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

Inhibition of hybrid layer degradation by cavity pretreatment: Meta- and trial sequential analysis

OBJECTIVES

Inhibition of hybrid layer degradation, for example via inhibition of matrix-metallo-proteinases (MMP) could reduce risk of retention loss and failure of adhesively placed restorations. This systematic review investigated such inhibitory pretreatment qualitatively and via meta- and trial-sequential-analysis.

DATA SOURCES

We included randomized clinical trials comparing degradation inhibitory cavity pretreatment versus no, placebo or alternative treatments prior adhesive placement of resin-based restorations. Trials reporting retention loss or failure (graded bravo-delta in USPHS or similar criteria) were included. Trial selection, data extraction, and risk of bias assessment were conducted independently by two reviewers. Fixed- or random-effects intention-to-treat, per-protocol, and scenario meta-analyses were performed, and trial-sequential-analysis used to control for risk of random errors. Electronic databases (PubMed, Embase, Cochrane CENTRAL) were systematically screened, and hand searches and cross-referencing performed.

STUDY SELECTION

The ten included trials involved 208 patients (695 cavities) and used chlorhexidine (seven trials), ethanol-wet-bonding (two trials), and quaternary ammonium compounds for degradation inhibition. All but one trial had high risk of bias. Follow-up ranged from 6 to 36 months. Risk of retention loss was not significantly decreased after pretreatment (per-protocol OR [95% CI] 1.37 [0.68/2.77], intention-to-treat: 1.25 [0.76/2.04]). This was found for risk of restoration failure as well (per-protocol: 0.86 [0.56/1.34], intention-to-treat: 1.22 [0.83/1.80]). Scenario analyses found great uncertainty introduced by attrition. According to trial sequential analysis, no firm evidence was reached.

CONCLUSIONS

There is insufficient evidence to recommend or refute degradation inhibitory cavity pretreatment prior adhesively placing resin-based restorations. This may change if teeth are followed-up for longer.

CLINICAL SIGNIFICANCE

Dentists can perform cavity pretreatments for inhibition of hybrid layer degradation, but a beneficial effect is not supported by sufficient evidence. The impact of further effects (e.g. disinfection, pulp-irritation) remains unclear.

NaF Inhibits Matrix-Bound Cathepsin-Mediated Dentin Matrix Degradation

Matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs) degrade the collagen fibrils of demineralized dentin. Sodium fluoride (NaF) has previously been shown to inhibit recombinant MMP-2 and MMP-9. This study aimed to evaluate the efficacy of NaF on the inhibition of dentin-bound MMPs and CCs. Dentin beams were completely demineralized in 10% phosphoric acid. The baseline total MMP activity and dry masses were measured. Beams were assigned to test groups based on similar MMP activity and dry mass (n = 10/group), and incubated in artificial saliva (control) or artificial saliva with NaF containing 6-238 mM fluoride for 1, 7 and 21 days. The dry mass loss and MMP activities were reassessed at each time point. The proteolytic activity was screened by gelatin zymography. ICTP and CTX released to the incubation medium were analyzed as indices of MMP and cathepsin K activity, respectively. The beams were examined under scanning electron microscopy. All NaF doses reduced the dry mass loss after 21 days (p < 0.05). NaF inhibition of the total MMP activity ranged between 5 and 80%. In gelatin zymography, the bands of MMP-2 and MMP-9 became less prominent with increasing NaF levels. NaF did not decrease the released ICTP (p > 0.05). Less CTX release was detected with F ≥179 mM (p < 0.05). CaF2-like minerals were observed on the beams. High levels of NaF may slow the degradation of the dentin matrix due to the inhibition of cathepsin K. Fluoride does not seem effective in the direct inhibition of proteolysis by dentin matrix-bound MMPs.

The effects of chlorhexidine and ethanol on push-out bond strength of fiber posts

CONTEXT

Irrigation of root canals with chlorhexidine (CHX) and ethanol is common practice to prevent root canal infection during postplacement. However, pretreatment with these solvents may interfere with the bond strength of posts.

AIMS

This study aimed to evaluate if root dentin pretreatment using CHX and/or ethanol influences the push-out bond strength of fiber-reinforced composite resin (FRCR) posts.

MATERIALS AND METHODS

Fifty space posts prepared in endodontically treated extracted human canine roots were randomly divided into five groups (n = 10) according to the dentin pretreatment: Distilled water (W); 1% CHX diacetate solution (1C); CHX diacetate + 99% ethanol (1CE); 99% ethanol (E); and 2% CHX digluconate solution (2C). After pretreatment, the adhesive system (Peak Universal Bond; Ultradent, South Jordan, UT, USA) was applied in the root dentin and the FRCR was cemented with resin cement. Then, horizontal slices of 2 mm were obtained from each root third and the push-out bond strength was assessed. Statistical analysis was done using analysis of variance (ANOVA) and Tukey's tests (P = 0.05).

RESULTS

At all thirds, 1CE and E groups presented similar push-out bond strength values (P > 0.05), which were higher than the other groups (P < 0.05). W, 1C, and 2C groups were similar (P > 0.05).

CONCLUSION

The root dentin pretreatment with ethanol, alone or mixed with CHX diacetate increased the bond strength of FRCR luted with resin cement.

Marginal Integrity of Bulk Versus Incremental Fill Class II Composite Restorations

Bulk-fill composites have been introduced to facilitate the placement of deep direct resin composite restorations. This study aimed at analyzing the cervical marginal integrity of bulk-fill vs incremental and open-sandwich class II resin composite restorations after thermomechanical cycling using replica scanning electron microscopy (SEM) and ranking according to the World Dental Federation (FDI) criteria. Box-only class II cavities were prepared in 91 maxillary premolars with the gingival margin placed 1 mm above and below the cemento-enamel junction. Eighty-four premolars were divided into self-etch and total-etch groups, then subdivided into six restorative subgroups (n=7): 1-Tetric Ceram HB (TC) was used incrementally and in the open-sandwich technique with 2-Tetric EvoFlow (EF) and 3-Smart Dentin Replacement (SD). Bulk-fill restoratives were 4-SonicFill (SF), 5-Tetric N-Ceram Bulk Fill (TN), and 6-Tetric EvoCeram Bulk Fill (TE). In subgroups 1-5, Tetric N-Bond self-etch and Tetric N-Bond total-etch adhesives were used, whereas in subgroup 6, AdheSE self-etch and ExciTE F total etch were used. One more group (n=7) was restored with Filtek P90 Low Shrink Posterior Restorative (P9) only in combination with its self-etch P90 System Adhesive. Materials were manipulated and light cured (20 seconds, 1600 mW/cm(2)), and restorations were artificially aged by thermo-occlusal load cycling. Polyvinyl-siloxane impressions were taken and poured with epoxy resin. Resin replicas were examined by SEM (200×) for marginal sealing, and percentages of perfect margins were analyzed. Moreover, samples were examined using loupes (3.5×) and explorers and categorized according to the FDI criteria. Results were statistically analyzed (SEM by Kruskal-Wallis test and FDI by chi-square test) without significant differences in either the replica SEM groups (p=0.848) or the FDI criteria groups (p>0.05). The best SEM results at the enamel margin were in TC+EF/total-etch and SF/total-etch and at the cementum margins were in SF/total-etch and TE/self-etch, while the worst were in TC/self-etch at both margins. According to FDI criteria, the best was TE/total-etch at the enamel margin, and the poorest was P9/self-etch at the cementum margin. Groups did not differ significantly, and there was a strong correlation in results between replica SEM and FDI ranking.

