. After the light-curing of the adhesive, a nanohybrid resin composite was applied onto the surfaces and then light-cured following the manufacturer`s guidelines. All specimens were stored in distilled water at 37 °C for 24 h mechanical testing. Shear bond strength tests were performed using a universal testing machine. Surfaces were analyzed by SEM, light interferometry, FTIR, and liquid contact angle measurement. Statistical analysis was performed by one-way ANOVA and Tukey's post hoc tests (p < 0.05).

RESULTS

No adhesion was achieved between untreated PEEK a resin-matrix composite, regardless of the adhesive conditioning time points. Shear bond strength of H₂SO₄-etched PEEK to resin-matrix composite increased with time (0 mmin. 4.95 ± 2.86 MPa < 1 min: 9.35 ± 2.26 MPa < 3 min: 17.84 ± 2.82 MPa < 5 min: 21.43 ± 5.00 MPa). SEM images revealed a significant modification of PEEK surface topography after the H₂SO₄ etching.

SIGNIFICANCE

The acidic adhesive was unable to modify the untreated PEEK surface to establish an effective adhesion although a synergistic effect was noticed when the universal (acidic) adhesive was applied over a H₂SO₄-etched PEEK surface, thus improving the PEEK to resin-matrix composite adhesion.

Solubility of bioceramic- and epoxy resin-based root canal sealers: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated whether epoxy resin-based root canal sealers present an increased solubility than calcium silicate-based root canal sealers. A systematic search was performed in the following databases: PubMed, Science Direct, Scopus, Web of Science and Open Grey. The inclusion criteria consisted of in vitro studies that compared the solubility of epoxy resin-based and calcium silicate-based sealers. The quality assessment and data extraction of the selected articles were performed. The meta-analysis of the pooled data and the subgroups according to the root thirds were carried out using the RevMan software (P < 0.05). After the duplicate removal and eligibility criteria assessment, a total of 22 studies were included all of them were considered as having a low risk of bias. The meta-analysis demonstrated overall lower solubility of AH Plus. AH Plus presented lower solubility than Bio-C Sealer, BioRoot RCS, MTA Fillapex, Sealer Plus and Total Fill BC Sealer.

Known data on the effectiveness of silver nano particles on root canal disinfection

The goal of endodontic treatment is the debridement and removal of the microbial ecosystem associated with the disease process. The need for root canal disinfectants increases especially in those cases where infection is resistant to the regular treatment and the outcome of endodontic therapy is often compromised. Therefore, it is of interest to document the known effectiveness of silver nanoparticle based root canal disinfectants with other root canal disinfectants on microbial load reduction during root canal disinfection. Known data shows that the overall risk of bias for the selected studies was moderate. Silver nanoparticle based root canal disinfectants showed superior reduction of microbial counts in majority of the studies. This data is limited to vitro studies with no clinical information to validate the use of antimicrobial properties of silver nanoparticles used as root canal disinfectant.

Influence of nanoparticulated chitosan on the biomodification of eroded dentin: clinical and photographic longitudinal analysis of restorations

To evaluate the influence of the pre-treatment with 2.5% nanoparticulate chitosan (2.5% NanoChi) solution on eroded dentin before the restorative dental treatment. The sample consisted of 22 patients (age between 33 and 52 years) with shallow or medium erosion lesions located in two homologous teeth. The teeth were randomly assigned according to dentin treatment: with 2.5% NanoChi and without with chitosan (control). The NanoChi were applied immediately after acid etching. The teeth were restored with Single Bond Universal (3 M) and Charisma resin (Kulzer). Analyzes were done using modified USPHS (retention, secondary caries, marginal adaptation, and sensitivity) and photographic (color, marginal pigmentation, and anatomical form) criteria at 7 days (baseline) and 1 year. Population demographics, Kaplan-Meier estimates and log-rank test (Mantel-Cox) were calculated for 1 year (α = 0.05). No significant difference was found in the survival rates between groups (p > 0.05) at 7 days and 1 year after treatment. After 7 days, 100% of the restorations were scored as Alpha on all criteria. After 1 year, 91% of the NanoChi restorations were scored as Alpha and 9% as Charlie for the retention, marginal adaptation, and anatomical form criteria, while 86% of the control restorations (without NanoChi) received the Alpha score and 14% received the Charlie. Secondary caries, sensitivity, color, and marginal pigmentation criteria were scored as Alpha in 100% of the restorations. The biomodification of eroded dentin with 2.5% NanoChi did not influence the survival of the restorations after 1 year. The application of 2.5% NanoChi on eroded dentin did not increase failures of resin restorations after 1 year and it can be used as a pre-treatment solution.

