Adhesive/Dentin interface: the weak link in the composite restoration

Grafting MAP peptide to dental polymer inhibits MMP-8 activity

Matrix metalloproteinases (MMPs) are a class of zinc and calcium-dependent endopeptidases responsible for degrading extracellular matrix (ECM) components. Their activity is critical for both normal biological function and pathological processes (Dejonckheere et al., Cytokine Growth Factor Rev 2011;22:73-81). In dental restorations, the release and subsequent acid activation of MMPs contributes to premature failure. In particular, MMP-8 accelerates degradation by cleaving the collagen matrix within the dentin substrate in incompletely infiltrated aged bonded dentin (Buzalaf et al., Adv Dent Res 2012;24:72-76), hastening the need for replacement of restorations. Therefore, development of a dental adhesive that better resists MMP-8 activity is of significant interest. We hypothesize that modification of the polymer surface with an inhibitor would disable MMP-8 activity. Here, we identify the metal abstraction peptide (MAP) as an inhibitor of MMP-8 and demonstrate that tethering MAP to methacrylate polymers effectively inhibits catalysis. Our findings indicate complete inhibition of MMP-8 is achievable using a grafting approach. This strategy has potential to improve longevity of dental adhesives and other polymers and enable rational design of a new generation of biocompatible materials.

Non-thermal atmospheric plasmas in dental restoration: improved resin adhesive penetration

OBJECTIVE

To investigate the influence of non-thermal plasma treatment on the penetration of a model dental adhesive into the demineralized dentine.

METHODS

Prepared dentine surfaces were conditioned with Scotchbond Universal etchant for 15s and sectioned equally perpendicular to the etched surfaces. The separated halves were randomly selected for treatment with an argon plasma brush (input current 6mA, treatment time 30s) or gentle argon air blowing (treatment time 30s, as control). The plasma-treated specimens and control specimens were applied with a model adhesive containing 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]-propane (BisGMA) and 2-hydroxyethyl methacrylate (HEMA) (mass ratio of 30/70), gently air-dried for 5s, and light-cured for 20s. Cross-sectional specimens were characterized using micro-Raman spectral mapping across the dentine, adhesive/dentine interface, and adhesive layer at 1-μm spatial resolution. SEM was also employed to examine the adhesive/dentine interfacial morphology.

RESULTS

The micro-Raman result disclosed that plasma treatment significantly improved the penetration of the adhesive, evidenced by the apparently higher content of the adhesive at the adhesive/dentine interface as compared to the control. Specifically, the improvement of the adhesive penetration using plasma technique was achieved by dramatically enhancing the penetration of hydrophilic monomer (HEMA), while maintaining the penetration of hydrophobic monomer (BisGMA). Morphological observation at the adhesive/dentine interface using SEM also confirmed the improved adhesive penetration. The results further suggested that plasma treatment could benefit polymerization of the adhesive, especially in the interface region.

CONCLUSION

The significant role of the non-thermal plasma brush in improving the adhesive penetration into demineralized dentine has been demonstrated. The results obtained may offer a better prospect of using plasma in dental restoration to optimize adhesion between tooth substrate and restorative materials.

Viscoelastic properties of collagen-adhesive composites under water-saturated and dry conditions

To investigate the time- and rate-dependent mechanical properties of collagen-adhesive composites, creep and monotonic experiments are performed under dry and wet conditions. The composites are prepared by infiltration of dentin adhesive into a demineralized bovine dentin. Experimental results show that for small stress level under dry conditions, both the composite and the neat adhesive have similar behavior. On the other hand, in wet conditions, the composites are significantly soft and weak compared to the neat adhesives. The behavior in the wet condition is found to be affected by the hydrophilicity of both the adhesive and the collagen. As the adhesive-collagen composites are a part of the complex construct that forms the adhesive-dentin interface, their presence will affect the overall performance of the restoration. We find that Kelvin-Voigt model with at least four elements is required to fit the creep compliance data, indicating that the adhesive-collagen composites are complex polymers with several characteristic time scales whose mechanical behavior will be significantly affected by loading rates and frequencies. Such mechanical properties have not been investigated widely for these types of materials. The derived model provides an additional advantage that it can be exploited to extract other viscoelastic properties which are, generally, time consuming to obtain experimentally. The calibrated model is utilized to obtain stress relaxation function, frequency-dependent storage and loss modulus, and rate-dependent elastic modulus.

Evaluation of three-dimensional biofilms on antibacterial bonding agents containing novel quaternary ammonium methacrylates

Antibacterial adhesives are promising to inhibit biofilms and secondary caries. The objectives of this study were to synthesize and incorporate quaternary ammonium methacrylates into adhesives, and investigate the alkyl chain length effects on three-dimensional biofilms adherent on adhesives for the first time. Six quaternary ammonium methacrylates with chain lengths of 3, 6, 9, 12, 16 and 18 were synthesized and incorporated into Scotchbond Multi-Purpose. Streptococcus mutans bacteria were cultured on resin to form biofilms. Confocal laser scanning microscopy was used to measure biofilm thickness, live/dead volumes and live-bacteria percentage vs. distance from resin surface. Biofilm thickness was the greatest for Scotchbond control; it decreased with increasing chain length, reaching a minimum at chain length 16. Live-biofilm volume had a similar trend. Dead-biofilm volume increased with increasing chain length. The adhesive with chain length 9 had 37% live bacteria near resin surface, but close to 100% live bacteria in the biofilm top section. For chain length 16, there were nearly 0% live bacteria throughout the three-dimensional biofilm. In conclusion, strong antibacterial activity was achieved by adding quaternary ammonium into adhesive, with biofilm thickness and live-biofilm volume decreasing as chain length was increased from 3 to 16. Antibacterial adhesives typically only inhibited bacteria close to its surface; however, adhesive with chain length 16 had mostly dead bacteria in the entire three-dimensional biofilm. Antibacterial adhesive with chain length 16 is promising to inhibit biofilms at the margins and combat secondary caries.

Effect of charge density of bonding agent containing a new quaternary ammonium methacrylate on antibacterial and bonding properties

OBJECTIVE

Quaternary amine charge density is important because when the negatively charged bacteria contact the positive quaternary amine charge, the electric balance is disturbed and the bacterium could be disrupted. There has been no report on the effects of charge density on the antibacterial efficacy of dental bonding agents. The objective of this study was to synthesize a new quaternary ammonium methacrylate, and investigate the effects of charge density of bonding agent on bacteria early-attachment, biofilm colony-forming units (CFU) and dentin bond strength.

METHODS

Dimethylaminododecyl methacrylate (DMAHDM) with an alkyl chain length of 16 was synthesized and mixed into Scotchbond Multi-Purpose adhesive and primer (SBMP) at mass fractions of 0%, 2.5%, 5%, 7.5%, and 10%. A microtensile dentin bond test was performed. The density of quaternary ammonium groups was measured using a fluorescein dye method. Streptococcus mutans (S. mutans) early-attachment was examined at 4 h, and biofilm colony-forming units (CFU) were measured at 2 days.

RESULTS

All groups had similar microtensile bonding strengths (mean±sd; n=40) of about 60 MPa (p>0.1). Quaternary amine charge density of bonding agents monotonically increased with increasing DMAHDM mass fraction. Bacteria early-attachment coverage greatly decreased with increasing DMAHDM content in the resin. Biofilm CFU at 10% DMAHDM was reduced by more than 4 log, compared to SBMP control. Charge density of bonding agent was inversely proportional to bacteria early-attachment coverage and biofilm CFU.

SIGNIFICANCE

Increasing the quaternary amine charge density of dentin bonding agent resin was shown to greatly reduce S. mutans attachment and decrease biofilm CFU by four orders of magnitude, without compromising the dentin bond strength. The new DMAHDM is promising for use in bonding agents and other antibacterial restorative materials to inhibit caries.

