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

Fatigue resistance of dentin bonds prepared with two- vs. three-step adhesives: Effect of carbodiimide

The application of a cross-linker to demineralized dentin is reportedly effective at extending the durability of dentin bonds.

OBJECTIVE

To compare the effect of a cross-linker pretreatment on the fatigue crack growth resistance of resin-dentin bonds prepared with a two- vs. three-step adhesive system.

METHODS

Bonded interface Compact Tension (CT) specimens were prepared using commercial two- and three-step etch-and-rinse adhesives and compatible hybrid resin-composite. For the treated groups, adhesive bonding was preceded by a 1min application of an experimental carbodiimide (EDC) conditioner to the acid-etched dentin. The control groups received no such treatment. The fatigue crack growth resistance was examined after storage in artificial saliva at 37°C for 0, 3 and 6 months.

RESULTS

There was no significant difference in the immediate fatigue crack growth resistance the control and EDC-treated groups at 0 months for either adhesive system. After 3 and 6 months of storage, the EDC-treated groups exhibited significantly greater (p≤0.05) fatigue crack growth resistance than the controls. Although the EDC treatment was equally effective in deterring degradation for both adhesives, bonds prepared with the three-step system exhibited the lowest resistance to fatigue crack growth overall.

SIGNIFICANCE

An EDC treatment applied during dentin bonding could help maintain the durability of bonds prepared with two or three-step adhesive bonding systems.

Recent Advances in Adhesive Bonding - The Role of Biomolecules, Nanocompounds, and Bonding Strategies in Enhancing Resin Bonding to Dental Substrates

PURPOSE OF REVIEW

To present an overview on the main agents (i.e., biomolecules and nanocompounds) and/or strategies currently available to amplify or stabilize resin-dentin bonding.

RECENT FINDINGS

According to studies retrieved for full text reading (2014-2017), there are currently six major strategies available to overcome resin-dentin bond degradation: (i) use of collagen crosslinking agents, which may form stable covalent bonds with collagen fibrils, thus strengthening the hybrid layer; (ii) use of antioxidants, which may allow further polymerization reactions over time; (iii) use of protease inhibitors, which may inhibit or inactivate metalloproteinases; (iv) modification of the bonding procedure, which may be performed by using the ethanol wet-bonding technique or by applying an additional adhesive (hydrophobic) coating, thereby strengthening the hybrid layer; (v) laser treatment of the substrate prior to bonding, which may cause specific topographic changes in the surface of dental substrates, increasing bonding efficacy; and (vi) reinforcement of the resin matrix with inorganic fillers and/or remineralizing agents, which may positively enhance physico-mechanical properties of the hybrid layer.

SUMMARY

With the present review, we contributed to the better understanding of adhesion concepts and mechanisms of resin-dentin bond degradation, showing the current prospects available to solve that problematic. Also, adhesively-bonded restorations may be benefited by the use of some biomolecules, nanocompounds or alternative bonding strategies in order to minimize bond strength degradation.

High-performance therapeutic quercetin-doped adhesive for adhesive-dentin interfaces

Almost half of dental restorations have failed in less than 10 years, and approximately 60% of practice time has been consumed to replace these dental restorations. As such, contemporary dentin adhesives should be modified to treat secondary caries and prevent the degradation of adhesive–dentin interfaces. To achieve this goal, we developed a versatile therapeutic adhesive in the present study by incorporating quercetin, which is a naturally derived plant extract, into a commercial adhesive at three concentrations (100, 500 and 1000 µg/mL). An unmodified adhesive served as a control. The antibacterial ability on Streptococcus mutans biofilm, conversion degree, microtensile bond strength, failure modes, in situ zymography, nanoleakage expression and cytotoxicity of quercetin-doped adhesive were comprehensively evaluated. Results showed that the quercetin-doped adhesive (500 µg/mL) preserved its bonding properties against collagenase ageing and inhibited the growth of S. mutans biofilm. Efficient bonding interface sealing ability, matrix metalloproteinase inhibition and acceptable biocompatibility were also achieved. Thus, a simple, safe and workable strategy was successfully developed to produce therapeutic adhesives for the extension of the service life of adhesive restorations.

Biocompatibility and bond degradation of poly-acrylic acid coated copper iodide-adhesives

OBJECTIVE

To investigate the effect of poly-acrylic acid (PAA) copper iodide (CuI) adhesives on bond degradation, tensile strength, and biocompatibility.

METHODS

PAA-CuI particles were incorporated into Optibond XTR, Optibond Solo and XP Bond in 0.1 and 0.5mg/ml. Clearfil SE Protect, an MDPB-containing adhesive, was used as control. The adhesives were applied to human dentin, polymerized and restored with composite in 2mm-increments. Resin-dentin beams (0.9±0.1mm²) were evaluated for micro-tensile bond strength after 24h, 6 months and 1year. Hourglass specimens (10×2×1mm) were evaluated for ultimate tensile strength (UTS). Cell metabolic function of human gingival fibroblast cells exposed to adhesive discs (8×1mm) was assessed with MTT assay. Copper release from adhesive discs (5×1mm) was evaluated with UV-vis spectrophotometer after immersion in 0.9% NaCl for 1, 3, 5, 7, 10, 14, 21 and 30 days. SEM, EDX and XRF were conducted for microstructure characterization.

RESULTS

XTR and Solo did not show degradation when modified with PAA-CuI regardless of the concentration. The UTS for adhesives containing PAA-CuI remained unaltered relative to the controls. The percent viable cells were reduced for Solo 0.5mg/ml and XP 0.1 or 0.5mg/ml PAA-CuI. XP demonstrated the highest ion release. For all groups, the highest release was observed at days 1 and 14.

SIGNIFICANCE

PAA-CuI particles prevented the bond degradation of XTR and Solo after 1year without an effect on the UTS for any adhesive. Cell viability was affected for some adhesives. A similar pattern of copper release was demonstrated for all adhesives.

