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

Resin-dentin bonding interface after photochemical surface treatment

OBJECTIVE

The aim of this study is to elucidate the structure of the resin-dentin interface formed by photochemical dentin treatment using an argon fluoride (ArF) excimer laser.

BACKGROUND DATA

The ArF excimer laser processes material by photochemical reaction without generating heat, while also providing surface conditioning that enhances material adhesion. In the case of bonding between resin and dentin, we demonstrated in a previous study that laser etching using an ArF excimer laser produced bonding strength comparable to that of the traditional bonding process; however, conditions of the bonding interface have not been fully investigated.

METHODS

A dentin surface was irradiated in air with an ArF excimer laser followed by bonding treatment. Cross sections were observed under light microscope, transmission electron microscope (TEM), and scanning electron microscope, then analyzed using an energy dispersive X-ray spectroscope (EDS): EDS line profiles of the elements C, O, Si, Cl, P, and Ca at the resin-dentin interface were obtained.

RESULTS

The density of C in resin decreased as it approached the interface, reaching its lowest level within the dentin at a depth of 2 μm from the resin-dentin interface on EDS. There was no hybrid layer observed at the interface on TEM. Therefore, it was suggested that the resin monomer infiltrated into the microspaces produced on the dentin surface by laser abrasion.

CONCLUSIONS

The monomer infiltration without hybrid layer is thought to be the adhesion mechanism after laser etching. Therefore, the photochemical processes at the bonding interface achieved using the ArF excimer laser has great potential to be developed into a new bonding system in dentistry.

Dentin bonding: can we make it last?

In dentin bonding, contemporary dental adhesive systems rely on formation of the hybrid layer, a biocomposite containing dentin collagen and polymerized resin adhesive. They are usually able to create at least reasonable integrity of the hybrid layer with high immediate bond strength. However, loss of dentin-bonded interface integrity and bond strength is commonly seen after aging both in vitro and in vivo. This is due to endogenous collagenolytic enzymes, matrix metalloproteinases, and cysteine cathepsins, responsible for the time-dependent loss of hybrid layer collagen. In addition, the hydrophilic nature of adhesive systems creates problems that lead to suboptimal hybrid layers. These problems include, for example, insufficient resin impregnation of dentin, phase separation, and a low rate of polymerization, all of which may reduce the longevity of the bonded interface. Preservation of the collagen matrix integrity by inhibition of endogenous dentin proteases is key to improving dentin bonding durability. Several approaches to retain the integrity of the hybrid layer and to improve the long-term dentin bond strength have been tested. These include the use of enzyme inhibitors, either separately or as incorporated into the adhesive resins; increase of collagen resistance to enzymatic degradation; and elimination of water from the interface to slow down or eliminate hydrolytic loss of the hybrid layer components. This review looks at the principles, current status, and future of the different techniques designed to prevent the loss of hybrid layer and bond strength.

Use of multifunctional phosphorylated PAMAM dendrimers for dentin biomimetic remineralization and dentinal tubule occlusion

Phosphorylated poly(amidoamine) dendrimers can induce biomimetic remineralization of demineralized dentin as analogs of non-collagenous proteins in the presence of polyacrylic acid, an amorphous calcium phosphate stabilizing agent.