Chemical interaction of 10-MDP (methacryloyloxi-decyl-dihydrogen-phosphate) in zinc-doped self-etch adhesives

OBJECTIVES

Zinc-doped dentine adhesives have been recently advocated to interfere with metallo-proteinases-mediated collagen degradation. Nevertheless, there is a little information about the effects of zinc ions on the chemical interaction of self-etch functional monomers to dentine. The aim of this study was to assess if the inclusion of zinc into the primers of self-etch adhesives containing MDP (10-methacryloyloxi-decyl-dihydrogen-phosphate) may interfere with their chemical interaction to calcium/dentine.

METHODS

Caries-free human molars were bonded using two commercial self-etching adhesives [Clearfil SE bond (CSE) and S3 bond (S3)] doped with zinc nitrate and submitted to microtensile bond strength (μTBS) and interface nanoleakage evaluation. Moreover, MDP was synthesised to evaluate the chemical interaction with calcium/dentine through atomic absorption spectroscopy (AAS) and SEM-EDX in the presence or absence of zinc ions.

RESULTS

AAS showed increasing formation of MDP-zinc rather than MDP-calcium salts (p=0.002) in the presence of zinc. SEM-EDX confirmed the formation of zinc-rich phosphate deposits that were probably responsible for the significant reduction in μTBS and increased interfacial nanoleakage attained with zinc-doped CSE and S3.

CONCLUSION

These outcomes demonstrated that the excessive presence of zinc ions may jeopardise the bonding performance of MDP-containing self-etch adhesives.

Swelling equilibrium of dentin adhesive polymers formed on the water-adhesive phase boundary: experiments and micromechanical model

During their application to the wet, oral environment, dentin adhesives can experience phase separation and composition change, which can compromise the quality of the hybrid layer formed at the dentin-adhesive interface. The chemical composition of polymer phases formed in the hybrid layer can be represented using a ternary water-adhesive phase diagram. In this paper, these polymer phases are characterized using a suite of mechanical tests and swelling experiments. The experimental results were evaluated using a granular micromechanics-based model incorporating poro-mechanical effects and polymer-solvent thermodynamics. The variation in the model parameters and model-predicted polymer properties was studied as a function of composition along the phase boundary. The resulting structure-property correlations provide insight into interactions occurring at the molecular level in the saturated polymer system. These correlations can be used for modeling the mechanical behavior of the hybrid layer, and are expected to aid in the design and improvement of water-compatible dentin adhesive polymers.

Degradation in the dentin-composite interface subjected to multi-species biofilm challenges

Oral biofilms can degrade the components in dental resin-based composite restorations, thus compromising marginal integrity and leading to secondary caries. This study investigates the mechanical integrity of the dentin-composite interface challenged with multi-species oral biofilms. While most studies used single-species biofilms, the present study used a more realistic, diverse biofilm model produced directly from plaques collected from donors with a history of early childhood caries. Dentin-composite disks were made using bovine incisor roots filled with Z100(TM) or Filtek(TM) LS (3M ESPE). The disks were incubated for 72 h in paired CDC biofilm reactors, using a previously published protocol. One reactor was pulsed with sucrose, and the other was not. A sterile saliva-only control group was run with sucrose pulsing. The disks were fractured under diametral compression to evaluate their interfacial bond strength. The surface deformation of the disks was mapped using digital image correlation to ascertain the fracture origin. Fracture surfaces were examined using scanning electron microscopy/energy-dispersive X-ray spectroscopy to assess demineralization and interfacial degradation. Dentin demineralization was greater under sucrose-pulsed biofilms, as the pH dropped <5.5 during pulsing, with LS and Z100 specimens suffering similar degrees of surface mineral loss. Biofilm growth with sucrose pulsing also caused preferential degradation of the composite-dentin interface, depending on the composite/adhesive system used. Specifically, Z100 specimens showed greater bond strength reduction and more frequent cohesive failure in the adhesive layer. This was attributed to the inferior dentin coverage by Z100 adhesive, which possibly led to a higher level of chemical and enzymatic degradation. The results suggested that factors other than dentin demineralization were also responsible for interfacial degradation. A clinically relevant in vitro biofilm model was therefore developed, which would effectively allow assessment of the degradation of the dentin-composite interface subjected to multi-species biofilm challenge.

Stabilization of dentin matrix after cross-linking treatments, in vitro

OBJECTIVES

To evaluate the effect of EDC on elastic modulus (E), MMPs activity, hydroxyproline (HYP) release and thermal denaturation temperature of demineralized dentin collagen.

METHODS

Dentin beams were obtained from human molars and completely demineralized in 10 wt% H3PO4 for 18 h. The initial E and MMP activity were determined with three-point bending and microcolorimetric assay, respectively. Extra demineralized beams were dehydrated and the initial dry mass (DM) was determined. All the beams were distributed into groups (n=10) and treated for 30 s or 60 s with: water, 0.5 M, 1 M or 2 M EDC or 10% glutaraldehyde (GA). After treatment, the new E and MMP activity were redetermined. The beams submitted to DM measurements were storage for 1 week in artificial saliva, after that the mass loss and HYP release were evaluated. The collagen thermal denaturation temperature (TDT) was determined by DSC analysis. Data for E, MMP activity and HYP release were submitted to Wilcoxon and Kruskal-Wallis or Mann-Whitney tests. Mass loss and TDT data were submitted to ANOVA and Tukey tests at the 5% of significance.

RESULTS

EDC was able to significantly increase collagen stiffness in 60s. 10% GA groups obtained the highest E values after both 30 and 60s. All cross-linking agents decreased MMP activity and HYP release and increased TDT temperature. Significant differences were identified among EDC groups after 30 or 60 s of cross-linking, 1M or 2M EDC showed the lowest MMP activity.

SIGNIFICANCE

Cross-linking agents are capable of preventing dentin collagen degradation. EDC treatment may be clinically useful to increase resin-dentin stability.

Multivariate analysis of attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopic data to confirm phase partitioning in methacrylate-based dentin adhesive

Water is ubiquitous in the mouths of healthy individuals and is a major interfering factor in the development of a durable seal between the tooth and composite restoration. Water leads to the formation of a variety of defects in dentin adhesives; these defects undermine the tooth-composite bond. Our group recently analyzed phase partitioning of dentin adhesives using high-performance liquid chromatography (HPLC). The concentration measurements provided by HPLC offered a more thorough representation of current adhesive performance and elucidated directions to be taken for further improvement. The sample preparation and instrument analysis using HPLC are, however, time-consuming and labor-intensive. The objective of this work was to develop a methodology for rapid, reliable, and accurate quantitative analysis of near-equilibrium phase partitioning in adhesives exposed to conditions simulating the wet oral environment. Analysis by Fourier transform infrared (FT-IR) spectroscopy in combination with multivariate statistical methods, including partial least squares (PLS) regression and principal component regression (PCR), were used for multivariate calibration to quantify the compositions in separated phases. Excellent predictions were achieved when either the hydrophobic-rich phase or the hydrophilic-rich phase mixtures were analyzed. These results indicate that FT-IR spectroscopy has excellent potential as a rapid method of detection and quantification of dentin adhesives that experience phase separation under conditions that simulate the wet oral environment.