Evaluate the effect of different mmps inhibitors on adhesive physical properties of dental adhesives, bond strength and mmp substarte activity

We have evaluated and compare the effect of different exogenous MMP inhibitors on adhesive physical properties of dental adhesives, bond strength, micro permeability and MMP substrate activity. 180-grit Sic paper was used to obtain the superficial dentin surface from each and every tooth after the wet grinding procedure. Dentin was exposed to four different MMP inhibitors to evaluate the effect on resin adhesive dentin interface. The four groups used in study were: 2% chlorhexidine digluconate, 2% doxycycline solution, 5% Proanthocyanidin (PR), Control Group. We evaluated and compared the four groups at each and every step of etching, bonding and resin application. Then, the immunolabeling was done with the help of the secondary antibodies with the pH of 7 and the dilution of 1:20. Amongst all the etching pretreatment groups, CHE group (Chlorhexidine etching group) revealed highest exposure to collagen fibrils than the other groups of etching. Then after the CHE group, the next group which has the second highest exposure DOE group. MMP inhibitor application for time duration of 1 minute after the etching procedures significantly improves the bond strength, exposure to collagen fibres and uniforms the dense form of dentin hybrid layer.

Dentin on the nanoscale: Hierarchical organization, mechanical behavior and bioinspired engineering

OBJECTIVE

Knowledge of the structural organization and mechanical properties of dentin has expanded considerably during the past two decades, especially on a nanometer scale. In this paper, we review the recent literature on the nanostructural and nanomechanical properties of dentin, with special emphasis in its hierarchical organization.

METHODS

We give particular attention to the recent literature concerning the structural and mechanical influence of collagen intrafibrillar and extrafibrillar mineral in healthy and remineralized tissues. The multilevel hierarchical structure of collagen, and the participation of non-collagenous proteins and proteoglycans in healthy and diseased dentin are also discussed. Furthermore, we provide a forward-looking perspective of emerging topics in biomaterials sciences, such as bioinspired materials design and fabrication, 3D bioprinting and microfabrication, and briefly discuss recent developments on the emerging field of organs-on-a-chip.

RESULTS

The existing literature suggests that both the inorganic and organic nanostructural components of the dentin matrix play a critical role in various mechanisms that influence tissue properties.

SIGNIFICANCE

An in-depth understanding of such nanostructural and nanomechanical mechanisms can have a direct impact in our ability to evaluate and predict the efficacy of dental materials. This knowledge will pave the way for the development of improved dental materials and treatment strategies.

CONCLUSIONS

Development of future dental materials should take into consideration the intricate hierarchical organization of dentin, and pay particular attention to their complex interaction with the dentin matrix on a nanometer scale.

Quality and Survival of Direct Light-Activated Composite Resin Restorations in Posterior Teeth: A 5- to 20-Year Retrospective Longitudinal Study

PURPOSE

To analyze the clinical success of direct light-activated composite resin restorations in posterior teeth. The quality of the margins and occlusal surfaces were evaluated, as well as their survival, according to their extensions and locations. The clinical performance of posterior composite resin restorations with different compositions were compared. All restorations were performed by the first author in his private practice, in a 5- to 20-year period.

MATERIALS AND METHODS

Several types of composite resins, provided by different manufacturers, were placed in posterior teeth, after isolation with rubber dams. To be included in the study, the restorations had to have been in function for at least 5 years and had to have been placed between October 1993 and October 2008 by the first author. The established failure criteria were: tooth and/or restoration fracture, secondary caries, endodontic treatment, or tooth loss. Included patients must have been treated in the first author's office for at least 7 years and still in the practice through 2013; all patients had complete dental arches. Patients with removable dental prostheses or disabilities, who had moved, or who had died were excluded. Of 210 patients who fulfilled the inclusion criteria, 138 randomly selected subjects were clinically examined between November 2013 and April 2014. Of these 138 patients, 61 had received 105 direct-light-activated composite resin restorations in posterior teeth, which met the inclusion criteria. Twenty-nine patients (47.5%) underwent annual maintenance therapy. The patient-based data collected from clinical exams and personal records were recorded on a specially designed form. Age, gender, period of clinical attendance, tooth preparation, location, size, quality and longevity of the restorations, restorative materials, adhesive systems, parafunctional habits, secondary caries, and maintenance therapy were the variables evaluated. Authors were blinded to the clinical assessments. Cohen's Kappa coefficient of the quality analysis of the margins and occlusal surfaces of the restorations ranged from 0.78 to 1. Data processing was performed using Epidat software, v3.1, developed by the Consellería de Sanidade de la Xunta de Galicia with the support of PAHO-WHO and SPSS software v13.0. If the number of complete values was too small, a Kaplan-Meier curve could not be used. Therefore the Fisher's exact test, Chi-square test, Kruskal-Wallis test, and Mann-Whitney non-parametric test were indicated to analyze significant differences.

RESULTS

At the time of the examinations, 103 (98%) restorations were in function, and 98 (95.1%) were rated as clinically successful. Two restorations failed (2%). The observed mean survival time of restorations that remained functional was 11 years and 7 months.

CONCLUSIONS

In the present report, direct light-activated composite resin restorations in posterior teeth showed a high clinical success rate and long-term mean survival time. These composite resins might be considered the material of choice to restore medium, extended, and in some clinical situations, large preparations in posterior teeth.

No-waiting dentine self-etch concept-Merit or hype

OBJECTIVE

A recently-launched universal adhesive, G-Premio Bond, provides clinicians with the alternative to use the self-etch technique for bonding to dentine without waiting for the adhesive to interact with the bonding substrate (no-waiting self-etch; Japanese brochure), or after leaving the adhesive undisturbed for 10s (10-s self-etch; international brochure). The present study was performed to examine in vitro performance of this new universal adhesive bonded to human coronal dentine using the two alternative self-etch modes.

METHODS

One hundred and ten specimens were bonded using two self-etch application modes and examined with or without thermomechanical cycling (10,000 thermal cycles and 240,000 mechanical cycles) to simulate one year of intraoral functioning. The bonded specimens were sectioned for microtensile bond testing, ultrastructural and nanoleakage examination using transmission electron microscopy. Changes in the composition of mineralised dentine after adhesive application were examined using Fourier transform infrared spectroscopy.

RESULTS

Both reduced application time and thermomechanical cycling resulted in significantly lower bond strengths, thinner hybrid layers, and significantly more extensive nanoleakage after thermomechanical cycling. Using the conventional 10-s application time improved bonding performance when compared with the no-waiting self-etch technique. Nevertheless, nanoleakage was generally extensive under all testing parameters employed for examining the adhesive.