Role of dentin MMPs in caries progression and bond stability

Dentin can be described as a biological composite with collagen matrix embedded with nanosized hydroxyapatite mineral crystallites. Matrix metalloproteinases (MMPs) and cysteine cathepsins are families of endopeptidases. Enzymes of both families are present in dentin and collectively capable of degrading virtually all extracellular matrix components. This review describes these enzymes and their presence in dentin, mainly focusing on their role in dentin caries pathogenesis and loss of collagen in the adhesive hybrid layer under composite restorations. MMPs and cysteine cathepsins present in saliva, mineralized dentin, and/or dentinal fluid may affect the dentin caries process at the early phases of demineralization. Changes in collagen and noncollagenous protein structure may participate in observed decreases in mechanical properties of caries-affected dentin and reduce the ability of caries-affected dentin to remineralize. These endogenous enzymes also remain entrapped within the hybrid layer during the resin infiltration process, and the acidic bonding agents themselves (irrespective of whether they are etch-and-rinse or self-etch) can activate these endogenous protease proforms. Since resin impregnation is frequently incomplete, denuded collagen matrices associated with free water (which serves as a collagen cleavage reagent for these endogenous hydrolase enzymes) can be enzymatically disrupted, finally contributing to the degradation of the hybrid layer. There are multiple in vitro and in vivo reports showing that the longevity of the adhesive interface is increased when nonspecific enzyme-inhibiting strategies are used. Different chemicals (i.e., chlorhexidine, galardin, and benzalkonium chloride) or collagen cross-linker agents have been successfully employed as therapeutic primers in the bonding procedure. In addition, the incorporation of enzyme inhibitors (i.e., quaternary ammonium methacrylates) into the resin blends has been recently promoted. This review will describe MMP functions in caries and hybrid layer degradation and explore the potential therapeutic role of MMP inhibitors for the development of improved intervention strategies for MMP-related oral diseases.

Polymer nanocarriers for dentin adhesion

To obtain more durable adhesion to dentin, and to protect collagen fibrils of the dentin matrix from degradation, calcium- and phosphate-releasing particles have been incorporated into the dental adhesive procedure. The aim of the present study was to incorporate zinc-loaded polymeric nanocarriers into a dental adhesive system to facilitate inhibition of matrix metalloproteinases (MMPs)-mediated collagen degradation and to provide calcium ions for mineral deposition within the resin-dentin bonded interface. PolymP- N : Active nanoparticles (nanoMyP) were zinc-loaded through 30-minute ZnCl2 immersion and tested for bioactivity by means of 7 days' immersion in simulated body fluid solution (the Kokubo test). Zinc-loading and calcium phosphate depositions were examined by scanning and transmission electron microscopy, elemental analysis, and x-ray diffraction. Nanoparticles in ethanol solution infiltrated into phosphoric-acid-etched human dentin and Single Bond (3M/ESPE) were applied to determine whether the nanoparticles interfered with bonding. Debonded sticks were analyzed by scanning electron microscopy. A metalloproteinase collagen degradation assay was also performed in resin-infiltrated dentin with and without nanoparticles, measuring C-terminal telopeptide of type I collagen (ICTP) concentration in supernatants, after 4 wk of immersion in artificial saliva. Numerical data were analyzed by analysis of variance (ANOVA) and Student-Newman-Keuls multiple comparisons tests (p < .05). Nanoparticles were effectively zinc-loaded and were shown to have a chelating effect, retaining calcium regardless of zinc incorporation. Nanoparticles failed to infiltrate demineralized intertubular dentin and remained on top of the hybrid layer, without altering bond strength. Calcium and phosphorus were found covering nanoparticles at the hybrid layer, after 24 h. Nanoparticle application in etched dentin also reduced MMP-mediated collagen degradation. Tested nanoparticles may be incorporated into dental adhesive systems to provide the appropriate environment in which dentin MMP collagen degradation is inhibited and mineral growth can occur.

Preparation and properties of calcium-silicate filled resins for dental restoration. Part II: Micro-mechanical behaviour to primed mineral-depleted dentine

OBJECTIVE

Evaluating microtensile bond strength (μTBS) and Knoop micro-hardness (KHN) of resin bonded-dentine interfaces created with two methacrylate-based systems either incorporating Bioglass 45S5 (3-E&RA/BG) or MTA (3-E&RA/WMTA).

MATERIALS AND METHODS

Solvated resins (50% ethanol/50% co-monomers) were used as primers while their neat counterparts were filled with the two calcium-silicate compounds. Application of neat resin adhesive with no filler served as control (3-E&RA). μTBS, KHN analysis and confocal tandem scanning microscopy (TSM) micropermeability were carried out after 24 h and 10 months of storage in phosphate buffer solution (DPBS). Scanning electron microscopy (SEM) was also performed after debonding.