Effect of Minocycline on the Durability of Dentin Bonding Produced with Etch-and-Rinse Adhesives

OBJECTIVES

To evaluate the effect of minocycline and chlorhexidine pretreatment of acid-etched dentin on the longevity of resin-dentin bond strength (μTBS) and nanoleakage of two-step etch-and-rinse adhesives.

METHODS

Before application of Prime & Bond NT and Adper Single Bond 2 in occlusal dentin, the dentin surfaces were treated with 37% phosphoric acid, rinsed, air-dried, and rewetted with water (control group), 2% minocycline, or 2% chlorexidine digluconate. Composite buildups were constructed incrementally, and specimens were longitudinally sectioned to obtain bonded sticks (0.8 mm²) to be tested in tension (0.5 mm/min) immediately or after 24 months of water storage. For nanoleakage, two specimens of each tooth/period were immersed in the silver nitrate solution, photo-developed, and polished with SiC paper for analysis under energy-dispersive X-ray spectroscopy/scanning electron microscopy.

RESULTS

Reductions of the μTBS and increases in the nanoleakage were observed for both adhesives when the rewetting procedure was performed with water. Stable bonds were observed for the 2% minocycline and 2% chlorexidine digluconate groups after 24 months.

CONCLUSIONS

The use of 2% minocycline as pretreatment of acid-etched dentin is one alternative to retard the degradation of resin-dentin interfaces over a 24-month period as well as 2% chlorexidine digluconate.

Zinc-modified nanopolymers improve the quality of resin-dentin bonded interfaces

INTRODUCTION

Demineralized collagen fibers at the hybrid layer are susceptible to degradation. Remineralization may aid to improve bond longevity.

OBJECTIVES

The aim of the present study was to infiltrate zinc and calcium-loaded polymeric nanoparticles into demineralized dentin to facilitate hybrid layer remineralization.

MATERIALS AND METHODS

Zinc or calcium-loaded polymeric nanoparticles were infiltrated into etched dentin, and Single Bond Adhesive was applied. Bond strength was tested after 24 h and 6 months storage. Nanomechanical properties, dye-assisted confocal laser microscopy, and Masson's trichrome staining evaluation were performed to assess for the hybrid layer morphology, permeability, and remineralization ability after 24 h and 3 months. Data were analyzed by ANOVA and Student-Newman-Keuls multiple comparisons tests (p < 0.05).

RESULTS

Immediate bond strength was not affected by nanoparticles infiltration (25 to 30 MPa), while after 6 months, bond strengths were maintained (22 to 24 MPa). After 3 months, permeability occurred only in specimens in which nanoparticles were not infiltrated. Dentin remineralization, at the bottom of the hybrid layer, was observed in all groups. After microscopy analysis, zinc-loaded nanoparticles were shown to facilitate calcium deposition throughout the entire hybrid layer. Young's modulus at the hybrid layer increased from 2.09 to 3.25 GPa after 3 months, in specimens with zinc nanoparticles; meanwhile, these values were reduced from 1.66 to 0.49 GPa, in the control group.

CONCLUSION

Infiltration of polymeric nanoparticles into demineralized dentin increased long-term bond strengths. Zinc-loaded nanoparticles facilitate dentin remineralization within the complete resin-dentin interface.

CLINICAL RELEVANCE

Resin-dentin bond longevity and dentin remineralization at the hybrid layer were facilitated by zinc-loaded nanoparticles.

Effect of Carbodiimide on Bonding Durability of Adhesive-cemented Fiber Posts in Root Canals

This study was undertaken to investigate whether using a protein cross-linker, 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC), improves bonding stability of fiber posts to root dentin using three resin cements. Sixty human maxillary central incisor roots were randomly divided into six groups after endodontic treatment, according to the cements used with and without EDC pretreatment. In the etch-and-rinse group, 0.3 M EDC aqueous solution was applied on acid-etched root dentin prior to Excite DSC/Variolink II for post cementation. In the self-etch and self-adhesive groups, EDC was used on EDTA-conditioned root space prior to application of ED Primer II/Panavia F2.0 and Clearfil SA, respectively. After microslicing the root dentin, a push-out bond strength (BS) test was performed immediately or after one-year of water storage for each group. Data were analyzed using three-way analysis of variance and Tukey tests (α=0.05). A significant effect of cement type, time, EDC, and Time × Cement and Time × EDC interactions were observed (p≤0.001). EDC pretreatment did not affect immediate bonding of the three cements (p>0.05). Aging significantly reduced the BS in all the groups (p≤0.001), but EDC groups exhibited a higher BS compared with the respective control groups (p<0.001). Despite the significant effect of aging on decreasing the BS of fiber post to radicular dentin, EDC could diminish this effect for the three tested cements.

The effect of proanthocyanidin-containing 10% phosphoric acid on bonding properties and MMP inhibition

OBJECTIVES

This study evaluated the effect of etching using 2% proanthocynidin-containing 10% phosphoric acid 2% PA/10% PhA vs. 35% phosphoric acid 35% PhA on immediate (IM) and 6-months (6M) resin-enamel microshear bond strength (μSBS), resin-dentin microtensile bond strength (μTBS), nanoleakage (NL) and as well as in situ MMP inhibition potential.

METHODS

The dentin surface of human were exposed and then etched using 35% phosphoric acid for 15s or 2% PA/10% phosphoric acid for 30s. After rinsing with water, the dentin was bonded with Single Bond Plus (3M ESPE) and composite build-ups were constructed, followed by polymerization. The teeth were sectioned and the bonds were testing for microtensile bond strength (μTBS) and by SEM for NL analysis at IM and 6M. For MMP activity, resin-dentin slices were prepared for in situ zymography, and analyzed under confocal microscopy. For μSBS, others teeth had flattened enamel surfaces etched according the experimental groups and prepared to microshear procedure. The specimens were tested IM and after 6M by microshear bond strength. The data were submitted to two-way repeated measures ANOVA and Tukey's test (α=0.05).

RESULTS

Acid-etching using the 2% PA/10% phosphoric acid did not lower the μTBS in IM (p>0.05) compared to the control 35% phosphoric acid group. However, after 6M, only the 2% PA/10% PhA etched dentin had remained stable the resin-dentin bond strength (p<0.05). Bonds made with 35% PhA showed significant increase in NL% after 6M (p<0.05). Dentin bonds made with 2% PA/10% phosphoric acid showed no increase in NL% after 6 months. The MMP activity within the resin-dentin interface was almost completely reduced after 2% PA/10% PhA etching, while the 35% PhA exhibited intense MMP activity. For μSBS, the type of etchant and the storage period did not affect the resin-enamel bond strengths (p>0.05).

SIGNIFICANCE

Ten percent phosphoric acid containing 2% PA can produce stable resin-dentin and enamel-resin interfaces, without requiring additional steps in the bonding procedure. Future studies for longer evaluation time are required.