Effects of quaternary ammonium chain length on antibacterial bonding agents

The objectives of this study were to synthesize new quaternary ammonium methacrylates (QAMs) with systematically varied alkyl chain lengths (CL) and to investigate, for the first time, the CL effects on antibacterial efficacy, cytotoxicity, and dentin bond strength of bonding agents. QAMs were synthesized with CL of 3 to 18 and incorporated into Scotchbond Multi-Purpose (SBMP) bonding agent. The cured resins were inoculated with Streptococcus mutans. Bacterial early attachment was investigated at 4 hrs. Biofilm colony-forming units (CFU) were measured after 2 days. With CL increasing from 3 to 16, the minimum inhibitory concentration and minimum bactericidal concentration were decreased by 5 orders of magnitude. Incorporating QAMs into SBMP reduced bacterial early attachment, with the least colonization at CL = 16. Biofilm CFU for CL = 16 was 4 log lower than SBMP control (p < .05). All groups had similar dentin bond strengths (p > .1). The new antibacterial materials had fibroblast/odontoblast viability similar to that of commercial controls. In conclusion, increasing the chain length of new QAMs in bonding agents greatly increased the antibacterial efficacy. A reduction in Streptococcus mutans biofilm CFU by 4 log could be achieved, without compromising bond strength and cytotoxicity. New QAM-containing bonding agents are promising for a wide range of restorations to inhibit biofilms.

Effect of changes to the manufacturer application techniques on the shear bond strength of simplified dental adhesives

PURPOSE

The aim of this work was to assess the shear bond strength (SBS) between a composite resin and dentin, promoted by two dental adhesive systems (one-step self-etching adhesive Easy Bond [3M ESPE], and two-step etch-and-rinse adhesive Scotchbond 1XT [3M ESPE]) with different application protocols (per manufacturer's instruction (control group); with one to four additional adhesive layers; or with an extra hydrophobic adhesive layer).

METHODS

Proximal enamel was removed from ninety caries-free human molars to obtain two dentin discs per tooth, which were randomly assigned to twelve experimental groups (n=15). After adhesion protocol, the composite resin (Filtek Z250 [3M ESPE]) was applied. Specimens were mounted in the Watanabe test device and shear bond test was performed in a universal testing machine with a crosshead speed of 5 mm/min. Data were analyzed with ANOVA followed by Student-Newman-Keuls tests (P<0.05).

RESULTS

The highest SBS mean value was attained with the Easy Bond three layers group (41.23±2.71 MPa) and the lowest with Scotchbond 1XT per manufacturer's instructions (27.15±2.99 MPa). Easy Bond yielded higher SBS values than Scotchbond 1XT. There were no statistically significant differences (P>0.05) between the application protocols tested, except for the three and four layers groups, that presented higher SBS results compared to manufacturer's instruction groups (P<0.05). No statistically significant differences were detected between the three and four layers groups (P≥0.05).

CONCLUSION

It is recommendable to apply three adhesive layers when using Easy Bond and Scotchbond 1XT adhesives, since it improves SBS values without consuming much time.

Dental plaque microcosm response to bonding agents containing quaternary ammonium methacrylates with different chain lengths and charge densities

OBJECTIVES

Antibacterial bonding agents are promising to combat bacteria and caries at tooth-restoration margins. The objectives of this study were to incorporate new quaternary ammonium methacrylates (QAMs) to bonding agent and determine the effects of alkyl chain length (CL) and quaternary amine charge density on dental plaque microcosm bacteria response for the first time.

METHODS

Six QAMs were synthesized with CL=3, 6, 9, 12, 16, 18. Each QAM was incorporated into Scotchbond multi-purpose (SBMP). To determine the charge density effect, dimethylaminododecyl methacrylate (DMAHDM, CL=16) was mixed into SBMP at mass fraction=0%, 2.5%, 5%, 7.5%, 10%. Charge density was measured using a fluorescein dye method. Dental plaque microcosm using saliva from ten donors was tested. Bacteria were inoculated on resins. Early-attachment was tested at 4h. Biofilm colony-forming units (CFU) were measured at 2 days.

RESULTS

Incorporating QAMs into SBMP reduced bacteria early-attachment. Microcosm biofilm CFU for CL=16 was 4 log lower than SBMP control. Charge density of bonding agent increased with DMAHDM content. Bacteria early-attachment decreased with increasing charge density. Biofilm CFU at 10% DMAHDM was reduced by 4 log. The killing effect was similarly-strong against total microorganisms, total streptococci, and mutans streptococci.

CONCLUSIONS

Increasing alkyl chain length and charge density of bonding agent was shown for the first time to decrease microcosm bacteria attachment and reduce biofilm CFU by 4 orders of magnitude. Novel antibacterial resins with tailored chain length and charge density are promising for wide applications in bonding, cements, sealants and composites to inhibit biofilms and caries.

Correlation between degree of conversion, resin-dentin bond strength and nanoleakage of simplified etch-and-rinse adhesives

OBJECTIVES

The aim of this study was to correlate the degree of conversion measured inside the hybrid layer (DC) with the microtensile resin-dentin bond strength (μTBS) and silver nitrate uptake or nanoleakage (SNU) for five simplified etch-and-rinse adhesive systems.

METHODS

Fifty-five caries free extracted molars were used in this study. Thirty teeth were used for μTBS/SNU [n=6] and 25 teeth for DC [n=5]. The dentin surfaces were bonded with the following adhesives: Adper Single Bond 2 (SB), Ambar (AB), XP Bond (XP), Tetric N-Bond (TE) and Stae (ST) followed by composite resin build-ups. For μTBS and SNU test, bonded teeth were sectioned in order to obtain stick-shaped specimens (0.8mm(2)), which were tested under tensile stress (0.5mm/min). Three bonded sticks, from each tooth, were not tested in tensile stress and they were immersed in 50% silver nitrate, photo-developed and analyzed by scanning electron microscopy. Longitudinal 1-mm thick sections were prepared for the teeth assigned for DC measurement and evaluated by micro-Raman spectroscopy.

RESULTS

ST showed lowest DC, μTBS, and higher SNU (p<0.05). All other adhesives showed similar DC, μTBS, and SNU (p>0.05), except for TE which showed an intermediate SNU level. The DC was positively correlated with μTBS and negatively correlated with SNU (p<0.05). SNU was also negatively correlated with μTBS (p<0.05).

SIGNIFICANCE

The measurement of DC inside the hybrid layer can provide some information about bonding performance of adhesive systems since this property showed a good correlation with resin-dentin bond strength and SNU values.

In vitro load-induced dentin collagen-stabilization against MMPs degradation

INTRODUCTION

Teeth are continuously subjected to stresses during mastication, swallowing and parafunctional habits, producing a significant reduction of the bonding efficacy in adhesive restorations. The purpose of this study was to evaluate the metalloproteinases (MMPs)-mediated dentin collagen degradation of hybrid layers created by using different demineralization processes, previous resin infiltration, and in vitro mechanical loading.

METHODS

Human dentin beams (0.75×0.75×5.0mm) were subjected to different treatments: (1) untreated dentin; (2) demineralization by 37% phosphoric acid (PA) or by 0.5% M ethylenediaminetetraacetic acid (EDTA); (3) demineralization by PA, followed by application of Adper(™) Single Bond (SB); (4) demineralization by EDTA, followed by application of SB. In half of the specimens, mechanical loadings (100,000 cycles, 2Hz, 49N) were applied to dentin beams. Specimens were stored in artificial saliva. C-terminal telopeptide (ICTP), determinations (which indicates the amount of collagen degradation) (radioimmunoassay) were performed after 24h, 1 week and 4 weeks.

RESULTS

Load cycling decreased collagen degradation when dentin was untreated or PA-demineralized and EDTA-treated. ICTP values increased when both PA-demineralized and EDTA-treated and infiltrated with SB dentin beams were loaded, except in samples that were subjected to EDTA treatment and SB infiltration after 4w of storage, which showed similar values of collagenolytic activity than the non loaded specimens. Load cycling preserved the initial (24h) ICTP determination at any time point, in all groups of the study, except in PA-demineralized and SB infiltrated dentin which showed an increased of collagen degradation values, over time. This same trend was observed in all groups without loading.