RESULTS

High μTBS values were achieved in all groups after 24 h of DPBS storage. On the contrary, solely the specimens created using 3-E&RA/BG and 3-E&RA/WMTA agents showed no significant reduction in terms of μTBS even after 10 months in DPBS; similarly, they did not restore the average superficial micro-hardness to the level of sound dentine, but maintained unchanged KHN values, and no statistical decrease was found following 10 months of DPBS storage. The only statistically significant changes occurred in the resin-dentine interfaces bonded with 3-E&RA that were subjected to a reduction of both μTBS and KHN values with ageing. In terms of micropermeability, adverse results were obtained with 3-E&RA while 3-E&RA/BG and 3-E&RA/WMTA demonstrated a beneficial effect after prolonged DPBS storage.

CONCLUSION

Calcium-silicate filled composite resins performed better than a current etch-and-rinse adhesive and had a therapeutic/protective effect on the micro-mechanical properties of mineral-depleted resin-dentine interfaces.

CLINICAL SIGNIFICANCE

The incorporation of calcium-silicates into dental restorative and bonding agents can create more biomimetic (life-like) restorations. This will not only enable these materials to mimic the physical characteristics of the tooth structure, but will also stabilize and protect the remaining dental hard tissues.

Doxycycline-encapsulated nanotube-modified dentin adhesives

This article presents details of fabrication, biological activity (i.e., anti-matrix metalloproteinase [anti-MMP] inhibition), cytocompatibility, and bonding characteristics to dentin of a unique doxycycline (DOX)-encapsulated halloysite nanotube (HNT)-modified adhesive. We tested the hypothesis that the release of DOX from the DOX-encapsulated nanotube-modified adhesive can effectively inhibit MMP activity. We incorporated nanotubes, encapsulated or not with DOX, into the adhesive resin of a commercially available bonding system (Scotchbond Multi-Purpose [SBMP]). The following groups were tested: unmodified SBMP (control), SBMP with nanotubes (HNT), and DOX-encapsulated nanotube-modified adhesive (HNT+DOX). Changes in degree of conversion (DC) and microtensile bond strength were evaluated. Cytotoxicity was examined on human dental pulp stem cells (hDPSCs). To prove the successful encapsulation of DOX within the adhesives-but, more important, to support the hypothesis that the HNT+DOX adhesive would release DOX at subantimicrobial levels-we tested the antimicrobial activity of synthesized adhesives and the DOX-containing eluates against Streptococcus mutans through agar diffusion assays. Anti-MMP properties were assessed via β-casein cleavage assays. Increasing curing times (10, 20, 40 sec) led to increased DC values. There were no statistically significant differences (p > .05) in DC within each increasing curing time between the modified adhesives compared to SBMP. No statistically significant differences in microtensile bond strength were noted. None of the adhesives eluates were cytotoxic to the human dental pulp stem cells. A significant growth inhibition of S. mutans by direct contact illustrates successful encapsulation of DOX into the experimental adhesive. More important, DOX-containing eluates promoted inhibition of MMP-1 activity when compared to the control. Collectively, our findings provide a solid background for further testing of encapsulated MMP inhibitors into the synthesis of therapeutic adhesives that may enhance the longevity of hybrid layers and the overall clinical performance of adhesively bonded resin composite restorations.

Proteins, pathogens, and failure at the composite-tooth interface

In the United States, composites accounted for nearly 70% of the 173.2 million composite and amalgam restorations placed in 2006 (Kingman et al., 2012), and it is likely that the use of composite will continue to increase as dentists phase out dental amalgam. This trend is not, however, without consequences. The failure rate of composite restorations is double that of amalgam (Ferracane, 2013). Composite restorations accumulate more biofilm, experience more secondary decay, and require more frequent replacement. In vivo biodegradation of the adhesive bond at the composite-tooth interface is a major contributor to the cascade of events leading to restoration failure. Binding by proteins, particularly gp340, from the salivary pellicle leads to biofilm attachment, which accelerates degradation of the interfacial bond and demineralization of the tooth by recruiting the pioneer bacterium Streptococcus mutans to the surface. Bacterial production of lactic acid lowers the pH of the oral microenvironment, erodes hydroxyapatite in enamel and dentin, and promotes hydrolysis of the adhesive. Secreted esterases further hydrolyze the adhesive polymer, exposing the soft underlying collagenous dentinal matrix and allowing further infiltration by the pathogenic biofilm. Manifold approaches are being pursued to increase the longevity of composite dental restorations based on the major contributing factors responsible for degradation. The key material and biological components and the interactions involved in the destructive processes, including recent advances in understanding the structural and molecular basis of biofilm recruitment, are described in this review. Innovative strategies to mitigate these pathogenic effects and slow deterioration are discussed.