Effect of carboidiimide on thermal denaturation temperature of dentin collagen

OBJECTIVES

1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) has been shown to cross-link dentin type I collagen. Increased cross-linking usually elevates the glass transition temperature of polymers. The aim of this study was to evaluate the cross-linking reaction promoted by EDC in different aqueous concentrations by measuring the thermal denaturation temperature (Td) of human dentin collagen.

METHODS

The Td of dehydrated collagen and of insoluble dentin matrix collagen immersed in 0.5M or 1M EDC aqueous solution for different treatment times was obtained using a Differential Scanning Calorimeter (DSC). Specimens were also analyzed by Energy Dispersive X-Ray Spectroscopy.

RESULTS

EDC-treated dentin collagen showed a significantly higher Td than the untreated specimens when immersed in either 0.5M EDC or 1M EDC for 10min or longer (p<0.05). EDC-treated dentin collagen showed an increase of sulfur and chloride, not detectable in EDC-untreated dentin specimens. Conversely, the relative amount of carbon, nitrogen and oxygen was not modified by treatments.

SIGNIFICANCE

EDC-treated dentin collagen showed a higher Td than the untreated control at all tested concentrations and immersion times. A higher Td can be considered an indirect indicator of a more resistant and highly cross-linked collagen network. More data are needed to confirm these results.

Submicron-to-nanoscale structure characterization and organization of crystals in dentin bioapatites

The aim of this study was to ascertain the crystal morphology and to assess the ultrastructure and texture changes of sound (SD) and caries-affected dentin (CAD) after being restored with Zn-free and Zn-containing amalgam.

Resin bond strength to water versus ethanol-saturated human dentin pretreated with three different cross-linking agents

Context:

Resin-dentin bonds are unstable owing to hydrolytic and enzymatic degradation. Several approaches such as collagen cross-linking and ethanol-wet bonding (EWB) have been developed to overcome this problem. Collagen cross-linking improves the intrinsic properties of the collagen matrix. However, it leaves a water-rich collagen matrix with incomplete resin infiltration making it susceptible to fatigue degradation. Since EWB is expected to overcome the drawbacks of water-wet bonding (WWB), a combination of collagen cross-linking with EWB was tested.

Aim:

The aim of this study was to compare the effect of pretreatment with different cross-linking agents such as ultraviolet A (UVA)-activated 0.1% riboflavin, 1 M carbodiimide, and 6.5 wt% proanthocyanidin on the immediate and long-term bond strengths of an etch and rinse adhesive system to water- versus ethanol-saturated dentin within clinically relevant application time periods.

Settings and Design:

Long-term in vitro study evaluating the microtensile bond strength of adhesive-dentin interface after different surface pretreatments.

Subjects and Methods:

Eighty freshly extracted human molars were prepared to expose dentin, etched with 37% phosphoric acid for 15 s rinsed, and grouped randomly. They were blot-dried and pretreated with different cross-linkers: 0.1% riboflavin for 2 min followed by UVA activation for 2 min; 1 M carbodiimide for 2 min; 6.5 wt% proanthocyanidin for 2 min and rinsed. They were then bonded with Adper Single Bond Adhesive (3M ESPE), by either WWB or EWB, followed by resin composite build-ups (Filtek Z350, 3M ESPE). Bonded specimens in each group were then sectioned and divided into two halves. Microtensile bond strength was tested in one half after 24 h and the other after 6 months storage in artificial saliva.

Statistical Analysis Used:

Analysis was done using SPSS version 18 software (SPSS Inc., Chicago, IL, USA). Intergroup comparison of bond strength was done using ANOVA with post hoc Tukey's test, and intragroup comparison was done using paired t-test.

Results:

The microtensile bond strength of cross-linked groups was higher compared to control group (P < 0.001). EWB showed much higher bond strength values on cross-linked dentin compared to noncross-linked dentin. UVA-activated riboflavin group exhibited highest bond strengths followed by carbodiimide and proanthocyanidin groups, respectively, on both water- as well as ethanol-saturated dentin. Even after 6 months storage, cross-linked groups showed significantly higher values compared to initial bond strength values of control group (P < 0.001).

Conclusions:

0.1% riboflavin pretreatment of dentin followed by UVA activation for 2 min exhibited highest increase in bond strength values at 24 h and least reduction in bond strength values after 6 months storage compared to other groups. Biomodification of dentin using collagen cross-linking followed by EWB exhibited a synergistic effect in improving the resin-dentin bond durability.

Effect of carbodiimide on the structural stability of resin/dentin interface

Clinical longevity of composite resin restorations is a significant problem in adhesive dentistry. Most of the current simplified adhesives present good immediate bonding, but the bond strength gradually falls over a period due to biodegradation at the resin-dentin interface. Various strategies have been proposed to improve the durability of resin-dentin bond including the use of matrix metalloproteinases inhibitors and collagen cross-linkers, biomimetic remineralization, ethanol wet bonding, to improve the physical and mechanical properties of the bonding substrate, i.e., dentin. However, all are under preliminary research and without any conclusive evidence. Therefore, this paper addresses the current challenge in dental adhesion, i.e., poor durability of resin-dentin bond and introduces the concept of dentin biomodification as an alternative way for improving the long-term bonding effectiveness of current adhesives to dentin and also provides an overview of a synthetic collagen cross-linking agent carbodiimide (EDC) including its mechanism of action, literature review of studies evaluating EDC, variables associated with its use and its cytotoxicity. Search was performed across the electronic databases (PubMed, Ebsco host, and Google search engine) to identify manuscripts for inclusion, using the keywords: carbodiimide, dentin bonding, durability, resin-dentin interface, and collagen cross-linking. Thirty-five articles were finally included, and the last search was made in February 2016.

On the stiffness of demineralized dentin matrices

Resin bonding to dentin requires the use of self-etching primers or acid etching to decalcify the surface and expose a layer of collagen fibrils of the dentin matrix. Acid-etching reduces the stiffness of demineralized dentin from approximately 19 GPa-1 MPa, requiring that it floats in water to prevent it from collapsing during bonding procedures. Several publications show that crosslinking agents like gluteraladehyde, carbodiimide or grape seed extract can stiffen collagen and improve resin-dentin bond strength.

OBJECTIVE

The objective was to assess a new approach for evaluating the changes in stiffness of decalcified dentin by polar solvents and a collagen cross-linker.

METHODS

Fully demineralized dentin beams and sections of etched coronal dentin were subjected to indentation loading using a cylindrical flat indenter in water, and after treatment with ethanol or ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC). The stiffness was measured as a function of strain and as a function of loading rate from 1 to 50 μm/s.

RESULTS

At a strain of 0.25% the elastic modulus of the fully demineralized dentin was approximately 0.20 MPa. It increased to over 0.90 MPa at strains of 1%. Exposure to ethanol caused an increase in elastic modulus of up to four times. Increasing the loading rate from 1 to 50 μm/s caused an increase in the apparent modulus of up to three times in both water and ethanol. EDC treatment caused increases in the stiffness in fully demineralized samples and in acid-etched demineralized dentin surfaces in situ.

SIGNIFICANCE

Changes in the mechanical behavior of demineralized collagen matrices can be measured effectively under hydration via indentation with cylindrical flat indenters. This approach can be used for quantifying the effects of bonding treatments on the properties of decalcified dentin after acid etching, as well as to follow the loss of stiffness over time due to enzymatic degradation.