CONCLUSION

Although sufficient bond strength to dentine may be achieved using the present universal adhesive in the no-waiting self-etch mode that does not require clinicians to wait prior to polymerisation of the adhesive, this self-etch concept requires further technological refinement before it can be recommended as a clinical technique.

CLINICAL SIGNIFICANCE

Although the surge for cutting application time to increase user friendliness remains the most frequently sought conduit for advancement of dentine bonding technology, the use of the present universal adhesive in the no-waiting self-etch mode may not represent the best use of the adhesive.

Substantivity of Carbodiimide Inhibition on Dentinal Enzyme Activity over Time

The use of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide HCl (EDC) has recently been investigated for its effectiveness in the prevention of collagen degradation over time and the improvement of resin-dentin bond durability. The objective of the present study was to evaluate the effects of a 0.3 M EDC-containing conditioner on endogenous enzymatic activities within the hybrid layer (HL) created by a self-etch or an etch-and-rinse adhesive after 1 y. The activity within the HL was examined using in situ zymography and confocal laser scanning microscopy after 24 h or 1-y storage in artificial saliva. Dentin specimens were bonded with Clearfil SE Bond (CSE) or XP Bond (XPB). For CSE, the self-etching primer was applied and treated with 0.3 M EDC for 1 min, and then the bonding agent was applied. For XPB, dentin was etched and treated with 0.3 M EDC for 1 min and then bonded with the primer-bonding agent. Control specimens were prepared without EDC treatment. Slices containing the adhesive-dentin interface were covered with fluorescein-conjugated gelatin and observed with a multiphoton confocal microscope. Fluorescence intensity emitted by hydrolyzed fluorescein-conjugated gelatin was quantified, and the amount of gelatinolytic activity was represented by the percentage of green fluorescence emitted within the HL. After 24 h of storage, enzymatic activity was detected by in situ zymography within the HLs of both tested adhesives, with XPB higher than CSE ( P < 0.05). Almost no fluorescence signal was detected when specimens were pretreated with EDC compared to controls ( P < 0.05). After 1 y of storage, enzymatic activities significantly increased for all groups (excluding XPB control) compared to 24-h storage ( P < 0.05), with EDC pretreated specimens exhibiting significantly lower activity than controls ( P < 0.05). The present study showed, for the first time, that the use of EDC for both the self-etch and the etch-and-rinse approaches results in the reduction but not complete inhibition of matrix-bound collagenolytic enzyme activities over time in the HL.

Chlorhexidine-Loaded Amorphous Calcium Phosphate Nanoparticles for Inhibiting Degradation and Inducing Mineralization of Type I Collagen

A major shortcoming of contemporary dentin adhesives is their limited durability. Exposed collagen fibrils within the bonding interface are degraded by matrix metalloproteinases (MMPs), resulting in aging of the resin-dentin bond. In this study, chlorhexidine-loaded amorphous calcium phosphate (ACP) nanoparticles were synthesized to induce the mineralization of collagen fibrils. The nanoparticles sustainably released chlorhexidine to inhibit MMPs during mineralization. Three types of ACP nanoparticles were prepared: N-ACP containing no chlorhexidine, C-ACP containing chlorhexidine acetate, and G-ACP containing chlorhexidine gluconate, which had a higher drug-loading than C-ACP. Scanning and transmission electron microscopy indicated that the synthesized nanoparticles had diameters of less than 100 nm. Some had diameters of less than 40 nm, which was smaller than the width of gap zones in the collagen fibrils. Energy dispersive X-ray spectroscopy, Fourier-transform infrared spectroscopy, and high performance liquid chromatography confirmed the presence of chlorhexidine in the nanoparticles. X-ray diffraction confirmed that the nanoparticles were amorphous. The drug loading was 0.11% for C-ACP and 0.53% for G-ACP. In vitro release profiles indicated that chlorhexidine was released sustainably via first-order kinetics. Released chlorhexidine inhibited the degradation of collagen in human dentine powder, and its effect lasted longer than that of pure chlorhexidine of the same concentration. The ACP could induce the mineralization of self-assembled type I collagen fibrils. The chlorhexidine-loaded ACP nanoparticles sustainably released chlorhexidine and ACP under appropriate conditions. This is useful for inhibiting degradation and inducing the mineralization of dentine collagen fibrils.

The effect of double-coating and times on the immediate and 6-month dentin bonding of universal adhesives

OBJECTIVE

The purpose of this study was to evaluate the effect of double-application coats and times on microtensile bond strength (μTBS) and adhesive-dentin interfaces created by dentin adhesive systems after 6 months of storage in water.

MATERIALS AND METHODS

Two-hundred sixteen extracted non-carious human third molars were selected for the study. Single-Bond Universal (SU) and All-Bond Universal (AU), Adper Easy One (Eo) Self-Etch adhesive and Adper Single-Bond 2 (Sb) etch-and-rinse adhesive were applied to a flat dentin surface using three methods (1): dentin adhesives were applied as recommended by the manufacturers; (2): two consecutive coats of dentin adhesives were applied before photo-polymerization; and (3): a single coat of adhesive was applied but with twice the manufacturers recommended application time. Microtensile bond strength was determined either immediately or after 6 months of water storage. Data were analyzed using one-way analysis of variance and Tukey's post-hoc tests.

RESULTS

At 24 h, groups 1, 2, and 3 exhibited statistically similar results for all dentin adhesive systems. For AU-Er, group 3 showed significantly higher bond strength than all group of AU-Se after 6 months.

CONCLUSION

Universal adhesives seemed more stable against water degradation than traditional two-step etch-and-rinse and all-in-one systems within the 6-month period.

[Progress on matrix metalloproteinase inhibitors]

Continuing advances in dentin bonding technology and adhesives revolutionized bonding of resin-based composite restorations. However, hybrid layers created by contemporary dentin adhesives present imperfect durability, and degradation of collagen matrix by endogenous enzymes is a significant factor causing destruction of hybrid layers. Bond durability can be improved by using enzyme inhibitors to prevent collagen degradation and to preserve integrity of collagen matrix. This review summarizes progress on matrix metalloproteinase inhibitors (including chlorhexidine, ethylenediaminetetraacetic acid, quaternary ammonium salt, tetracycline and its derivatives, hydroxamic acid inhibitors, bisphosphonate derivative, and cross-linking agents) and suggests prospects for these compounds.