INTERPRETATION

Mechanical loading enhances collagen's resistance to enzymatic degradation in natural and demineralized dentin. Mild acids (EDTA) lead to a lower volume of demineralized/unprotected collagen to be cleaved by MMPs. Load cycling produced an increase of collagen degradation when PA-demineralized dentin and EDTA-treated dentin were infiltrated with resin, but EDTA-treated dentin showed a constant collagenolytic degradation, over time.

A Zn-doped etch-and-rinse adhesive may improve the mechanical properties and the integrity at the bonded-dentin interface

OBJECTIVE

The objective of the study was to determine if zinc-doped etch-and-rinse dentin adhesive may induce therapeutic effects within the resin-dentin interface.

METHODS

Human acid-etched dentin was infiltrated with Adper™ Single Bond Plus (SB, 3M ESPE, St. Paul, MN, USA), SB doped with 10wt.% ZnO nanoparticles (ZnO-SB) or SB doped with 2wt.% ZnCl2 (ZnCl2-SB). AFM/nanoindentation analysis was performed on fully hydrated specimens to evaluate the nanomechanical properties (Hi: hardness; Ei: modulus of elasticity) across the resin-dentin interface after different SBF storage periods (24h, 1m, 3m). Confocal laser microscopy (CLSM) was used to evaluate the ultramorphology and micropermeability at 24h and 3m of SBF storage.

RESULTS

SB control specimens exhibited a decrease in Hi in the hybrid layer (HL) and bottom of the hybrid layer (BHL) and a decrease in Ei in the HL after 3m of SBF storage, indicating that severe degradation occurred in the control interface. ZnO-SB bonded specimens preserved the initial Hi and Ei at the HL and BHL subsequent SBF storage; ZnCl2-SB bonded specimens showed a decrease in Ei, in the HL over time. CLSM analysis confirmed that both Zn-doped adhesives were able to preserve the integrity of the HL.

SIGNIFICANCE

Specific formulation of Zn-doped etch-and-rinse adhesives may offer the possibility to maintain the nano-mechanical properties along the dentin-bonded interface by inhibiting dentin MMPs and by protective mineral crystals formation within the resin-dentin interface. Clinical advantages may be expected by preserving and improving the integrity of the hybrid layer when Zn-doped adhesives are employed.

Mechanical properties of methacrylate-based model dentin adhesives: effect of loading rate and moisture exposure

The aim of this study is to investigate the mechanical behavior of model methacrylate-based dentin adhesives under conditions that simulate the wet oral environment. A series of monotonic and creep experiments were performed on rectangular beam samples of dentin adhesive in three-point bending configuration under different moisture conditions. The monotonic test results show a significant effect of loading rate on the failure strength and the linear limit (yield point) of the stress-strain response. In addition, these tests show that the failure strength is low, and the failure occurs at a smaller deformation when the test is performed under continuously changing moisture conditions. The creep test results show that under constant moisture conditions, the model dentin adhesives can have a viscoelastic response under certain low loading levels. However, when the moisture conditions vary under the same low loading levels, the dentin adhesives have an anomalous creep response accompanied by large secondary creep and high strain accumulation.

Overview of Clinical Alternatives to Minimize the Degradation of the Resin-dentin Bonds

The incorporation of hydrophilic and acidic resin monomers substantially improved the initial bonding of contemporary etch-and-rinse (ER) and self-etch (SE) adhesives to intrinsically wet dental substrates, providing quite favorable immediate results, regardless of the bonding approach used. However, in the long term, the bonding effectiveness of most simplified ER and SE adhesives drop dramatically. This review examines the fundamental processes that are responsible for the aging mechanisms involved in the degradation of the resin-bonded interfaces and some possible clinical approaches that have been effective in minimizing or even preventing the degradation of the adhesive interfaces produced with simplified adhesives. The incorporation of some of the feasible approaches - described in this review - may improve the quality of the adhesive restorations performed in clinical practice, while manufacturers develop bonding materials that are less susceptible to the aging mechanisms present in the oral environment.

Posterior composite restoration update: focus on factors influencing form and function

Restoring posterior teeth with resin-based composite materials continues to gain popularity among clinicians, and the demand for such aesthetic restorations is increasing. Indeed, the most common aesthetic alternative to dental amalgam is resin composite. Moderate to large posterior composite restorations, however, have higher failure rates, more recurrent caries, and increased frequency of replacement. Investigators across the globe are researching new materials and techniques that will improve the clinical performance, handling characteristics, and mechanical and physical properties of composite resin restorative materials. Despite such attention, large to moderate posterior composite restorations continue to have a clinical lifetime that is approximately one-half that of the dental amalgam. While there are numerous recommendations regarding preparation design, restoration placement, and polymerization technique, current research indicates that restoration longevity depends on several variables that may be difficult for the dentist to control. These variables include the patient’s caries risk, tooth position, patient habits, number of restored surfaces, the quality of the tooth–restoration bond, and the ability of the restorative material to produce a sealed tooth–restoration interface. Although clinicians tend to focus on tooth form when evaluating the success and failure of posterior composite restorations, the emphasis must remain on advancing our understanding of the clinical variables that impact the formation of a durable seal at the restoration–tooth interface. This paper presents an update of existing technology and underscores the mechanisms that negatively impact the durability of posterior composite restorations in permanent teeth.

A characterization of the mechanical behavior of resin-infiltrated dentin using nanoscopic Dynamic Mechanical Analysis

This study explored the spatial variations in mechanical behavior of resin-infiltrated dentin using nanoscopic Dynamic Mechanical Analysis (DMA).

OBJECTIVE

The objectives were to: (1) evaluate the mechanical behavior of resin-infiltrated dentin using a scanning-based approach to nanoindentation, (2) identify contributions of the collagen matrix to time-dependent deformation of the hybrid layer, and (3) assess the importance of specimen hydration on the nanoDMA response.

METHODS

Specimens of completely demineralized dentin infiltrated with commercial resin adhesive and control samples of resin adhesive were evaluated using a nanoindenter in scanning mode. The load and displacement responses were used to perform DMA and to estimate the complex (E*), storage (E') and loss (E″) moduli over selected regions of evaluation. The importance of hydration on the mechanical behavior was also examined from a comparison of responses in the hydrated and dehydrated conditions.

RESULTS

In the hydrated state the apparent complex, storage and loss moduli for the resin-infiltrated dentin samples were 3.5±0.3GPa, 3.4±0.2GPa and 0.9±0.3GPa, respectively. Those values for the resin adhesive control were 2.7±0.3GPa, 2.7±0.3GPa and 0.2±0.02GPa, respectively. Viscoelastic deformation of the resin-infiltrated collagen exceeded that occurring in regions of uniform resin adhesive. Though dehydration resulted in a significant increase in both the complex and storage moduli of the macro hybrid layer, the largest changes occurred to the resin adhesive.

SIGNIFICANCE

The microstructure and hydration play critical roles on the mechanical behavior of the hybrid layer and nanoDMA provides a potent measurement tool for identifying the spatial variations.

Magnetic resonance imaging of solid dental restoration materials using 3D UTE sequences: visualization and relaxometry of various compounds

OBJECT

Due to an increasing scientific interest in MR-imaging of carious lesions and teeth, an accurate signal characterization of dental restoration materials is necessary for optimization of MR sequence protocols and evaluation of material degradation. Therefore, signal yield and relaxation behavior of common dental restoration materials in comparison to those of dentine of extracted human teeth were assessed in vitro by ultrashort echo time (UTE) sequences.

MATERIALS AND METHODS

Eighteen material samples and dentine of two freshly extracted human teeth were investigated on a 3T whole-body clinical MR-scanner. Transverse (T2*) and longitudinal relaxation times (T1) were quantified using a recently published modified Ernst equation that takes relevant in-pulse relaxation effects into account.