Inhibition of matrix metalloproteinases and toxicity of gold and platinum nanoparticles in L929 fibroblast cells

This study evaluated the inhibition of matrix metalloproteases (MMPs) and cellular responses elicited by gold (Au) and platinum (Pt) nanoparticles (NPs). The interaction of MMP-1 and NPs was evaluated using an MMP assay kit. The cultured L929 cells were exposed to various concentrations of NPs. The cellular responses to NPs were examined using a cytotoxicity assay (that evaluated cell viability and lactic dehydrogenase production), real-time polymerase chain reaction (RT-qPCR), and transmission electron microscopy. Both types of NPs, when used at concentrations above 10 μg ml(-1), inhibited MMP-1 activity. No cytotoxic effects were found when the cells were exposed to AuNPs. In contrast, PtNPs, at both 100 and 400 μg ml(-1), induced cytotoxicity. No inflammatory responses (production of interleukin-6 and tumor necrosis factor-alpha) to NPs were identified by RT-qPCR. The negative surface charge of NPs (COOH(-)) binds to the Zn(2+) of the MMP active center by chelation, leading to MMP inhibition. Gold nanoparticles are plausible candidates for MMP inhibitors in resin-bonding materials because they effectively inhibit MMP-1 activity without cytotoxic or inflammatory effects.

Effect of carbodiimide on the fatigue crack growth resistance of resin-dentin bonds

Recent studies have shown that ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) inactivates endogenous dentin proteases, thereby preventing collagen degradation and improving the durability of adhesive bonds to dentin. Bond durability is routinely assessed by monotonic microtensile testing, which does not consider the cyclic nature of mastication.

OBJECTIVE

To characterize the effect of an EDC pretreatment on the fatigue crack growth behavior of resin-dentin bonds.

METHODS

Bonded interface Compact Tension (CT) specimens were prepared using a three-step etch-and-rinse adhesive and hybrid resin-composite. Adhesive bonding of the treated groups included a 1 min application of an experimental EDC conditioner to the acid-etched dentin. The control groups did not receive EDC treatment. The fatigue crack growth resistance was examined after storage in artificial saliva for 0, 3 and 6 months.

RESULTS

There was no significant difference in the immediate fatigue crack growth resistance of the EDC-treated and control groups at 0 months. However, after the 3 and 6 months storage periods the EDC-treated groups exhibited significantly greater (p≤0.05) fatigue crack growth resistance than the control specimens.

SIGNIFICANCE

Although the EDC treatment maintained the fatigue crack growth resistance of the dentin bonds through 6 months of storage, additional studies are needed to assess its effectiveness over longer periods and in relation to other cross-linking agents.

Novel rechargeable calcium phosphate dental nanocomposite

OBJECTIVES

Calcium phosphate (CaP) composites with Ca and P ion release can remineralize tooth lesions and inhibit caries. But the ion release lasts only a few months. The objectives of this study were to develop rechargeable CaP dental composite for the first time, and investigate the Ca and P recharge and re-release of composites with nanoparticles of amorphous calcium phosphate (NACP) to achieve long-term inhibition of caries.

METHODS

Three NACP nanocomposites were fabricated with resin matrix of: (1) bisphenol A glycidyl dimethacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA) at 1:1 mass ratio (referred to as BT group); (2) pyromellitic glycerol dimethacrylate (PMGDM) and ethoxylated bisphenol A dimethacrylate (EBPADMA) at 1:1 ratio (PE group); (3) BisGMA, TEGDMA, and Bis[2-(methacryloyloxy)ethyl] phosphate (BisMEP) at 2:1:1 ratio (BTM group). Each resin was filled with 20% NACP and 50% glass particles, and the composite was photo-cured. Specimens were tested for flexural strength and elastic modulus, Ca and P ion release, and Ca and P ion recharge and re-release.

RESULTS

NACP nanocomposites had strengths 3-fold of, and elastic moduli similar to, commercial resin-modified glass ionomer controls. CaP ion recharge capability was the greatest for PE group, followed by BTM group, with BT group being the lowest (p<0.05). For each recharge cycle, CaP re-release reached similarly high levels, showing that CaP re-release did not decrease with more recharge cycles. After six recharge/re-release cycles, NACP nanocomposites without further recharge had continuous CaP ion release for 42 d.

SIGNIFICANCE

Novel rechargeable CaP composites achieved long-term and sustained Ca and P ion release. Rechargeable NACP nanocomposite is promising for caries-inhibiting restorations, and the Ca and P ion recharge and re-release method has wide applicability to dental composites, adhesives, cements and sealants to achieve long-term caries-inhibition.

Paucity of Nanolayering in Resin-Dentin Interfaces of MDP-based Adhesives

Self-assembled nanolayering structures have been reported in resin-dentin interfaces created by adhesives that contain 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP). These structures have been hypothesized to contribute to bond durability. The objective of the present study was to determine the extent of nanolayering in resin-dentin interfaces after application of commercialized 10-MDP-containing self-etch and universal adhesives to human dentin. Seven commercialized adhesives were examined: Adhese Universal (Ivoclar-Vivadent), All-Bond Universal (Bisco, Inc.), Clearfil SE Bond 2, Clearfil S3 Bond Plus, Clearfil Universal Bond (all from Kuraray Noritake Dental Inc.), G-Premio Bond (GC Corp.), and Scotchbond Universal (3M ESPE). Each adhesive was applied in the self-etch mode on midcoronal dentin according to the respective manufacturer's instructions. Bonded specimens (n = 6) were covered with flowable resin composite, processed for transmission electron microscopy, and examined at 30 random sites without staining. Thin-film glancing angle X-ray diffraction (XRD) was used to detect the characteristic peaks exhibited by nanolayering (n = 4). The control consisted of 15%wt, 10%wt, and 5%wt 10-MDP (DM Healthcare Products, Inc.) dissolved in a mixed solvent (ethanol and water weight ratio 9:8, with photoinitiators). Experimental primers were applied to dentin for 20 s, covered with hydrophobic resin layer, and examined in the same manner. Profuse nanolayering with highly ordered periodicity (~3.7 nm wide) was observed adjacent to partially dissolved apatite crystallites in dentin treated with the 15% 10-MDP primer. Three peaks in the 2θ range of 2.40° (3.68 nm), 4.78° (1.85 nm), and 7.18° (1.23 nm) were identified from thin-film XRD. Reduction in the extent of nanolayering was observed in the 10% and 5% 10-MDP experimental primer-dentin interface along with lower intensity XRD peaks. Nanolayering and characteristic XRD peaks were rarely observed in specimens prepared from the commercialized adhesives. The sparsity of nanolayering in resin-dentin interfaces created by commercialized adhesives challenges its clinical effectiveness as a mechanism for improving bond longevity in dentin bonding.

Effect of adjunctive application of epigallocatechin-3-gallate and ethanol-wet bonding on adhesive-dentin bonds

OBJECTIVES

To determine the effect of the combined use of epigallocatechin-3-gallate (EGCG) and ethanol-wet bonding (EWB) on resin-dentin bonds.

METHODS

Sixty molars were sectioned, polished, and randomly divided into six groups (n=10) according to the following pretreatments: group 1, water-wet bonding (WWB); group 2, WWB with 0.02% (w/v) EGCG; group 3, WWB with 0.1% EGCG; group 4, EWB; group 5, EWB with 0.02% EGCG; and group 6, EWB with 0.1% EGCG. An etch-and-rinse adhesive was then used, followed by the resin composites building. The microtensile bond strength (MTBS), failure modes and interfacial nanoleakage were separately determined after 24h water storage or 10,000 runs of thermocycling.