Novel dental adhesive with triple benefits of calcium phosphate recharge, protein-repellent and antibacterial functions

OBJECTIVE

A new adhesive containing nanoparticles of amorphous calcium phosphate (NACP) with calcium (Ca) and phosphate (P) ion rechargeability was recently developed; however, it was not antibacterial. The objectives of this study were to: (1) develop a novel adhesive with triple benefits of Ca and P ion recharge, protein-repellent and antibacterial functions via dimethylaminohexadecyl methacrylate (DMAHDM) and 2-methacryloyloxyethyl phosphorylcholine (MPC); and (2) investigate dentin bond strength, protein adsorption, Ca and P ion concentration, microcosm biofilm response and pH properties.

METHODS

MPC, DMAHDM and NACP were mixed into a resin consisting of ethoxylated bisphenol A dimethacrylate (EBPADMA), pyromellitic glycerol dimethacrylate (PMGDM), 2-hydroxyethyl methacrylate (HEMA) and bisphenol A glycidyl dimethacrylate (BisGMA). Protein adsorption was measured using a micro bicinchoninic acid method. A human saliva microcosm biofilm model was tested on resins. Colony-forming units (CFU), live/dead assay, metabolic activity, Ca and P ion concentration and biofilm culture medium pH were determined.

RESULTS

The adhesive with 5% MPC+5% DMAHDM+30% NACP inhibited biofilm growth, reducing biofilm CFU by 4 log, compared to control (p<0.05). Dentin shear bond strengths were similar (p>0.1). Biofilm medium became a Ca and P ion reservoir having ion concentration increasing with NACP filler level. The adhesive with 5% MPC+5% DMAHDM+30% NACP maintained a safe pH>6, while commercial adhesive had a cariogenic pH of 4.

SIGNIFICANCE

The new adhesive with triple benefits of Ca and P ion recharge, protein-repellent and antibacterial functions substantially reduced biofilm growth, reducing biofilm CFU by 4 orders of magnitude, and yielding a much higher pH than commercial adhesive. This novel adhesive is promising to protect tooth structures from biofilm acids. The method of using NACP, MPC and DMAHDM is promising for application to other dental materials to combat caries.

Quaternary ammonium-based biomedical materials: State-of-the-art, toxicological aspects and antimicrobial resistance

Microbial infections affect humans worldwide. Many quaternary ammonium compounds have been synthesized that are not only antibacterial, but also possess antifungal, antiviral and anti-matrix metalloproteinase capabilities. Incorporation of quaternary ammonium moieties into polymers represents one of the most promising strategies for preparation of antimicrobial biomaterials. Various polymerization techniques have been employed to prepare antimicrobial surfaces with quaternary ammonium functionalities; in particular, syntheses involving controlled radical polymerization techniques enable precise control over macromolecular structure, order and functionality. Although recent publications report exciting advances in the biomedical field, some of these technological developments have also been accompanied by potential toxicological and antimicrobial resistance challenges. Recent evidenced-based data on the biomedical applications of antimicrobial quaternary ammonium-containing biomaterials that are based on randomized human clinical trials, the golden standard in contemporary medicinal science, are included in the present review. This should help increase visibility, stimulate debates and spur conversations within a wider scientific community on the implications and plausibility for future developments of quaternary ammonium-based antimicrobial biomaterials.

Fatigue testing of biomaterials and their interfaces

OBJECTIVE

The objective of this article is to describe the importance of fatigue to the success of restorative dentistry, with emphasis on the methods for evaluating the fatigue properties of materials in this field, and the durability of their bonded interfaces.

METHODS

The stress-life fatigue and fatigue crack growth approaches for evaluating the fatigue resistance of dental biomaterials are introduced. Emphasis is placed on in vitro studies of the hard tissue foundation, restorative materials and their bonded interfaces. The concept of durability is then discussed, including the effects of conventional "mechanical" fatigue combined with pervasive threats of the oral environment, including variations in pH and the activation of endogenous dentin proteases.

RESULTS

There is growing evidence that fatigue is a principal contributor to the failure of restorations and that measures of static strength, used in qualifying new materials and practices, are not reflective of the fatigue performance. Results of selected studies show that the fundamental steps involved in the placement of restorations, including the cutting of preparations and etching, cause a significant reduction to the fatigue strength of the hard tissue foundation. In regards to the bonded interface, results of studies focused on fatigue resistance highlight the importance of the hybridization of resin tags, and that a reduction in integrity of the dentin collagen is detrimental to the durability of dentin bonds.

SIGNIFICANCE

Fatigue should be a central concern in the development of new dental materials and in assessing the success of restorative practices. A greater recognition of contributions from fatigue to restoration failures, and the development of approaches with closer connection to in vivo conditions, will be essential for extending the definition of lifelong oral health.

Epigallocatechin-3-gallate and Epigallocatechin-3-O-(3-O-methyl)-gallate Enhance the Bonding Stability of an Etch-and-Rinse Adhesive to Dentin

This study evaluated epigallocatechin-3-gallate (EGCG) and epigallocatechin-3-O-(3-O-methyl)-gallate (EGCG-3Me) modified etch-and-rinse adhesives (Single Bond 2, SB 2) for their antibacterial effect and bonding stability to dentin. EGCG-3Me was isolated and purified with column chromatography and preparative high performance liquid chromatography. EGCG and EGCG-3Me were incorporated separately into the adhesive SB 2 at concentrations of 200, 400, and 600 µg/mL. The effect of cured adhesives on the growth of Streptococcus mutans (S. mutans) was determined with scanning electron microscopy and confocal laser scanning microscopy; the biofilm of bacteria was further quantified via optical density 600 values. The inhibition of EGCG and EGCG-3Me on dentin-originated collagen proteases activities was evaluated with a proteases fluorometric assay kit. The degree of conversion (DC) of the adhesives was tested with micro-Raman spectrum. The immediate and post-thermocycling (5000 cycles) bond strength was assessed through Microtensile Bond Strength (MTBS) test. Cured EGCG/EGCG-3Me modified adhesives inhibit the growth of S. mutans in a concentration-dependent manner. The immediate MTBS of SB 2 was not compromised by EGCG/EGCG-3Me modification. EGCG/EGCG-3Me modified adhesive had higher MTBS than SB 2 after thermocycling, showing no correlation with concentration. The DC of the adhesive system was affected depending on the concentration of EGCG/EGCG-3Me and the depth of the hybrid layer. EGCG/EGCG-3Me modified adhesives could inhibit S. mutans adhesion to dentin–resin interface, and maintain the bonding stability. The adhesive modified with 400 µg/mL EGCG-3Me showed antibacterial effect and enhanced bonding stability without affect the DC of adhesive.