RESULTS

All investigated samples could be successfully visualized but maximum signal yield was highly variable between samples. T1-values of the investigated dental restoration materials ranged between 28 and 365 ms, whereas T2*-values ranged between 96 and 917 μs. In contrast, T1-values of dentine (T1=545 ms±299 ms) were higher, while T2*-values (T2*=478 μs±271 μs) showed similar values.

CONCLUSIONS

Dental restoration materials and dentine of extracted human teeth can be visualized by UTE sequences and show a broad range of signal yield and relaxation times.

Fatigue of the resin-enamel bonded interface and the mechanisms of failure

The durability of adhesive bonds to enamel and dentin and the mechanisms of degradation caused by cyclic loading are important to the survival of composite restorations. In this study a novel method of evaluation was used to determine the strength of resin-enamel bonded interfaces under oth static and cyclic loading, and to identify the mechanisms of failure. Specimens with twin interfaces of enamel bonded to commercial resin composite were loaded in monotonic and cyclic 4-point flexure to failure within a hydrated environment. Results for the resin-enamel interface were compared with those for the resin composite (control) and values reported for resin-dentin adhesive bonds. Under both modes of loading the strength of the resin-enamel interface was significantly (p≤0.0001) lower than that of the resin composite and the resin-dentin bonded interface. Fatigue failure of the interface occurred predominantly by fracture of enamel, adjacent to the interface, and not due to adhesive failures. In the absence of water aging or acid production of biofilms, the durability of adhesive bonds to enamel is lower than that achieved in dentin bonding.

Fatigue of the resin-dentin interface: a new approach for evaluating the durability of dentin bonds

There are concerns regarding the longevity of resin composite restorations and the clinical relevance of in vitro bond strength testing to the durability of dentin bonds in vivo.

OBJECTIVE

The objectives of this investigation were to: (1) develop a new method of experimental evaluation for quantifying the durability of dentin bonds, (2) apply this method to characterize the interfacial strength of a selected commercial system under both monotonic and cyclic loading, and (3) distinguish mechanisms contributing to the interface degradation and failure.

METHODS

A new method for fatigue testing the resin-dentin interface was developed based on a four-point flexure arrangement that includes two identical bonded interfaces. Cyclic loading of specimens comprised of coronal dentin bonded to a commercial resin composite and controls of resin composite was performed to failure within a hydrated environment. Scanning electron microscopy and nanoscopic dynamic mechanical analysis were used to evaluate failure mechanisms.

RESULTS

The fatigue strength of the resin-dentin interface was significantly lower (p≤0.0001) than that of the resin composite and reported for dentin over the entire finite life regime. Defined at 1×10(7) cycles, the apparent endurance limit of the resin-dentin interface was 13MPa, in comparison to 48MPa and 44MPa for the resin composite and dentin, respectively. The ratio of fully reversed endurance limit to ultimate strength of the interface (0.26) was the lowest of the three materials.

SIGNIFICANCE

The proposed approach for characterizing the fatigue strength of resin-dentin bonds may offer new insights concerning durability of the bonded interface.

Comparison of quaternary ammonium-containing with nano-silver-containing adhesive in antibacterial properties and cytotoxicity

OBJECTIVE

Antibacterial primer and adhesive are promising to help combat biofilms and recurrent caries. The objectives of this study were to compare novel bonding agent containing quaternary ammonium dimethacrylate (QADM) with bonding agent containing nanoparticles of silver (NAg) in antibacterial activity, contact-inhibition vs. long-distance inhibition, glucosyltransferases (gtf) gene expressions, and cytotoxicity for the first time.

METHODS

QADM and NAg were incorporated into Scotchbond Multi-Purpose adhesive and primer. Microtensile dentin bond strength was measured. Streptococcus mutans (S. mutans) biofilm on resin surface (contact-inhibition) as well as S. mutans in culture medium away from the resin surface (long-distance inhibition) were tested for metabolic activity, colony-forming units (CFUs), lactic acid production, and gtf gene expressions. Eluents from cured primer/adhesive samples were used to examine cytotoxicity against human gingival fibroblasts.

RESULTS

Bonding agent with QADM greatly reduced CFU and lactic acid of biofilms on the resin surface (p<0.05), while having no effect on S. mutans in culture medium away from the resin surface. In contrast, bonding agent with NAg inhibited not only S. mutans on the resin surface, but also S. mutans in culture medium away from the resin surface. Bonding agent with QADM suppressed gtfB, gtfC and gtfD gene expressions of S. mutans on its surface, but not away from its surface. Bonding agent with NAg suppressed S. mutans gene expressions both on its surface and away from its surface. Bonding agents with QADM and NAg did not adversely affect microtensile bond strength or fibroblast cytotoxicity, compared to control (p>0.1).

SIGNIFICANCE

QADM-containing adhesive had contact-inhibition and inhibited bacteria on its surface, but not away from its surface. NAg-containing adhesive had long-distance killing capability and inhibited bacteria on its surface and away from its surface. The novel antibacterial adhesives are promising for caries-inhibition restorations, and QADM and NAg could be complimentary agents in inhibiting bacteria on resin surface as well as away from resin surface.

Novel calcium phosphate nanocomposite with caries-inhibition in a human in situ model

OBJECTIVES

Secondary caries at the restoration margins remains the main reason for failure. Although calcium phosphate (CaP) composites are promising for caries inhibition, there has been no report of CaP composite to inhibit caries in situ. The objectives of this study were to investigate the caries-inhibition effect of nanocomposite containing nanoparticles of amorphous calcium phosphate (NACP) in a human in situ model for the first time, and to determine colony-forming units (CFU) and Ca and P ion concentrations of biofilms on the composite restorations.

METHODS

NACP with a mean particle size of 116 nm were synthesized via a spray-drying technique. Two composites were fabricated: NACP nanocomposite, and control composite filled with glass particles. Twenty-five volunteers wore palatal devices containing bovine enamel slabs with cavities restored with NACP or control composite. After 14 days, the adherent biofilms were collected for analyses. Transverse microradiography determined the enamel mineral profiles at the margins, and the enamel mineral loss ΔZ was measured.

RESULTS

NACP nanocomposite released Ca and P ions and the release significantly increased at cariogenic low pH (p<0.05). Biofilms on NACP nanocomposite contained higher Ca (p=0.007) and P ions (p=0.005) than those of control (n=25). There was no significant difference in biofilm CFU between the two composites (p>0.1). Microradiographs showed typical subsurface lesions in enamel next to control composite, but much less lesion around NACP nanocomposite. Enamel mineral loss ΔZ (mean±sd; n=25) around NACP nanocomposite was 13.8±9.3 μm, much less than 33.5±19.0 μm of the control (p=0.001).

SIGNIFICANCE

Novel NACP nanocomposite substantially reduced caries formation in a human in situ model for the first time. Enamel mineral loss at the margins around NACP nanocomposite was less than half of the mineral loss around control composite. Therefore, the Ca and P ion-releasing NACP nanocomposite is promising for caries-inhibiting restorations.

Push-out bond strength and SEM evaluation of a new bonding approach into the root canal

Objective

This study evaluated the performance of different adhesive systems in fiber post placement aiming to clarify the influence of different hydrophobic experimental blend adhesives, and of one commercially available adhesive on the frictional retention during a luting procedure.

Material and Methods

One luting agent (70 Wt% BisGMA, 28.5% TEGDMA; 1.5% p-tolyldiethanolamine) to cement fiber posts into root canals was applied with 4 different adhesive combinations: Group 1: The etched roots were rinsed with water for 30 s to remove the phosphoric acid, then rinsed with 99.6% ethanol for 30 s, and blotdried. A trial adhesive (base to catalyst on a 1:1 ratio) was used with an experimental luting agent (35% Bis-GMA, 14.37% TeGDMA, 0.5% eDMAB, 0.13% CQ); Group 2: A trial adhesive (base to catalyst on a 1:2 ratio) was luted as in Group 1; Group 3: One-Step Plus (OSP, Bisco Inc.) following the ethanol bonding technique in combination with the luting agent as in Group 1; Group 4: OSP strictly following the manufacturer's instructions using the luting agent as in Group 1. The groups were challenged with push-out tests. Posted root slices were loaded until post segment extrusion in the apical-coronal direction. Failure modes were analyzed under scanning electron microscopy.