RESULTS

Both pretreatment method (P<0.05) and thermocycling (P<0.05) significantly influenced bond strength and nanoleakage. Irrespective of thermocycling, the 0.02% EGCG/ethanol (group 5) pretreated adhesive-dentin interfaces showed higher MTBS than the control group (P<0.05). Nanoleakage expression of all groups increased after thermocycling (P<0.05) except group 5. Adhesive failure was the main fracture pattern in all groups.

CONCLUSION

This study showed that pretreatment with 0.02% EGCG/ethanol solutions can effectively improve immediate bond strength and bond stability of etch-and-rinse adhesives on dentin.

CLINICAL SIGNIFICANCE

The adjunctive application of EGCG and EWB provides a new strategy for dentists to obtain the desired bond effectiveness during adhesive restoration in clinical practice.

Is chlorhexidine-methacrylate as effective as chlorhexidine digluconate in preserving resin dentin interfaces?

OBJECTIVES

The aim of the current study was to evaluate the effect of 2% CHX and 2% CHX-methacrylate compared to the resin-dentin bonds created by a two-step etch-and-rinse adhesive system after 24h, 6min and 12min.

METHODS

Microtensile bond strengths and interfacial nanoleakage within resin-dentin interfaces created by Adper Single Bond 2, with or without CHX or CHX-methacrylate pre-treatment for 30s on acid-etched dentin surfaces, were evaluated after 24h, 6min and 12min of storage in distilled water at 37°C.

RESULTS

Twelve months of storage resulted in a significant decrease in microtensile bond strength in the control group, and significant increases in silver nanoleakage. In contrast, Single Bond 2+CHX, and to a greater extent CHX-methacrylate, significantly reduced the rate of deterioration of resin-dentin interfaces over the 12min water storage period, in terms of bond strength.

CONCLUSIONS

Similar to Single Bond 2+CHX, Single Bond+CHX-methacrylates reduced the degradation of resin-bonded interfaces over a 12 month storage period. Thus it can be concluded that Single Bond 2+CHX-methacrylate may be important to improve durability of bonded interfaces and therefore, prolong the life span of adhesive restorations.

CLINICAL SIGNIFICANCE

Although CHX primers have been shown to enhance the durability of etch-and-rinse adhesives, that protection is lost after 2h. The use of CHX-methacrylate should last much longer since it may copolymerize with adhesive monomers, unlike CHX.

Cervical Interfacial Bonding Effectiveness of Class II Bulk Versus Incremental Fill Resin Composite Restorations

Cervical interfacial bonding quality has been a matter of deep concern. The purpose of this study was to analyze microtensile bond strength (MTBS) and cervical interfacial gap distance (IGD) of bulk-fill vs incremental-fill Class II composite restorations. Box-only Class II cavities were prepared in 91 maxillary premolars (n = 7) with gingival margin placement 1 mm above the cementoenamel junction at one side and 1 mm below it on the other side. Eighty-four maxillary premolars were divided into self-etch and total-etch groups and further subdivided into six restorative material subgroups used incrementally and with an open-sandwich technique: group 1, Tetric Ceram HB (TC) as a control; group 2, Tetric EvoFlow (EF); group 3, SDR Smart Dentin Replacement (SDR); group 4, SonicFill (SF); group 5, Tetric N-Ceram Bulk Fill (TN); and group 6, Tetric EvoCeram Bulk Fill (TE). Groups 2-6 were bulk-fill restoratives. Tetric N-Bond Self-Etch (se) and Tetric N-Bond total-etch (te) adhesive were used in subgroups 1–5, whereas AdheSE (se) and ExciTE F (te) were used in subgroup 6. In an additional group, Filtek P90 Low Shrink Restorative (P90) was used only with its corresponding self-etch bond. The materials were manipulated, light-cured (1600 mW/cm2), artificially aged (thermal and occlusal load-cycling), and sectioned. Two microrods/restoration (n = 14/group) were tested for MTBS at a crosshead-speed of 0.5 mm/min (Instron testing machine). Fracture loads were recorded (Newtons), and MTSBs were calculated (Megapascals). Means were statistically analyzed by the Kruskal-Wallis test, Conover-Inman post hoc analysis for MTBS (multiple comparisons), and Mann-Whitney U test for IGD. The ends of the fractures were examined for failure mode. One microrod/restoration (n = 7/group) was investigated by scanning electron microscopy (×1200) for IGD.

MTBS values for SF/te, P90 in enamel, and TC+SDR/te in enamel and cementum were significantly higher compared with those for the control TC/te and TC/se in cementum. Most of the failures were mixed. IGDs were generally smaller at enamel margins, and the smallest IGDs were found in P90 at both enamel and cementum margins. Bulk-fill and silorane-based composites might provide better cervical interfacial quality than incremental-fill restorations.

Redução da atividade proteolítica da dentina após curtos períodos de aplicação de proantocianidina

ResumoIntroduçãoAgentes promotores de ligações cruzadas têm sido investigados como inibidores da atividade enzimática da dentina, o que favoreceria a longevidade das restaurações adesivas.ObjetivoAvaliar o efeito do tratamento da dentina com proantocianidina (PA), em curtos períodos de tempo, na inibição da atividade de MMPs in situ.Material e métodoQuarenta espécimes de dentina (1×1×6 mm) foram obtidos de molares hígidos e divididos em quatro grupos (n=10). Os espécimes foram condicionados com ácido fosfórico por 15 s, seguido de lavagem em água deionizada. A dentina condicionada foi tratada com: água, 5% PA por 5 s, 15 s ou 30 s. A atividade de MMP foi analisada colorimetricamente (SensoLyte®) e os dados de absorbância (412 nm) foram submetidos aos testes de ANOVA e Tukey (α=0,05).ResultadoTodos os períodos de tratamento foram capazes de reduzir a atividade de MMPs, sendo que os melhores resultados foram observados para a dentina tratada com PA por 15 s (63,1% redução) e 30 s (70,2%). O tratamento por 5 s foi capaz de inibir 39,9% das MMPs.ConclusãoA aplicação de PA sobre a dentina condicionada foi capaz de reduzir a atividade de MMPs mesmo em períodos de tempo extremamente curtos, como 5 s. No entanto, melhores resultados foram obtidos com os maiores períodos de tratamento.

Effect of EDTA Conditioning and Carbodiimide Pretreatment on the Bonding Performance of All-in-One Self-Etch Adhesives

Objective. This study evaluated the effect of ethylenediaminetetraacetic acid (EDTA) conditioning and carbodiimide (EDC) pretreatment on the shear bond strength of two all-in-one self-etch adhesives to dentin. Methods. Flat coronal dentin surfaces were prepared on one hundred and sixty extracted human molars. Teeth were randomly divided into eight groups according to two different self-etch adhesives used [G-Bond and OptiBond-All-In-One] and four different surface pretreatments: (a) adhesive applied following manufacturer's instructions; (b) dentin conditioning with 24% EDTA gel prior to application of adhesive; (c) EDC pretreatment followed by application of adhesive; (d) application of EDC on EDTA conditioned dentin surface followed by application of adhesive. Composite restorations were placed in all the samples. Ten samples from each group were subjected to immediate and delayed (6-month storage in artificial saliva) shear bond strength evaluation. Data collected was subjected to statistical analysis using three-way ANOVA and post hoc Tukey's test at a significance level of p < 0.05.  Results and Conclusion. EDTA preconditioning as well as EDC pretreatment alone had no significant effect on the immediate and delayed bond strengths of either of the adhesives. However, EDC pretreatment on EDTA conditioned dentin surface resulted in preservation of resin-dentin bond strength of both adhesives with no significant fall over six months.