Nanoleakage evaluation at adhesive-dentin interfaces by different observation methods

The purpose of this study was to evaluate the capability and characteristics of different nanoleakage observation methods, including light microscope (LM), field-emission scanning electron microscope (FESEM), transmission electron microscope (TEM), and confocal laser scanning microscope (CLSM). Dentin specimens were bonded with either an etch-and-rinse adhesive (SBMP) or a self-etch adhesive (GB), and prepared for nanoleakge evaluation according to different observation methods. LM, FESEM and CLSM results demonstrated that the SBMP group showed more interfacial nanoleakage than the GB group (p<0.05); by contrast, no significant difference was found in TEM results (p>0.05), however, TEM illustrated concrete nanoleakage forms or patterns. The results suggested that different observation methods might exhibit distinct images and a certain degree of variations in nanoleakage statistical results. Researchers should carefully design and calculate the optimum assembly in combination with qualitative and quantitative approaches to obtain objective and accurate nanoleakage evaluation.

Quercetin as a simple but versatile primer in dentin bonding

A quercetin/ethanol solution may serve as a simple but versatile primer to obtain desirable bonding stability and prevent secondary caries.

The remineralization effectiveness of PAMAM dendrimer with different terminal groups on demineralized dentin in vitro

The aim of this study was to examine the dentin remineralization extent that poly(amido amine) (PAMAM) induces quantitatively, and select the most effective kind of PAMAM with a certain terminal group for dentin remineralization, both for the first time.

Intrafibrillar mineralization of polyacrylic acid-bound collagen fibrils using a two-dimensional collagen model and Portland cement-based resins

The biomimetic remineralization of apatite-depleted dentin is a potential method for enhancing the durability of resin-dentin bonding. To advance this strategy from its initial proof-of-concept design, we sought to investigate the characteristics of polyacrylic acid (PAA) adsorption to desorption from type I collagen and to test the mineralization ability of PAA-bound collagen. Portland cement and β-tricalcium phosphate (β-TCP) were homogenized with a hydrophilic resin blend to produce experimental resins. The collagen fibrils reconstituted on nickel (Ni) grids were mineralized using different methods: (i) group I consisted of collagen treated with Portland cement-based resin in simulated body fluid (SBF); (ii) group II consisted of PAA-bound collagen treated with Portland cement-based resin in SBF; and (iii) group III consisted of PAA-bound collagen treated with β-TCP-doped Portland cement-based resin in deionized water. Intrafibrillar mineralization was evaluated using transmission electron microscopy. We found that a carbonyl-associated peak at pH 3.0 increased as adsorption time increased, whereas a hydrogen bond-associated peak increased as desorption time increased. The experimental resins maintained an alkaline pH and the continuous release of calcium ions. Apatite was detected within PAA-bound collagen in groups II and III. Our results suggest that PAA-bound type I collagen fibrils can be mineralized using Portland cement-based resins.

Epigallocatechin-3-gallate increased the push out bond strength of an epoxy resin sealer to root dentin

This study aimed to investigate the effect of epigallocatechin-3-gallate (EGCG) from green tea extract on the push out bond strength of an epoxy resin sealer to root dentin. Seventy single root canal premolars were decoronated and instrumented. The roots were randomly irrigated with different final irrigation protocols (n=16): 17%EDTA (EDTA), 17%EDTA followed by 2.5%NaOCl (EDTA+NaOCl), 17%EDTA followed by 1 mg/mL EGCG (EDTA+EGCG) and 1 mg/mL EGCG (EGCG). Other six root canals were received only 2.5%NaOCl as a control group. One root from each group (n=1) was excluded and prepared for SEM investigation. All root canals were then obturated and horizontally sectioned to perform the push out test. EDTA+EGCG group had the highest bond strength (p<0.05). EGCG group showed higher bond strength than EDTA group (p<0.05). The use of EGCG as a final irrigant significantly increased the push out bond strength of an epoxy resin sealer to root dentin.

Influence of EDC on Dentin-Resin Shear Bond Strength and Demineralized Dentin Thermal Properties

This study aimed to evaluate the bonding strength and thermal properties of demineralized dentin with and without EDC treatment. Sound human molars were randomly divided into seven treatment groups (n = 20): control, 80% ethanol, and five EDC ethanol solutions (0.01–1.0 M). In each group, 16 samples were used for bond strength assessment and 4 samples were used for scanning electron microscopy (SEM) analysis. A further 70 intact molars were used to obtain a fine demineralized dentin powder, treated with the same solutions and were evaluated the crosslink degree by ninhydrin test and denaturation temperature (T_d) by differential scanning calorimetry. EDC-treated specimens (<1.0 M) had a higher bond strength, especially 0.3 and 0.5 M group, than the control counterpart. There was a significant drop in bond strength of 1.0 M EDC group. SEM revealed a homogeneous and regular interface under all treatments. EDC treatment significantly increased the demineralized dentin cross-link degree and T_d compared with the control and ethanol treatments. The 0.3 and 0.5 M treatments showed the highest cross-link degree and T_d. In terms of mechnical and theramal properties consideration, 0.3 and 0.5 M EDC solutions may be favorable for when applied with etch-and-rinse adhesives, but it is still needed further long-term study.