[Study of the types of matrix metalloproteinases involved in dentin bonding interface degradation]

OBJECTIVE

To study the types of matrix metalloproteinases (MMPs) involved in dentin bonding interface degradation.

METHODS

Dentin slices were prepared and treated with two adhesive systems (Single Bond 2 or Clearfil S3 Bond). The dentin surface was bonded with composite resin. All specimens were immersed in sterile artificial saliva for 0 or 6 months, and their micro-shear bond strength (muSBS) were measured. The fracture modes were observed through field emission scanning electron microscope (FE-SEM). Dentin slices with 4 mm x 3 mm x 1 mm dimensions were prepared. The slices were divided into three groups according to the treatment modes (negative control, Single Bond 2, and Clearfil S3 Bond). All specimens were stored in sterile artificial saliva for 0 or 6 months. The concentrations of MMP-1, -2, -3, -8, and -9 of each group were detected through fluorescent microsphere immunoassay.

RESULTS

The muSBS of both adhesive systems significantly decreased after storage aging. Significant differences in failure modes within the four groups tested in this study were observed. Compared with the negative control, the concentrations of MMP-1 and MMP-3 in different adhesive groups showed no significant difference after storage aging. However, the concentrations of MMP-2, -8, and -9 in Single Bond 2 group and the concentrations of MMP-8 and -9 in Clearfil S3 Bond group significantly decreased after 6 months of storage aging.

CONCLUSION

Significant degradation occur in the dentin bonding interface of both adhesive groups under 6 months aging challenge. The concentrations ofdentinal MMP-2, -8, and -9 significantly decrease after treatment with adhesives and aging, indicating that these MMPs have an important function in dentin bonding interface degradation.

Degradation in the fatigue strength of dentin by cutting, etching and adhesive bonding

The processes involved in placing resin composite restorations may degrade the fatigue strength of dentin and increase the likelihood of fractures in restored teeth.

OBJECTIVE

The objective of this study was to evaluate the relative changes in strength and fatigue behavior of dentin caused by bur preparation, etching and resin bonding procedures using a 3-step system.

METHODS

Specimens of dentin were prepared from the crowns of unrestored 3rd molars and subjected to either quasi-static or cyclic flexural loading to failure. Four treated groups were prepared including dentin beams subjected to a bur treatment only with a conventional straight-sided bur, or etching treatment only. An additional treated group received both bur and etching treatments, and the last was treated by bur treatment and etching, followed by application of a commercial resin adhesive. The control group consisted of "as sectioned" dentin specimens.

RESULTS

Under quasi-static loading to failure there was no significant difference between the strength of the control group and treated groups. Dentin beams receiving only etching or bur cutting treatments exhibited fatigue strengths that were significantly lower (p≤0.0001) than the control; there was no significant difference in the fatigue resistance of these two groups. Similarly, the dentin receiving bur and etching treatments exhibited significantly lower (p≤0.0001) fatigue strength than that of the control, regardless of whether an adhesive was applied.

SIGNIFICANCE

The individual steps involved in the placement of bonded resin composite restorations significantly decrease the fatigue strength of dentin, and application of a bonding agent does not increase the fatigue strength of dentin.

The effects of host derived metalloproteinases on dentin bond and the role of MMPs inhibitors on dentin matrix degradation

OBJECTIVES

The work has the objective to analyze the literature on the degradation of the adhesive interface. In particular the study is focused on the role of the metalloproteinase in the hydrolytic degradation of collagen matrix in the bonded interface. The survey will concern also the latest innovations to improve and increase the link between dentin and the restorative materials through the MMPs inhibitors.

METHODS

The research has been carried out in the MEDLINE database by choosing keywords as "metalloproteinases" and "dentin bond" and "degradation". In vitro studies were included in the research, excluding studies with no human and deciduous teeth. Language was limited to English.