Effect of Thermocycling, Degree of Conversion, and Cavity Configuration on the Bonding Effectiveness of All-in-One Adhesives

The aim of this study was to compare five all-in-one bonding agents with respect to microleakage, microtensile bond strength (μTBS), degree of conversion (DC) and the impact of cavity configuration. The materials tested were Adper Easy Bond, Clearfil S3 Bond, iBond, Optibond All-in-One, Xeno IV, and Adper Single Bond Plus as a control. The DC of each adhesive was measured on the surfaces of dentin discs (n=5) by attenuated total reflectance Fourier transform infrared spectroscopy. One hundred and forty-four extracted human molars were randomly divided and assigned to one of the five tested adhesives and the control group. The μTBS to dentin was measured on flat occlusal dentin with and without thermocycling and to the gingival floor dentin of class II cavities (n=8). All specimens were restored with Filtek Z250 resin composite. Class II samples were immersed in a 5% methylene blue dye solution for 24 hours, and microleakage was examined under a stereomicroscope. Micromorphological analysis of demineralized/deproteinized specimens was done using scanning electron microscopy. The DC and microleakage data were statistically analyzed by one-way analysis of variance (ANOVA) and μTBS data by two-way ANOVA followed by a Bonferroni multiple comparison post hoc test (α=0.05) and Weibull-distribution survival analysis. The relation between different variables and μTBS and microleakage was tested by the Pearson correlation coefficient and regression statistics. A moderate direct relation between DC and μTBS durability was found for all the adhesives tested. Significant wide variations exist among the results obtained for single-bottle adhesives tested regarding their μTBS and microleakage. Some of the all-in-one materials tested have shown significantly inferior results under a high C-factor or after aging. The use of these materials should be carefully considered.

Effect of ultraviolet A-induced crosslinking on dentin collagen matrix

OBJECTIVES

The aim of this study was to evaluate the effect of using UVA-induced crosslinking with or without riboflavin as photosensitizers on degradation of dentin matrix by dentin proteases.

METHODS

Demineralized dentin specimens (0.4×3×6 mm(3), n=10/group) were subjected to: (RP1), 0.1% riboflavin-5 phosphate/UVA for 1 min; (RP5), 0.1% riboflavin-5 phosphate/UVA for 5 min; (R1), 0.1% riboflavin/UVA for 1 min; (R5), 0.1% riboflavin-UVA for 5 min; (UV1), UVA for 1 min; (UV5), UVA for 5 min. Specimens were incubated in 1 mL zinc and calcium containing media for 1 day and 1 week. An untreated group served as control (CM). After incubation, the loss of dry mass of samples was measured and aliquots of media were analyzed for the release of C-terminal fragment telopeptide (ICTP vs. CTX) of collagen to evaluate for cathepsin K (CA-K) and total matrix metalloproteinase (MMP)-mediated degradation. Data were analyzed using repeated measures ANOVA at α=0.05.

RESULTS

Although UVA radiation alone reduced dentin degradation, UVA-activated riboflavin or riboflavin-5 phosphate inhibited MMP and CA-K activities more than UVA alone. The effects of crosslinking were more pronounced in 7-day samples; only with CA-K were the effects of crosslinking with or without photosensitizer significantly different from controls in 1-day samples.

SIGNIFICANCE

The use of bioactive forms (RP) or longer treatment time did not result with better effect. The use of UVA crosslinking reduces dentin matrix degradation, especially with photosensitizers.

Bonding efficacy of etch-and-rinse adhesives after dentin biomodification using ethanol saturation and collagen cross-linker pretreatment

Aim:

To evaluate whether the application of two simplified etch-and-rinse adhesives to biomodified dentin using ethanol-wet bonding (EWB) and collagen cross-linker (CCL) pretreatment improves their sealing ability.

Materials and Methods:

In 176 extracted human molars, the pulp-chambers were deroofed, and teeth were sectioned horizontally. Samples were randomly divided into eight groups according to four bonding techniques using two simplified etch-and-rinse adhesives; Adper Single Bond 2 (ASB) and XP Bond (XPB). The bonding protocols included: (a) Water-wet bonding (WWB); (b) EWB; (c) WWB and CCL application; (d) EWB and CCL application. After composite resin restorations, dye leakage evaluation and scanning electron microscope analysis were done. Leakage scores were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests at a significance level of P < 0.05.

Result:

For both ASB and XPB adhesives, least dye leakage was observed in EWB groups (b and d) (P = 0.918 and P = 0.399 respectively) which showed no significant difference, while maximum leakage scores were seen in WWB groups (a and c). Regardless of CCL application and adhesives used, EWB technique depicted (P = 0.003 and P = 0.004) significantly greater sealing ability than WWB.

Conclusion:

Bonding of ASB and XPB using EWB significantly improved their sealing ability. Biomodification using CCL pretreatment had no significant effect on the sealing ability of adhesives bonded with either WWB or EWB.

On the durability of resin-dentin bonds: Identifying the weakest links

Fatigue of resin-dentin adhesive bonds is critical to the longevity of resin composite restorations.

OBJECTIVES

The objectives were to characterize the fatigue and fatigue crack growth resistance of resin-dentin bonds achieved using two different commercial adhesives and to identify apparent "weak-links".

METHODS

Bonded interface specimens were prepared using Adper Single Bond Plus (SB) or Adper Scotchbond Multi-Purpose (SBMP) adhesives and 3M Z100 resin composite according to the manufacturers' instructions. The stress-life fatigue behavior was evaluated using the twin bonded interface approach and the fatigue crack growth resistance was examined using bonded interface Compact Tension (CT) specimens. Fatigue properties of the interfaces were compared to those of the resin-adhesive, resin composite and coronal dentin.

RESULTS

The fatigue strength of the SBMP interface was significantly greater than that achieved by SB (p≤0.01). Both bonded interfaces exhibited significantly lower fatigue strength than that of the Z100 and dentin. Regarding the fatigue crack growth resistance, the stress intensity threshold (ΔKth) of the SB interface was significantly greater (p≤0.01) than that of the SBMP, whereas the ΔKth of the interfaces was more than twice that of the parent adhesives.

SIGNIFICANCE

Collagen fibril reinforcement of the resin adhesive is essential to the fatigue crack growth resistance of resin-dentin bonds. Resin tags that are not well hybridized into the surrounding intertubular dentin and/or poor collagen integrity are detrimental to the bonded interface durability.

Rechargeable dental adhesive with calcium phosphate nanoparticles for long-term ion release

OBJECTIVES

The tooth-resin bond is the weak link of restoration, with secondary caries as a main reason for failure. Calcium phosphate-containing resins are promising for remineralization; however, calcium (Ca) and phosphate (P) ion releases last only a couple of months. The objectives of this study were to develop the first rechargeable CaP bonding agent and investigate the key factors that determine CaP ion recharge and re-release.