Poly (amido amine) and nano-calcium phosphate bonding agent to remineralize tooth dentin in cyclic artificial saliva/lactic acid

The objectives of this study were to develop a novel method to remineralize dentin lesions, and investigate the remineralization effects of poly (amido amine) (PAMAM) dendrimer plus a bonding agent with nanoparticles of amorphous calcium phosphate (NACP) in a cyclic artificial saliva/lactic acid environment for the first time. Dentin lesions were produced via phosphoric acid. Four groups were tested: (1) dentin control, (2) dentin with PAMAM, (3) dentin with NACP bonding agent, and (4) dentin with PAMAM plus NACP bonding agent. Specimens were treated with cyclic artificial saliva/lactic acid. The remineralized dentin was examined using scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), hardness and attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR). NACP bonding agent yielded a dentin shear bond strength similar to commercial controls (Prime & Bond NT, Dentsply; Scotchbond Multi-purpose, 3M) (p>0.1). Increasing NACP in bonding agent from 0 to 40% did not affect bond strength. NACP bonding agent neutralized the acid and released Ca ions with concentrations of 4 to 20mmol/L, and P ions of 2 to 9mmol/L. PAMAM or NACP bonding agent alone achieved slight remineralization. The PAMAM+NACP group achieved the greatest dentin remineralization p<0.05). At 20days, PAMAM+NACP increased the hardness of pre-demineralized dentin to reach the normal dentin hardness (p>0.1). In conclusion, superior remineralization of PAMAM+NACP bonding agent was demonstrated for the first time. PAMAM+NACP bonding agent induced dentin remineralization under acid challenge, when conventional remineralization methods such as PAMAM alone did not work well. The novel PAMAM+NACP bonding agent method is promising to improve the longevity of resin-dentin bonds, inhibit caries, and protect teeth.

In vitro remineralization of hybrid layers using biomimetic analogs

Resin-dentin bond degradation is a major cause of restoration failures. The major aim of the current study was to evaluate the impact of a remineralization medium on collagen matrices of hybrid layers of three different adhesive resins using nanotechnology methods. Coronal dentin surfaces were prepared from freshly extracted premolars and bonded to composite resin using three adhesive resins (FluoroBond II, Xeno-III-Bond, and iBond). From each tooth, two central slabs were selected for the study. The slabs used as controls were immersed in a simulated body fluid (SBF). The experimental slabs were immersed in a Portland cement-based remineralization medium that contained two biomimetic analogs (biomineralization medium (BRM)). Eight slabs per group were retrieved after 1, 2, 3, and 4 months, respectively and immersed in Rhodamine B for 24 h. Confocal laser scanning microscopy was used to evaluate the permeability of hybrid layers to Rhodamine B. Data were analyzed by analysis of variance (ANOVA) and Tukey's honest significant difference (HSD) tests. After four months, all BRM specimens exhibited a significantly smaller fluorescent area than SBF specimens, indicating a remineralization of the hybrid layer (P≤0.05). A clinically applicable biomimetic remineralization delivery system could potentially slow down bond degradation.

Bioactive Polymeric Nanoparticles for Periodontal Therapy

Aims

to design calcium and zinc-loaded bioactive and cytocompatible nanoparticles for the treatment of periodontal disease.

Methods

PolymP-nActive nanoparticles were zinc or calcium loaded. Biomimetic calcium phosphate precipitation on polymeric particles was assessed after 7 days immersion in simulated body fluid, by scanning electron microscopy attached to an energy dispersive analysis system. Amorphous mineral deposition was probed by X-ray diffraction. Cell viability analysis was performed using oral mucosa fibroblasts by: 1) quantifying the liberated deoxyribonucleic acid from dead cells, 2) detecting the amount of lactate dehydrogenase enzyme released by cells with damaged membranes, and 3) by examining the cytoplasmic esterase function and cell membranes integrity with a fluorescence-based method using the Live/Dead commercial kit. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests.

Results

Precipitation of calcium and phosphate on the nanoparticles surfaces was observed in calcium-loaded nanoparticles. Non-loaded nanoparticles were found to be non-toxic in all the assays, calcium and zinc-loaded particles presented a dose dependent but very low cytotoxic effect.

Conclusions

The ability of calcium-loaded nanoparticles to promote precipitation of calcium phosphate deposits, together with their observed non-toxicity may offer new strategies for periodontal disease treatment.

Zinc-Containing Restorations Create Amorphous Biogenic Apatite at the Carious Dentin Interface: A X-Ray Diffraction (XRD) Crystal Lattice Analysis

The aim of this research was to assess the ability of amalgam restorations to induce amorphous mineral precipitation at the caries-affected dentin substrate. Sound and caries-affected dentin surfaces were subjected to both Zn-free and Zn-containing dental amalgam restorations. Specimens were submitted to thermocycling (100,000 cycles/5°C-55°C, 3 months). Dentin surfaces were studied by atomic force microscopy (nanoroughness), X-ray diffraction, field emission scanning electron microscopy, and energy-dispersive analysis, for physical and morphological surface characterization. Zn-containing amalgam placement reduced crystallinity, crystallite size, and grain size of calcium phosphate crystallites at the dentin surface. Both microstrain and nanoroughness were augmented in caries-affected dentin restored with Zn-containing amalgams. Caries-affected dentin showed the shortest mineral crystallites (11.04 nm), when Zn-containing amalgams were used for restorations, probably leading to a decrease of mechanical properties which might favor crack propagation and deformation. Sound dentin restored with Zn-free amalgams exhibited a substantial increase in length of grain particles (12.44 nm) embedded into dentin crystallites. Zn-containing amalgam placement creates dentin mineralization and the resultant mineral was amorphous in nature. Amorphous calcium phosphate provides a local ion-rich environment, which is considered favorable for in situ generation of prenucleation clusters, promotong further dentin remineralization.

Microleakage of Lithium Disilicate Crown Margins Finished on Direct Restorative Materials

OBJECTIVE

For some esthetic clinical situations, it is necessary to finish crown margins on direct restorative materials to preserve tissue integrity, bonding integrity, and biological width. The purpose of this research was to investigate microleakage at the interface between bonded lithium disilicate crowns and various direct restorative materials in a class III and class V position.

METHODS AND MATERIALS

Class III or class V restorations were prepared on one side of extracted incisors with either Tetric EvoCeram, Tetric Evoceram Bulk, Fuji II LC, or Tetric Evoflow. The teeth were prepared for and received a lithium disilicate crown. After load fatiguing, the specimens were thermo-cycled with a fuchsin dye and sectioned. The depth and area of dye penetration were measured with a dimensional grid in micrometers using stereomicroscopy and reported as mean dye depth and area (μm) ± SD. The comparison of multiple categorical independent variables with ratio scale dependent variables was evaluated with an analysis of variance and Tukey's post hoc analysis.