Results

Push-out strength was not significantly influenced by the luting agent (p>0.05). No statistically significant differences among the tested groups were found as Group 1 (exp 1 - ethanol-wet bonding technique)=Group 2 (exp 2 - ethanol-wet bonding technique)=Group 3 (OSP - ethanol-wet bonding technique)=Group 4 (control, OSP - water-wet bonding technique) (p>0.05). The dominating failure modes in all the groups were cohesive/adhesive failures, which were predominantly observed on the post/luting agent interface.

Conclusions

The results of this study support the hypothesis that the proposal to replace water with ethanol to bond fiber posts to the root canal using highly hydrophobic resin is plausible, but this seems to be more the proof of a concept than a clinically applicable procedure.

Effect of proanthocyanidins and photo-initiators on photo-polymerization of a dental adhesive

OBJECTIVES

To evaluate the effects of proanthocyanidins (PA) and photoinitiator type on the degree of conversion (DC) and polymerization rate (PR) of a model dental adhesive.

METHODS

Three types of photo-initiation systems were introduced into the Bis-GMA/HEMA co-monomer mixture, resulting in four resin formulations including CQ/A (0.5wt% CQ and EDMAB), CQ/A/I-1 (0.5wt% CQ, EDMAB and DPIHP), CQ/A/I-2 (1.0wt% CQ, EDMAB and DPIHP), and TPO (2.1wt% TPO). For each resin formulation, adhesives containing 0%, 2.5%, 5% and 10% of PA with respect to the weight of resin were produced after mixing the resin with various amount of PA/ethanol solution. When light-cured, the RP and DC of each adhesive was determined using ATR-FTIR spectroscopy.

RESULTS

Across and within the initiator groups, the DC followed the general trend of CQ/A2.5-PA>5-PA>10-PA, respectively. The change of PR with respect to photo-initiation systems and PA content was in a similar but less pronounced pattern.

CONCLUSION

PA hampered the polymerization of all adhesives regardless of photoinitiators used. The initiator formulations CQ/A/I-2 and TPO are better fit for PA-containing adhesives, both leading to >65% DC in the presence of 5% PA.

CLINICAL SIGNIFICANCE

The inclusion of PA in dental adhesives has been limited by its interference with the light-curing of adhesive resins. This study found photo-initiation formulations that could maintain a satisfactory degree of monomer conversion while a significant amount of PA is incorporated.

Novel dental adhesive containing antibacterial agents and calcium phosphate nanoparticles

Secondary caries remains the main reason for dental restoration failure. Replacement of failed restorations accounts for 50%-70% of all restorations performed. Antibacterial adhesives could inhibit biofilm acids at tooth-restoration margins, and calcium phosphate (CaP) ions could remineralize tooth lesions. The objectives of this study were to: (1) incorporate nanoparticles of silver (NAg), quaternary ammonium dimethacrylate (QADM), and nanoparticles of amorphous calcium phosphate (NACP) into bonding agent; and (2) investigate their effects on dentin bonding and microcosm biofilms. An experimental primer was made with pyromellitic glycerol dimethacrylate (PMGDM) and 2-hydroxyethyl methacrylate (HEMA). An adhesive was made with bisphenol-A-glycerolate dimethacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA). NAg was incorporated into primer at 0.1 wt %. The adhesive contained 0.1% NAg and 10% QADM, and 0%-40% NACP. Incorporating NAg into primer and NAg-QADM-NACP into adhesive did not adversely affect dentin bond strength (p > 0.1). Scanning electron microscopy showed numerous resin tags, and transmission electron microscopy revealed NAg and NACP in dentinal tubules. Viability of human saliva microcosm biofilms on primer/adhesive/composite disks was substantially reduced via NAg and QADM. Metabolic activity, lactic acid, and colony-forming units of biofilms were much lower on the new bonding agents than control (p < 0.05). In conclusion, novel dental bonding agents containing NAg, QADM, and NACP were developed with the potential to kill residual bacteria in the tooth cavity and inhibit the invading bacteria along tooth-restoration margins, with NACP to remineralize tooth lesions. The novel method of combining antibacterial agents (NAg and QADM) with remineralizing agent (NACP) may have wide applicability to other adhesives for caries inhibition.

The role of dentin moisture in the degradation of resin-dentin interfaces under clinical and laboratory conditions

BACKGROUND

The authors conducted a study to evaluate the influence of dentin moisture on the degradation of the resin-dentin interface in primary teeth under clinical and laboratory conditions.

METHODS

The authors prepared 40 Class I restorations (five teeth per group) by using a cylindrical diamond bur, leaving a flat dentin surface on the pulpal floor. They vigorously rubbed two coats of a simplified etch-and-rinse adhesive on either dry or wet demineralized dentin under clinical or laboratory conditions. After performing restorative procedures, the authors extracted teeth prepared under clinical conditions after 20 minutes (immediately) or the teeth exfoliated after six months. The authors also tested the teeth prepared under laboratory conditions immediately or after six months of being stored in water. They sectioned the teeth to obtain resin-dentin bonded specimens for microtensile testing and for silver nitrate uptake (SNU) under scanning electron microscopy. They performed a three-way analysis of variance and Tukey test (α = .05) on the SNU bond strength data.

RESULTS

Statistically higher bond strength values (megapascals [standard deviation]) were observed when bonding was performed under laboratory conditions (clinical = 25.2 [3.6] MPa versus laboratory = 28.5 [4.4] MPa; P < .05). Degradation occurred only in the wet dentin groups under both experimental conditions (immediately = 31.3 [4.5] MPa versus after six months = 21.3 [2.1] MPa; P < .05). SNU occurred in all groups and was statistically higher after six months of clinical function or water storage (immediately = 13.9 [4.9 SD] percent versus after six months = 34.1 [4.5 SD] percent; P < .05).

CONCLUSIONS

The bonding of adhesives to dry demineralized dentin produces adhesive interfaces that are more resistant to degradation regardless of the bonding condition.

CLINICAL IMPLICATIONS

Resin-dentin bond strengths produced under laboratory conditions in primary teeth may be higher than those obtained under clinical circumstances, although both conditions (clinical and laboratory) seemed to yield similar results. Bonding to dry demineralized primary tooth dentin produced resin-dentin interfaces that were more resistant to degradation.

On the fatigue behavior of resin-dentin bonds after degradation by biofilm

The durability of resin-dentin bonds is a growing concern in the placement of composite restorations. Most reported evaluations concerning the mechanical behavior of the bonded interface are conducted using static loading to failure only. They also do not account for the acid production of biofilms, which is one of the most common contributors to interfacial failures in vivo. In this investigation resin-dentin bonded interface specimens were exposed to S. mutans for 14 days and then subjected to quasi-static or cyclic four-point flexure to failure. Control specimens (without biofilm) were evaluated after aging for one and fourteen days. While no significant difference in flexure strength resulted from the duration of water aging (66.2 MPa vs. 56.9 MPa), biofilm exposure caused a significant reduction in strength (29.3 MPa; p ≤ 0.000). After water aging for one and fourteen days the apparent endurance limits were 13.0 MPa and 13.1 MPa, respectively. Biofilm treatment caused a significant (p ≤ 0.001) reduction in fatigue resistance of the interface, and the endurance limit was reduced to 9.9 MPa. Fatigue failure of the control specimens initiated within the resin composite adjacent to the interface, whereas failure of the biofilm treated specimens initiated within the hybrid layer and appeared attributed to the localized demineralization of dentin. Biofilm degradation is an important consideration in assessing the durability of resin-dentin bonds.