Impact of Access Cavity Design on Fracture Resistance of Endodontically Treated Molars: A Systematic Review

Objective

The main aim of this present systematic review is to ascertain whether a conservative endodontic cavity (ConsAC) has a better fracture resistance than a traditional access cavity (TradAC) in endodontically treated molars.

Materials and Methods

Three independent reviewers researched without limits in multiple engines: PubMed, ScienceDirect, Scopus, ResearchGate, EBSCOhost, Wiley Online Library, and Google Scholar, in addition to reference and hand search. Articles were chosen according to a certain inclusion and exclusion criteria, which, in brief, are in vitro studies assessing the fracture resistance difference between ConsAC and TradAC performed on extracted sound human molar teeth. A quality assessment criteria was produced to evaluate the chosen articles and categorized them according to their risk of bias into low, moderate and high.

Results

Out of a total of 105 studies, which were obtained from seven different search engines, only eight in vitro studies were included after eliminating the duplicates followed by the application of the eligibility criteria. Five of the articles showed low risk of bias while the others revealed a moderate risk of bias.

Conclusion

To sum up, there is insufficient evidence to give a final decision whether ConsAC is more advantageous than TradAC in terms of fracture resistance and further studies regarding this topic are needed.

Influence of etching mode and composite resin type on bond strength to dentin using universal adhesive system

Adhesive bond strength at the composite/dentin interface is influenced by various factors, including the etching mode and composite resin type. The purpose of this study was to evaluate the influence of the total-etch and self-etch mode on the microtensile bond strength (μTBS) of conventional and bulk-fill composite to dentin, using the universal adhesive system. Sixty non-carious human teeth were sectioned parallel to their longitudinal axis, using a low-speed diamond saw to obtain a flat dentin surface. According to the etching technique and composite resin type used, teeth were randomly divided into four different groups (n = 15): TC (total-etch/conventional composite), TB (total-etch/bulk-fill composite), SC (self-etch/conventional composite), and SB (self-etch/bulk-fill composite). Cylindric composite build-ups were made with 3M Filtek Z250 and 3M Filtek Bulkfill Posterior, using a plastic mold, 4 mm in diameter and 4 mm in height. The specimens were subjected to the μTBS test in a universal testing machine and failure force was recorded. Failure modes were determined using stereoscopic and scanning electron microscopy. Data were analyzed using the two-way ANOVA and Student's t test. The μTBS was significantly affected by the etching technique. A significant statistical difference was determined between total-etch and self-etch groups, irrespective of the composite resin type used. Higher bond strength was obtained in total-etch groups. The μTBS was not affected by the composite resin type. No significant statistical difference was determined between the conventional and bulk-fill groups, irrespective of the etching-mode.

Effect of Over-Etching and Prolonged Application Time of a Universal Adhesive on Dentin Bond Strength

This study investigated the effect of over-etching and prolonged application time of a universal adhesive on dentin bond strength. Ninety extracted human molars were ground to dentin and randomly allocated into nine groups (G1-9; n = 10 per group), according to the following acid etching and adhesive application times. In the control group (G1), phosphoric acid etching was performed for 15 s followed by application of the universal adhesive Scotchbond Universal (3M) for 20 s, as per manufacturer's instructions. In groups G2-5, both the etching and adhesive application times were either halved, doubled, quadrupled, or increased eightfold. In groups G6-9, etching times remained the same as in G2-5 (7.5 s, 30 s, 60 s, and 120 s, respectively), but the adhesive application time was set at 20 s as in the control group (G1). Specimens were then restored with a nanofilled composite material and subjected to microtensile bond strength testing. Bond strength data were statistically analyzed by ANOVA and Tukey's post-hoc tests (α = 0.05). The relationship of bond strength with etching and adhesive application time was examined using linear regression analysis. Treatment of dentin with halved phosphoric acid etching and adhesive application times (G2) resulted in a significant bond strength decrease compared to the control group (G1) and all other test groups, including the group with halved acid etching, but 20 s of adhesive application time (G6). No significant differences in bond strength were found for groups with multiplied etching times and an adhesive application time of 20 s or more, when compared to the control group (G1). In conclusion, a universal adhesive application time of at least 20 s is recommended when bonding to over-etched dentin.