METHODS

Nanoparticles of amorphous calcium phosphate (NACP) were synthesized. Pyromellitic glycerol dimethacrylate (PMGDM), ethoxylated bisphenol-A dimethacrylate (EBPADMA), 2-hydroxyethyl methacrylate (HEMA), and bisphenol-A glycidyl dimethacrylate (BisGMA) were used to synthesize three adhesives (denoted PE, PEH and PEHB). NACP were mixed into adhesive at 0-30% by mass. Dentin shear bond strengths were measured. Adhesive specimens were tested for Ca and P initial ion release. Then the ion-exhausted specimens were immersed in Ca and P solution to recharge the specimens, and the recharged specimens were then used to measure ion re-release for 7 days as one cycle. Then these specimens were again recharged and the re-release was measured for 7 days as the second cycle. Three recharge/re-release cycles were tested.

RESULTS

PEHB had the highest dentin bond strength (p<0.05). Increasing NACP content from 0 to 30% did not affect dentin bond strength (p>0.1), but increased CaP release and re-release (p<0.05). PEHB-NACP had the greatest recharge/re-release, and PE-NACP had the least (p<0.05). Ion release remained high and did not decrease with increasing the number of recharge/re-release cycles (p>0.1). After the third cycle, specimens without further recharge had continuous CaP ion release for 2-3 weeks.

SIGNIFICANCE

Rechargeable CaP bonding agents were developed for the first time to provide long-term Ca and P ions to promote remineralization and reduce caries. Incorporation of NACP into adhesive had no negative effect on dentin bond strength. Increasing NACP filler level increased the ion recharge and re-release capability. The new CaP recharge method and PMGDM-EBPADMA-NACP composition may have wide application in adhesives, composites and cements, to combat caries and remineralize lesions.

Gold Nanoparticles Inhibit Matrix Metalloproteases without Cytotoxicity

Nanoparticles (NPs) are currently the focus of considerable attention for dental applications; however, their biological effects have not been fully elucidated. The long-term, slow release of matrix metalloproteases (MMPs) digests collagen fibrils within resin-dentin bonds. Therefore, MMP inhibitors can prolong the durability of resin-dentin bonds. However, there have been few reports evaluating the combined effect of MMP inhibition and the cytotoxic effects of NPs for dentin bonding. The aim of this study was to evaluate MMP inhibition and cytotoxic responses to gold (AuNPs) and platinum nanoparticles (PtNPs) stabilized by polyvinylpyrrolidone (PVP) in cultured murine macrophages (RAW264) by using MMP inhibition assays, measuring cell viability and inflammatory responses (quantitative reverse transcription polymerase chain reaction [RT-qPCR]), and conducting a micromorphological analysis by fluorescence and transmission electron microscopy. Cultured RAW264 cells were exposed to metal NPs at various concentrations (1, 10, 100, and 400 µg/mL). AuNPs and PtNPs markedly inhibited MMP-8 and MMP-9 activity. Although PtNPs were cytotoxic at high concentrations (100 and 400 µg/mL), no cytotoxic effects were observed for AuNPs at any concentration. Transmission electron microscopy images showed a significant nonrandom intercellular distribution for AuNPs and PtNPs, which were mostly observed to be localized in lysosomes but not in the nucleus. RT-qPCR analysis demonstrated inflammatory responses were not induced in RAW264 cells by AuNPs or PtNPs. The cytotoxicity of nanoparticles might depend on the core metal composition and arise from a “Trojan horse” effect; thus, MMP inhibition could be attributed to the surface charge of PVP, which forms the outer coating of NPs. The negative charge of the surface coating of PVP binds to Zn2+ from the active center of MMPs by chelate binding and results in MMP inhibition. In summary, AuNPs are attractive NPs that effectively inhibit MMP activity without cytotoxicity or inflammatory responses.

Molecular weight and galloylation affect grape seed extract constituents' ability to cross-link dentin collagen in clinically relevant time

OBJECTIVE

To investigate the relationship between the structures of polyphenolic compounds found in grape seed extract (GSE) and their activity in cross-linking dentin collagen in clinically relevant settings.

METHODS

Representative monomeric and dimeric GSE constituents including (+)-catechin (pCT), (-)-catechin (CT), (-)-epicatechin (EC), (-)-epigallocatechin (EGC), (-)-epicatechin gallate (ECG), (-)-epigallocatechin gallate (EGCG), procyanidin B2 and a pCT-pCT dimer were purchased or synthesized. GSE was separated into low (PALM) and high molecular weight (PAHM) fractions. Human molars were processed into dentin films and beams. After demineralization, 11 groups of films (n=5) were treated for 1min with the aforementioned reagents (1wt% in 50/50 ethanol/water) and 1 group remained untreated. The films were studied by Fourier transform infrared spectroscopy (FTIR) followed by a quantitative mass spectroscopy-based digestion assay. Tensile properties of demineralized dentin beams were evaluated (n=7) after treatments (2h and 24h) with selective GSE species that were found to protect dentin collagen from collagenase.

RESULTS

Efficacy of GSE constituents in cross-linking dentin collagen was dependent on molecular size and galloylation. Non-galloylated species with degree of polymerization up to two, including pCT, CT, EC, EGC, procyanidin B2 and pCT-pCT dimer were not active. Galloylated species were active starting from monomeric form, including ECG, EGCG, PALM, GSE and PAHM. PALM induced the best overall improvement in tensile properties of dentin collagen.

SIGNIFICANCE

Identification under clinically relevant settings of structural features that contribute to GSE constituents' efficacy in stabilizing demineralized dentin matrix has immediate impact on optimizing GSE's use in dentin bonding.

In vitro longevity of bonding properties of universal adhesives to dentin

PURPOSE

To evaluate the immediate and 6-month resin-dentin bond strength (μTBS) and nanoleakage (NL) of universal adhesives that contain or do not contain methacryloyloxydecyl dihydrogen phosphate (MDP) and are used in the etch-and-rinse and self-etch strategies.

METHODS AND MATERIALS

Forty caries-free extracted third molars were divided into eight groups for μTBS (n=5). The groups were bonded with the Clearfil SE Bond (CSE) and Adper Single Bond 2 (SB) as controls; Peak Universal, self-etch (PkSe) and etch-and rinse (PkEr); Scotchbond Universal Adhesive, self-etch (ScSe) and etch-and-rinse (ScEr); and All Bond Universal, self-etch (AlSe) and etch-and-rinse (AlEr). After composite restorations, specimens were longitudinally sectioned to obtain resin-dentin bonded sticks (0.8 mm(2)). The μTBS of the specimens was tested immediately (IM) or after 6 months of water storage (6M) at 0.5 mm/min. Some sticks at each storage period were immersed in silver nitrate and photo developed, and the NL was evaluated with scanning electron microscopy. Data were analyzed with two-way repeated-measures analysis of variance and Tukey test (α=0.05).

RESULTS

At the IM period, PkSe and PkEr showed μTBS similar to the control adhesives (p>0.05) but increased NL pattern and lower μTBS after 6M (p<0.05). ScSe and ScEr showed intermediary μTBS values at the IM period but remained stable after 6 months (p>0.05). AlSe showed the lowest μTBS (p<0.05), but μTBS and NL remained stable after 6M (p>0.05). AlEr showed higher IM μTBS but showed higher degradation after 6M (p<0.05).