Effect of application mode on interfacial morphology and chemistry between dentine and self-etch adhesives

OBJECTIVE

To investigate the influence of application mode on the interfacial morphology and chemistry between dentine and self-etch adhesives with different aggressiveness.

METHODS

The occlusal one-third of the crown was removed from un-erupted human third molars, followed by abrading with 600 grit SiC under water. Rectangular dentine slabs were prepared by sectioning the tooth specimens perpendicular to the abraded surfaces. The obtained dentine slabs were treated with one of the two one-step self-etch adhesives: Adper Easy Bond (AEB, pH∼2.5) and Adper Prompt L-Pop (APLP, pH∼0.8) with (15s, active application) or without (15s, inactive application) agitation. The dentine slabs were fractured and the exposed adhesive/dentine (A/D) interfaces were examined with micro-Raman spectroscopy and scanning electron microscopy (SEM).

RESULTS

The interfacial morphology, degree of dentine demineralization (DD) and degree of conversion (DC) of the strong self-etch adhesive APLP showed more significant dependence on the application mode than the mild AEB. APLP exhibited inferior bonding at the A/D interface if applied without agitation, evidenced by debonding from the dentine substrate. The DDs and DCs of the APLP with agitation were higher than those of without agitation in the interface, in contrast to the comparable DD and DC values of two AEB specimen groups with different application modes. Raman spectral analysis revealed the important role of chemical interaction between acid monomers of self-etch adhesives and dentine in the above observations.

CONCLUSION

The chemical interaction with dentine is especially important for improving the DC of the strong self-etching adhesive at the A/D interface. Agitation could benefit polymerization efficacy of the strong self-etch adhesive through enhancing the chemical interaction with tooth substrate.

Hydrolytic degradation of the resin-dentine interface induced by the simulated pulpal pressure, direct and indirect water ageing

OBJECTIVES

The aim of this study was to compare the hydrolytic effects induced by simulated pulpal pressure, direct or indirect water exposure within the resin-dentine interfaces created with three "simplified" resin bonding systems (RBSs).

METHODS

A two-step/self-etching (CSE: Clearfil SE Bond), one-step/self-etching (S3: Clearfil S3) and etch-and-rinse/self-priming (SB: Single-bond 2) adhesives were applied onto dentine and submitted to three different prolonged (6 or 12 months) ageing strategies: (i) Simulated Pulpal Pressure (SPP); (ii) Indirect Water Exposure (IWE: intact bonded-teeth); (iii) Direct Water Exposure (DWE: resin-dentine sticks). Control and aged specimens were submitted to microtensile bond strength (μTBS) and nanoleakage evaluation. Water sorption (WS) survey was also performed on resin disks. Results were analysed with two-way ANOVA and Tukey's test (p < 0.05).

RESULTS

The μTBS of CS3 and SB dropped significantly (p < 0.05) after 6 months of SPP and DWE. CSE showed a significant μTBS reduction only after 12 months of DWE (p = 0.038). IWE promoted no statistical change in μTBS (p > 0.05) and no evident change in nanoleakage. Conversely, SPP induced a clear formation of "water-trees" in CS3 and SB. WS outcomes were CS3 > SB = CSE.

CONCLUSION

The hydrolytic degradation of resin-dentine interfaces depend upon the type of the in vitro ageing strategy employed in the experimental design. Direct water exposure remains the quickest method to age the resin-dentine bonds. However, the use of SPP may better simulate the in vivo scenario. However, the application of a separate hydrophobic solvent-free adhesive layer may reduce the hydrolytic degradation and increase the longevity of resin-dentine interfaces created with simplified adhesives.

Remineralization of demineralized enamel via calcium phosphate nanocomposite

Secondary caries remains the main problem limiting the longevity of composite restorations. The objective of this study was to investigate the remineralization of demineralized human enamel in vitro via a nanocomposite containing nanoparticles of amorphous calcium phosphate (NACP). NACP were synthesized by a spray-drying technique and incorporated into a dental resin. First, caries-like subsurface enamel lesions were created via an acidic solution. Then, NACP nanocomposite or a commercial fluoride-releasing control composite was placed on the demineralized enamel, along with control enamel without a composite. These specimens were then treated with a cyclic demineralization/remineralization regimen for 30 days. Quantitative microradiography showed typical enamel subsurface demineralization before cyclic demineralization/remineralization treatment, and significant remineralization in enamel under the NACP nanocomposite after the demineralization/remineralization treatment. The NACP nanocomposite had the highest enamel remineralization (mean ± SD; n = 6) of 21.8 ± 3.7%, significantly higher than the 5.7 ± 6.9% for fluoride-releasing composite (p < 0.05). The enamel group without composite had further demineralization of -26.1 ± 16.2%. In conclusion, a novel NACP nanocomposite was effective in remineralizing enamel lesions in vitro. Its enamel remineralization was 4-fold that of a fluoride-releasing composite control. Combined with the good mechanical and acid-neutralization properties reported earlier, the new NACP nanocomposite is promising for remineralization of demineralized tooth structures.

Experimental resin cements containing bioactive fillers reduce matrix metalloproteinase-mediated dentin collagen degradation

INTRODUCTION

Collagen dentin matrix may represent a suitable scaffold to be remineralized in the presence of bioactive materials. The purpose of this study was to determine if experimental resin cements containing bioactive fillers may modulate matrix metalloproteinase-mediated collagen degradation of etched dentin.

METHODS

Human dentin beams demineralized using 10% phosphoric acid or 0.5 mol/L EDTA were infiltrated with the following experimental resins: (1) unfilled resin, (2) resin with Bioglass 45S5 particles (Sylc; OSspray Ltd, London, UK), and (3) resin with β-tricalcium phosphate-modified calcium silicate cement (HCAT-β) particles. The filler/resin ratio was 40/60 wt%. The specimens were stored in artificial saliva, and the determination of C-terminal telopeptide (ICTP) was performed by radioimmunoassay after 24 hours, 1 week, and 4 weeks. Scanning electron microscopic analysis of dentin surfaces after 4 weeks of storage was also executed.

RESULTS

Collagen degradation was prominent both in phosphoric acid and EDTA-treated dentin. Resin infiltration strongly reduced the MMP activity in demineralized dentin. Resin-containing Bioglass 45S5 particles exerted higher and more stable protection of collagen at all tested dentin states and time points. HCAT-β induced collagen protection from MMPs only in EDTA-treated specimens. Dentin remineralization was achieved when dentin was infiltrated with the resin cements containing bioactive fillers.

CONCLUSIONS

MMP degradation of dentin collagen is strongly reduced in resin-infiltrated dentin. The inclusion of Bioglass 45S5 particles exerted an additional protection of collagen during dentin remineralization.

Comparison of chemical aging and water immersion time on durability of resin-dentin interface produced by an etch-and-rinse adhesive

AIM

The aim of this study was to analyze and compare the influence of short-term NaOCl-storage and long-term water storage on the microtensile bond strength (µTBS) of etch-and-rinse adhesive system to human dentin.

MATERIALS AND METHODS

Thirty-six third human molars were randomly divided into 6 groups (n = 6) according to the aging protocol: G1 (water, 24 hours); G2 (water, 6 months); G3 (water, 12 months); G4 (10% sodium hypochlorite--NaOCl, 1 hour); G5 (10% NaOCl, 3 hours) and G6 (10% NaOCl, 5 hours). A two-step etch-and-rinse adhesive (Adper Single Bond 2) was applied according to the manufacturers' instructions. A composite (Filtek Z250) was applied in four horizontal increments and was individually cured. Specimens were cut following the microtensile test technique, submitted to the different aging protocols, and tested in tension. The fracture pattern was observed in a stereomicroscope (40* magnification) and in a scanning electron microscope. The µTBS data were analyzed by ANOVA and Tukey's test (α = 0.05).