RESULTS

A statistically significant higher dye penetration was noted for all treatment groups compared with the positive control (side opposite the restoration after sagittal sectioning was used as positive control) regardless of material or placement area (p<0.05). In comparing treatment groups, the Tetric EvoFlow experienced a statistically higher dye penetration than did the other treatment groups regardless of material or placement area (p<0.05). There was no statistically significant difference between the Tetric EvoCeram, Tetric Evoceram Bulk, and Fuji II LC materials regardless of placement area (p>0.05).

CONCLUSIONS

Within the limitations of this study, it can be concluded that flowable composite materials as finish lines that interact with resin cements could lead to exacerbated interfacial degradation. Finishing lithium disilicate all-ceramic crowns on flowable resin composite materials in the esthetic zone should be used with caution. If necessary, finishing lithium disilicate all-ceramic crowns on nanofilled resin composite or resin-modified glass ionomer materials seems to provide the least dye penetration depth and area.

Comparative evaluation of the effect of chlorhexidine and Aloe barbadensis Miller (Aloe vera) on dentin stabilization using shear bond testing

INTRODUCTION

The main objective of adhesive dentistry is to create an effective, durable union between the tooth structure and restorative material. However, degradation of adhesive dentine interface remains largely responsible for the relatively short lifetime of tooth colored resin restoration.

AIM

The aim of the study is to compare the dentin collagen stabilization property of Chlorhexidine (CHX) and Aloe barbadensis Miller using shear bond strength testing.

MATERIALS AND METHODS

Occlusal reduction was done in sixty extracted human mandibular molars to expose the mid coronal dentin and divided into three groups n = 20. Following the surface pretreatment (Group 1 = control, Group 2 = CHX, Group 3 = Aloevera), dentine bonding agent and composite resin were applied and cured. The specimens were then subjected to shear bond strength testing.

RESULTS

From the results analyzed, it was noted that there was statistically significant difference between the groups Control and CHX and Control and A. barbadensis Miller (P < 0.05), specifically the values of Control < CHX and Control < A. barbadensis Miller (P < 0.05). However, there was no statistically significant difference between CHX and A. barbadensis Miller (P > 0.05). Hence, the following result for the shear bond strengths to dentin was obtained: Control < CHX ≈ A. barbadensis Miller.

CONCLUSION

CHX and A. barbadensis Miller, as pretreatment agents of acid demineralized dentin collagen, has no adverse effect on the immediate shear bond strength of a two-step etch and rinse adhesive to dentin.

Caries-resistant bonding layer in dentin

The present study examined the mechanism for caries resistance and the pulp responses in vital teeth following the use of the augmented-pressure adhesive displacement technique. Dentin adhesives were applied to the surface of sound dentin disks in 4 experimental groups: non-antibacterial adhesive and gentle adhesive displacement (N-G), non-antibacterial adhesive and augmented-pressure adhesive displacement (N-H), antibacterial adhesive and gentle adhesive displacement (A-G), antibacterial adhesive and augmented-pressure adhesive displacement (A-H). The depth of demineralization induced by biological or chemical demineralization models was measured using confocal laser scanning microscopy and analyzed with two-way ANOVA. Pulp responses of vital dog's teeth to the augmented-pressure adhesive displacement technique were evaluated using light microscopy. Depth of demineralization was significantly affected by "adhesive type" and "intensity of adhesive displacement" for biological demineralization. For chemical demineralization, only "intensity of adhesive displacement" showed significant influence on lesion depth. Pulp response of 0.1, 0.2 and 0.3 MPa groups showed only moderate disorganization of the odontoblast layer at 24 hours that completely re-organized after 3 weeks. Augmented-pressure adhesive displacement improves the caries resistance property of bonded dentin and does not cause irreversible pulpal damage to vital teeth when the air pressure employed is equal or smaller than 0.3 MPa.

Experimental primers containing synthetic and natural compounds reduce enzymatic activity at the dentin-adhesive interface under cyclic loading

OBJECTIVE

To evaluate the effect of experimental primers (chlorhexidine, enriched mixture of proanthocyanidins, and doxycycline) on the adhesive properties and gelatinolytic activity at dentin-resin interfaces of occlusal Class I restorations.

METHODS

The inactivation of enzymes by the experimental primers was assessed by fluorescence assay and gelatin zymography. To assess the adhesive properties, occlusal Class I cavities were prepared in sound human molars, etched with phosphoric acid and restored with one of the primers and an etch-and-rinse adhesive system (Adper Single Bond Plus-3M ESPE). After the restorative procedures, specimens were divided into two subgroups (n=6) consisting of storage in incubation buffer or axial cyclic loading at 50N and 1,000,000 cycles. Then, the specimens were sectioned and slices were assigned to in situ zymography assay and microtensile bond strength (TBS) test.

RESULTS

Fluorescence assay and gelatin zymography revealed that the experimental primers inactivated rMMPs. In situ zymography (2-way ANOVA, Tukey, p<0.05) showed that cyclic loading increased the gelatinolytic activity at the resin-dentin interface and the experimental primers decreased the gelatinolytic activity at the adhesive interface. The experimental primers had no significant effects on dentin-adhesive bond strengths with or without cyclic loading (2-way ANOVA, p>0.05).

SIGNIFICANCE

The use of experimental primers impaired the enzymatic activity at the dentin-adhesive interface after cyclic loading and the activity of rMMPs. Cyclic loading did not have a significant effect on the bond strength.

Novel Cavity Disinfectants Containing Quaternary Ammonium Monomer Dimethylaminododecyl Methacrylate

This study was set to assess the possible benefits of novel cavity disinfectants with 5% dimethylaminododecyl methacrylate (DMADDM); and compare the effectiveness of saliva microbial-aging method with water-aging in measuring the changing of resin-dentin bond strength. Three cavity disinfectants were tested: 0.2% Chlorhexidine (CHX); 5% DMADDM; and 5% DMADDM + 0.2% CHX. Microtensile bond strength (μTBS) test was performed after microbial-aging with saliva microbial or water aging for one month. Hydroxyproline (HYP), the production of collagen degradation, was measured spectrophotometrically. Additionally, the antibacterial effects of each reagent were evaluated. The 5% DMADDM exerted the least percentage of resin-dentin bond strength loss after one month microbial-aging (p < 0.05). There were no statistically significant differences of bond strength decrease after one month water aging among the tested groups (p > 0.05). Microbial-aging method yield more drop of bond strength than water aging in all groups except 5% DMADDM (p < 0.05). Meanwhile, 5% DMADDM had the same matrix metalloproteinases (MMPs) inhibitory effects as the other two agents (p > 0.05), but much stronger antibacterial capability than 0.2% CHX (p < 0.05). This indicated that a cavity disinfectant with 5% DMADDM is promising for improving the stability of resin-dentin bonds in appearance of saliva biofilm; and the saliva microbial-aging method is more promising for studying the durability of resin-dentin bonds than water aging.