Bonding Effectiveness of Contemporary Materials in Luting Glass-Ceramic to Dentine: An In Vitro Study

Aim:

To evaluate the shear bond strength (SBS) of resin cements, flowable composites, and a preheated composite in luting glass-ceramic to dentin.

Materials and Methods:

In total, 108 noncaries human third molar teeth embedded in acrylic blocks, grinded from the occlusal surfaces until dentin was exposed, and divided into 9 randomized groups ( n = 12). In total, 108 ceramic samples prepared in disc shape (3mm × 3mm) from IPS e. max CAD (Ivoclar Vivadent) blocks. Four adhesive resin cements: Variolink Esthetic DC (Ivoclar Vivadent), G-CEM LinkForce (GC), Panavia V5 (Kuraray Noritake), Maxcem Elite Chroma (Kerr), and three flowable composites: G-ænial Universal Flo (GC), Herculite XRV Ultra Flow (Kerr), Vertise Flow (Kerr), and one preheated composite: Enamel Plus HRI (Micerium) luted to the prepared occlusal surfaces of the teeth with total-etch, self-etch, and self-adhesive protocols. Then samples were thermocyled (5,000 cycles, 5–55°C, dwell time 20 s). SBS test was performed in a universal testing machine (at 0.5 mm/min). Failure modes were examined under a stereomicroscope at ×25 magnification. Data were analyzed using Kruskal–Wallis and Dunn–Bonferroni tests ( α = 0.05).

Results:

There were statistically significant differences among material types ( P < .05). Highest SBS values found in G-ænial Universal Flo (15.43 ± 5.67), and the lowest values obtained in Maxcem Elite Choroma (SA) (1.25 ± 1.47). There were no significant differences between self-etch (Panavia V5, Maxcem Elite Choroma [SE]) and self-adhesive (Maxcem Elite Choroma [SA], Vertise Flow) protocols ( P > .05).

Conclusion:

Flowable composites can be alternatives to resin cements when bonded with total-etch procedures. Bond strength of self-etch and self-adhesive applications is still to be developed.

Fractured alveolar process displacement evaluation-Effect of the rigidity of wire-composite splints

BACKGROUNDS/AIMS

Traumatic dental injuries with bone fractures require rigid splinting. The degree of rigidity of the wire-composite splints can be challenging. The aim of this study was to evaluate the effect of the rigidity of different wire-composite splints on alveolar process displacement.

MATERIAL AND METHODS

A model was created using polystyrene resin to simulate the anterior maxilla, bovine incisors to simulate maxillary incisors, and polyether impression material to simulate the periodontal ligament. An alveolar process fracture was created, while maintaining the labial bone connection with the PDL. Four wire-composite splints (0.3, 0.6, 0.9, and 1.2 mm in diameter) were compared with models without splints and with no fracture (n = 5). The alveolar process displacement was measured (3 times per model/per splint type) at the fractured and adjacent central incisor regions using a deflectometer (Instron) under functional cycling and static loading (100 N). Data (μm) were analyzed using RM ANOVA, followed by Tukey's HSD test (α = 0.05).

RESULTS

The displacement at the region of the adjacent incisor was not influenced by the splint during static and cycling load (P > .05). The Tukey test demonstrated that the model without splints had significantly higher alveolar process displacement at the traumatized teeth than that of all other splint models (P < .001). Increasing the wire diameter from 0.3 mm to 0.9 mm significantly reduced the alveolar process displacement (P < .001). No difference was observed between the 0.9 mm (P = .123) and 1.2 mm (P = .219) wire-composite splints irrespective of the measured tooth regions.

CONCLUSIONS

The rigidity of the wire-composite splint significantly influenced the mobility of the fractured alveolar process. The use of at least 0.9 mm wire was effective in reducing the fractured alveolar process displacement to a level that was similar to the adjacent teeth.