RESULTS

The effect of storage in 10% NaOCl for 1 or 3 hours was not significantly different from that of aging in distilled water (DW) for 6 or 12 months (p > 0.05). Beams immersed in DW for 24 hours and in 10% NaOCl for 5 hours showed the highest and lowest µTBS values respectively.

CONCLUSION

The aging protocols negatively influenced dentin bond strength. Aging specimens in 10% NaOCl for 1 or 3 hours can be an alternative method for long-term water storage (6 or 12 months) bond strength studies.

CLINICAL SIGNIFICANCE

This aging protocol allows a quick achievement of longitudinal bond strength data, so that results are available to the professionals in this area while the materials are yet present at the dental market.

Fourier transform infrared photoacoustic spectroscopy study of physicochemical interaction between human dentin and etch-&-rinse adhesives in a simulated moist bond technique

The purpose of this study was to provide the physicochemical interactions at the interfaces between two commercial etch-&-rinse adhesives and human dentin in a simulated moist bond technique. Six dentin specimens were divided into two groups (n=3) according to the use of two different adhesive systems: (a) 2-hydroxyethylmethacrylate (HEMA) and 4-methacryloxyethyl trimellitate anhydrate (4-META), and (b) HEMA. The Fourier transform infrared photoacoustic spectroscopy was performed before and after dentin treatment with 37% phosphoric acid, with adhesive systems and also for the adhesive systems alone. Acid-conditioning resulted in a decalcification pattern. Adhesive treated spectra subtraction suggested the occurrence of chemical bonding to dentin expressed through modifications of the OH stretching peak (3340 cm(-1)) and symmetric CH stretching (2900 cm(-1)) for both adhesives spectra; a decrease of orthophosphate absorption band (1040 to 970 cm(-1)) for adhesive A and a better resolved complex band formation (1270 to 970 cm(-1)) for adhesive B were observed. These results suggested the occurrence of chemical bonding between sound human dentin and etch-&-rinse adhesives through a clinical typical condition.

Anti-biofilm dentin primer with quaternary ammonium and silver nanoparticles

Antibacterial bonding agents could combat recurrent caries at the tooth-composite margins. The objectives of this study were to develop novel antibacterial dentin primers containing quaternary ammonium dimethacrylate (QADM) and nanoparticles of silver (NAg), and to investigate the effects on dentin bond strength and dental plaque microcosm biofilms for the first time. Scotchbond Multi-Purpose ("SBMP") bonding agent was used. QADM and NAg were incorporated into SBMP primer, yielding 4 primers: SBMP primer (control), control + 10% QADM (mass), control + 0.05% NAg, and control + 10% QADM + 0.05% NAg. Human saliva was collected to grow microcosm biofilms. The NAg particle size (mean ± SD; n = 100) was 2.7 ± 0.6 nm. Dentin shear bond strengths (n = 10) with human third molars were approximately 30 MPa for all groups (p > 0.1). QADM-NAg-containing primer increased the bacteria inhibition zone by 9-fold, compared with control primer (p < 0.05). QADM-NAg-containing primer reduced lactic acid production and colony-forming units of total micro-organisms, total streptococci, and mutans streptococci by an order of magnitude. In conclusion, novel QADM-NAg-containing primers were strongly antibacterial without compromising dentin bond strength, and hence are promising to inhibit biofilms and secondary caries. The processing method of incorporating QADM and NAg together into the same primer produced the strongest antibacterial effect, which could have a wide applicability to other bonding systems.

Quantitative analysis of aqueous phase composition of model dentin adhesives experiencing phase separation

There have been reports of the sensitivity of our current dentin adhesives to excess moisture, for example, water-blisters in adhesives placed on over-wet surfaces, and phase separation with concomitant limited infiltration of the critical dimethacrylate component into the demineralized dentin matrix. To determine quantitatively the hydrophobic/hydrophilic components in the aqueous phase when exposed to over-wet environments, model adhesives were mixed with 16, 33, and 50 wt % water to yield well-separated phases. Based upon high-performance liquid chromatography coupled with photodiode array detection, it was found that the amounts of hydrophobic BisGMA and hydrophobic initiators are less than 0.1 wt % in the aqueous phase. The amount of these compounds decreased with an increase in the initial water content. The major components of the aqueous phase were hydroxyethyl methacrylate (HEMA) and water, and the HEMA content ranged from 18.3 to 14.7 wt %. Different BisGMA homologues and the relative content of these homologues in the aqueous phase have been identified; however, the amount of crosslinkable BisGMA was minimal and, thus, could not help in the formation of a crosslinked polymer network in the aqueous phase. Without the protection afforded by a strong crosslinked network, the poorly photoreactive compounds of this aqueous phase could be leached easily. These results suggest that adhesive formulations should be designed to include hydrophilic multimethacrylate monomers and water compatible initiators.

Bond strengths, degree of conversion of the cement and molecular structure of the adhesive-dentine joint in fibre post restorations

OBJECTIVES

Because fibre post restorations are influenced by multiple factors such as the types of bonding materials, the dentine region and the time under moist exposure, this study sought to determine the bond strength of endodontic restorations and its relation to the degree of conversion of the cement layer and the molecular structure of the dentine-bonded joints.

METHODS

The performance of 2 etch-and-rinse (All-Bond 2 and One-Step Plus) and 2 self-etch (Clearfil SE Bond and Xeno III) adhesives at post spaces regions, after 7 d or 4 m, was evaluated. FRC Postec Plus posts were cemented to the root canal with a dual-cure resin cement (Duo-Link). Transverse sections of the tooth were subjected to push-out testing, to degree-of-conversion measurements and to hybrid layer evaluation through μ-Raman spectroscopy.

RESULTS

Coronal bonding was higher than cervical and middle bonding. The hybrid layer was thicker for the etch-and-rinse systems, with thicknesses decreasing towards the middle region. The degree of conversion measured for the 3-step etch-and-rinse group after 4 m was significantly higher than that for the self-etching groups.

CONCLUSIONS

Although not totally stable at the adhesive-dentine interface, the 3-step etch-and-rinse adhesive in the coronal dentine provided the best bond strength, degree of conversion of the cement and hybrid layer thickness in post restorations, in both short- and long-term analyses.

Interfacial adaptation of an epoxy-resin sealer and a self-etch sealer to root canal dentin using the System B or the single cone technique

The aim of this laboratory study was to compare the interfacial adaptation of an epoxy-resin and a self-etch sealer in mesial root canals of mandibular molars filled using the System-B/Elements Obturation Unit. Sixty mesial root canals of mandibular molars were prepared using the K3 rotary system up to 35.04 instrument and then filled with the aid of the System-B/Elements Obturation Unit using either gutta-percha/ThermaSeal Plus (n=15) or Resilon/Real Seal SE (n=15). The single cone technique using both materials was used as control. The sealers were stained with Rhodamine B dye and the teeth were filled and sectioned at 2, 4 and 6 mm from the apex. The interfacial marginal adaptation of sealers was evaluated using confocal microscopy. Statistical analyses were performed by the Kruskall-Wallis test (α=0.05). In general, microscopic analysis showed a quite regular gap distribution pattern at sealer-dentin interfaces, mainly for the two groups filled with Real Seal SE. This means that both nonbonding root-filling groups (ThermaSeal Plus) showed significantly higher amount of gap-free regions regardless of the filling technique (p<0.05). Better marginal adaptation was obtained with gutta-percha and epoxy resin-based sealer using either the system B or the single cone technique.