Effect of Lactic Acid on Microleakage of Class V Low-Shrinkage Composite Restorations

OBJECTIVES

To assess the effect of lactic acid (LA) on microleakage of silorane-based composite restorations and methacrylate-based composites with self-etch and etch-and-rinse bonding systems.

MATERIALS AND METHODS

Class V cavities were prepared in 120 extracted human teeth, divided into four groups and restored as follows: 1. Silorane-based composite+P90 adhesive system (P90); 2. Filtek Z250+SE Bond (Z250SE); 3. Filtek Z350+SE Bond (Z350SE) and 4. Filtek Z250+Single Bond (Z250SB). Half of the samples in each group were immersed in LA and the other half in distilled water (DW) for seven days. Degree of microleakage was determined by dye penetration. Data were analyzed using Kruskal Wallis and Mann Whitney-U tests (type 1 error was considered 0.05 for primary and 0.017 for post-hoc tests).

RESULTS

No significant difference was found in microleakage between LA and DW groups. The difference among groups in gingival margin microleakage was significant (P<0.05). The highest degree of microleakage was seen in Z250SB; which was significantly higher than Z250SE (DW: P=0.012 and LA: P=0.002) and Z350SE (DW: P=0.002 and LA: P=0.014). Microleakage was not significantly different between Z250SE and Z350SE (DW: P=0.683 and LA: P=0.533). The degree of microleakage of P90 in both media was lower than Z250SB and higher than that of Z250SE and Z350SE; but these differences were not significant.

CONCLUSIONS

Immersion in LA has no effect on microleakage of class V composite restorations regardless of the type of composite and adhesive system. At gingival margins, the highest microleakage occurred in Z250SB followed by P90 and self-etch groups.

Six-year clinical performance of etch-and-rinse and self-etch adhesives

OBJECTIVE

To evaluate the 6-year clinical performance of Xeno IV, Xeno III, and XP Bond adhesives in the restoration of non-carious cervical lesions (NCCLs).

METHODS

This was a randomized controlled clinical trial where 39 participants met the inclusion/exclusion criteria and were enrolled. Lesions restored were notch-shaped NCCLs. Prior to adhesive procedures, NCCLs were roughened. No enamel bevel was placed and no mechanical retention was created. Adhesive systems were applied following manufacturer's instructions and the NCCLs were restored with composite resin (TPH(3)). Restorations were finished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, and secondary caries using modified USPHS criteria. Descriptive statistics were performed. Logistic regression models were performed for each outcome separately with compound symmetry correlation structure where teeth were clustered by participants. All analyses were conducted using SAS 9.2.

RESULTS

The 6-year recall rate was 77.5% of the restorations (76.9% of the participants). No statistical differences were found between adhesives for retention, marginal discoloration, and marginal adaptation. Restorations failed by loss of retention (16.7%, 27.6%, and 11.8% of Xeno IV, Xeno III, and XP Bond restorations, respectively) and marginal discoloration (7.4% of Xeno IV restorations). For every unit increase in restoration volume it was 1.31 (95%C.I. 1.05, 1.63, P=0.01) times more likely that the restoration retention would be maintained.

SIGNIFICANCE

The tested adhesive systems presented similar clinical performance after six years of service, with annual failure rates of 2.8%, 4.6%, and 2.0% for Xeno IV, Xeno III, and XP Bond, respectively.

Radiographic, antibacterial and bond-strength effects of radiopaque caries tagging

Selectively excavated carious lesions remain radiographically detectable. Radiopaque tagging could resolve the resulting diagnostic uncertainty. We aimed to evaluate if tagging depends on lesions depths, is antibacterial, or affects dentin bond-strengths. Artificial lesions (depth-range: 152-682 μm, n = 34/group) were induced in human dentin samples, evaluated using wavelength-independent microradiography, treated with one of two tagging materials (70% SnCl2, 30% SnF2) and re-evaluated. To evaluate antimicrobial effects, 40 dentin samples were submitted to a Lactobacillus rhamnosus invasion-model. Infected samples were treated with placebo, 0.2% chlorhexidine, SnCl2, SnF2 (n = 10/group). Dentin was sampled and colony-forming units/mg determined. Micro-tensile bond-strengths of adhesive restorations (OptiBond FL, Filtek Z250) to tagged or untagged, sound and carious dentin were assessed (n = 12/group). Tagged surfaces were evaluated microscopically and via energy-dispersive X-ray-spectroscopy (EDS). Tagging effects of both materials decreased with increasing lesion depths (p < 0.001). Un-/chlorhexidine-treated dentin contained significantly more viable bacteria (median 7.3/3.7 × 10(5) CFU/mg) than tagged dentin (no CFU detectable, p < 0.001). Tagging decreased bond strengths (p < 0.001) on sound (-22%/-33% for SnCl2/SnF2) and carious dentin (-50%/-54%). This might be due to widespread tin chloride or fluoride precipitation, as detected via microscopy and EDS. While radiopaque tagging seems beneficial, an optimized application protocol needs to be developed prior clinical use.

[Comparative in vitro evaluation of modern glass ionomer cements for adhesion strength and fluoride release]

The study proved similar adhesion strength and fluoride release level in aqueous extracts of glass ionomer cements Cemion (VladMiVa, Russia), Glassin Rest (Omega-Dent, Russia), Cemfil 10 (StomaDent, Russia) and Fuji VIII (GC Corporation, Japan). Despite of close concentrations of fluoride in glasses, the rate of fluoride release in water from calcium and calcium-barium glasses is much higher than that of strontium glasses.