CONCLUSIONS

Universal adhesives that contain MDP showed higher and more stable μTBS with reduced NL at the interfaces after 6 months of water storage.

Use of poly (amidoamine) dendrimer for dentinal tubule occlusion: a preliminary study

The occlusion of dentinal tubules is an effective method to alleviate the symptoms caused by dentin hypersensitivity, a significant health problem in dentistry and daily life. The in situ mineralization within dentinal tubules is a promising treatment for dentin hypersensitivity as it induces the formation of mineral on the sensitive regions and occludes the dentinal tubules. This study was carried out to evaluate the in vitro effect of a whole generation poly(amidoamine) (PAMAM) dendrimer (G3.0) on dentinal tubule occlusion by inducing mineralization within dentinal tubules. Dentin discs were treated with PAMAM dendrimers using two methods, followed by the in vitro characterization using Attenuated total reflection Fourier-transform infrared spectroscopy (ATR-FTIR), X-ray diffraction (XRD), Field emission scanning electron microscopy (FE-SEM) and Energy-Dispersive X-ray Spectroscopy (EDS). These results showed that G3.0 PAMAM dendrimers coated on dentin surface and infiltrated in dentinal tubules could induce hydroxyapatite formation and resulted in effective dentinal tubule occlusion. Moreover, crosslinked PAMAM dendrimers could induce the remineralization of demineralized dentin and thus had the potential in dentinal tubule occlusion. In this in vitro study, dentinal tubules occlusion could be achieved by using PAMAM dendrimers. This could lead to the development of a new therapeutic technique for the treatment of dentin hypersensitivity.

Role of Host-Derived Proteinases in Dentine Caries and Erosion

Demineralization in dentinal caries and erosion exposes dentine organic matrix. This exposed matrix, containing type I collagen and non-collagenous proteins, is then degraded by host collagenolytic enzymes, matrix metalloproteinases (MMPs) and cysteine cathepsins. The knowledge of the identities and function of these enzymes in dentine has accumulated only within the last 15 years, but has already formed a field of research called ‘dentine degradomics'. This research has demonstrated the role of endogenous collagenolytic enzymes in caries and erosion development. In demineralized dentine, the enzymes degrade triple-helical collagen molecules, leading to the gradual loss of collagen matrix. Even before that, they can cleave off the terminal non-helical ends of collagen molecules called telopeptides, leading to the structural changes at the intramolecular gap areas, which may affect or even prevent intrafibrillar remineralization, which is considered essential in restoring the dentine's mechanical properties. They may also cause the loss of non-collagenous proteins that could serve as nucleation sites for remineralization. Here we review the findings demonstrating that inhibition of salivary or dentine endogenous MMPs and cysteine cathepsins may provide preventive means against the progression of caries or erosion. Furthermore, we also suggest the future directions for the new experimental preventive research to gain more knowledge of the enzymes and their function during and after dentine demineralization, and the pathways to find the clinically acceptable means to prevent the functional activity of these enzymes.

Immediate human pulp response to ethanol-wet bonding technique

OBJECTIVES

To evaluate the short-term response of human pulps to ethanol-wet bonding technique.

METHODS

Deep class V cavities were prepared on 17 sound premolars and divided into three groups. After acid-etching, the cavities from groups 1 (G1) and 2 (G2) were filled with 100% ethanol or distilled water, respectively, for 60 s before the application of Single Bond 2. In group 3 (G3, control), the cavity floor was lined with calcium hydroxide before etching and bonding. All cavities were restored with resin composite. Two teeth were used as intact control. The teeth were extracted 48h after the clinical procedures. From each tooth serial sections were obtained and stained with haematoxylin and eosin (H/E) and Masson's trichrome. Bacteria microleakage was assessed using Brown & Brenn. All sections were blindly evaluated for five histological features.

RESULTS

Mean remaining dentine thickness was 463±65μm (G1); 425±184μm (G2); and 348±194μm (G3). Similar pulp reactions followed ethanol- or water-wet bonding techniques. Slight inflammatory responses and disruption of the odontoblast layer related to the cavity floor were seen in all groups. Stained bacteria were not detected in any cavities. Normal pulp tissue was observed in G3 except for one case.

CONCLUSIONS

After 48h, ethanol-wet bonding does not increase pulpal damage compared to water-wet bonding technique.

CLINICAL SIGNIFICANCE

Ethanol-wet bonding may increase resin-dentine bond durability. This study reported the in vivo response of human pulp tissue when 100% ethanol was applied previously to an etch-and-rinse simplified adhesive system.

Letter to the Editor regarding "Depletion of water molecules during ethanol wet-bonding with etch and rinse dental adhesives"

I would like to comment on the above titled paper that recently published in Materials Science and Engineering C 33:21-27 (2013). I mentioned potential deficiencies in the study design. Then, I argued some statements made in the paper about interactions between bounded water around collagen molecules and resin infiltration, hence longevity of resin bonding. It is important to highlight these concerns regarding this paper so that readers are provided with another view of the ethanol wet-bonding concept.

Inhibition of matrix metalloproteinase activity in human dentin via novel antibacterial monomer

OBJECTIVE

Dentin-composite bond failure is caused by factors including hybrid layer degradation, which in turn can be caused by hydrolysis and enzymatic degradation of the exposed collagen in the dentin. The objectives of this study were to investigate a new antibacterial monomer (dimethylaminododecyl methacrylate, DMADDM) as an inhibitor for matrix metalloproteinases (MMPs), and to determine the effects of DMADDM on both soluble recombinant human MMPs (rhMMPs) and dentin matrix-bound endogenous MMPs.

METHODS

Inhibitory effects of DMADDM at six mass% (0.1% to 10%) on soluble rhMMP-8 and rhMMP-9 were measured using a colorimetic assay. Matrix-bound endogenous MMP activity was evaluated in demineralized human dentin. Dentin beams were divided into four groups (n=10) and incubated in calcium- and zinc-containing media (control medium); or control medium+0.2% chlorhexidine (CHX); 5% 12-methacryloyloxydodecylpyridinium bromide (MDPB); or 5% DMADDM. Dissolution of dentin collagen peptides was evaluated by mechanical testing in three-point flexure, loss of dentin mass, and a hydroxyproline assay.

RESULTS

Use of 0.1% to 10% DMADDM exhibited a strong concentration-dependent anti-MMP effect, reaching 90% of inhibition on rhMMP-8 and rhMMP-9 at 5% DMADDM concentration. Dentin beams in medium with 5% DMADDM showed 34% decrease in elastic modulus (vs. 73% decrease for control), 3% loss of dry dentin mass (vs. 28% loss for control), and significantly less solubilized hydroxyproline when compared with control (p<0.05).

SIGNIFICANCE

The new antibacterial monomer DMADDM was effective in inhibiting both soluble rhMMPs and matrix-bound human dentin MMPs. These results, together with previous studies showing that adhesives containing DMADDM inhibited biofilms without compromising dentin bond strength, suggest that DMADDM is promising for use in adhesives to prevent collagen degradation in hybrid layer and protect the resin-dentin bond.