RESULTS

The collagenolytic enzymes in mineralized dentin have been demonstrated to have an important role in dental hard tissue pathologies, including the degradation of the hybrid layer.

CONCLUSION

The preservation of the collagen matrix integrity is a key issue in the attempts to improve the dentin bonding durability.

Effect of Double-layer Application on Dentin Bond Durability of One-step Self-etch Adhesives

Purpose

The aim of this in vitro study was 1) to analyze the influence of a double-layer application technique of four one-step self-etch adhesive systems on dentin and 2) to determine its effect on the stability of the adhesive interfaces stored under different conditions.

Materials and Methods

Four different one-step self-etch adhesives were selected for the study (iBondSE, Clearfil S3 Bond, XenoV+, and Scotchbond Universal). Adhesives were applied according to manufacturers' instructions or with a double-layer application technique (without light curing of the first layer). After bonding, resin-dentin specimens were sectioned for microtensile bond strength testing in accordance with the nontrimming technique and divided into 3 subgroups of storage: a) 24 hours (immediate bond strength, T0), b) six months (T6) in artificial saliva at 37°C, or c) five hours in 10 % NaOCl at room temperature. After storage, specimens were stressed to failure. Fracture mode was assessed under a light microscope.

Results

At T0, iBond SE showed a significant increase in microtensile bond strength when the double-application technique was applied. All adhesive systems showed reduced bond strengths after six months of storage in artificial saliva and after storage in 10% NaOCl for five hours; however at T6, iBond SE, Clearfil S3 Bond, and XenoV+ showed significantly higher microtensile bond strength results for the double-application technique compared with the single-application technique. Scotchbond Universal showed no difference between single- or double-application, irrespective of the storage conditions.

Conclusion

The results of this study show that improvements in bond strength of one-step self-etch adhesives by using the double-application technique are adhesive dependent.

Optimization of direct currents to enhance dentine bonding of simplified one-step adhesive

The aim of this study was to investigate the effects of different direct current intensities on dentine bonding effectiveness of Clearfil S(3) Bond and on cell viability of human dental pulp cells (HDPCs). Thirty-five-third molars were sectioned and ground to provide flat surfaces. Clearfil S(3) Bond was applied under different current conditions for 30 s and then resin composite was built up. Specimens were processed for microtensile bond strength (µTBS) testing and for nanoleakage investigation using scanning electron microscopy. Primary HDPCs isolated from premolars were stimulated with different intensities of electric current for 30 s. Then, cell viability was tested using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Specimens bonded with application of electrical current intensities of 50, 60, 70, and 90 µA exhibited a significant increase in immediate µTBS compared with all other groups. Bonded interfaces prepared using electrically assisted current application showed reduced interfacial nanoleakage upon scanning electron microscopy. Electric current application, from 20 to 70 µA, had no effect on the viability of HDPCs. This study provides further evidence for its future clinical use.

Preheating impact on the degree of conversion and water sorption/solubility of selected single-bottle adhesive systems

OBJECTIVE

This study evaluated the degree of conversion (DC) and the water sorption/solubility of preheated single-bottle adhesive systems.

METHODS AND MATERIALS

Five adhesive systems were tested: Adper Easy One and Adper Single Bond 2 (3M ESPE), Excite and Tetric N-Bond (Ivoclar/Vivadent), and XP Bond (Dentsply/Caulk). After storage for two hours at 25°C or 60°C, 50 samples (n=5) were prepared for all adhesive systems and stored dry in lightproof containers at 37°C for 24 hours. Fourier transform infrared/attenuated total reflectance spectroscopy was used to evaluate the DC, and water sorption/solubility was measured by means of mass loss and gain after water storage. The data were analyzed by two-way analysis of variance followed by Tukey's test (p<0.05).

RESULTS

Preheated adhesive systems showed statistically significantly higher DC than those kept at 25°C. Except for XP Bond, preheated adhesive systems presented statistically significantly lower water sorption/solubility means.

CONCLUSIONS

Preheating improved the DC for all tested adhesive systems. Also, it promoted a decrease of water sorption/solubility, except for the XP Bond adhesive system.

Anti-proteolytic capacity and bonding durability of proanthocyanidin-biomodified demineralized dentin matrix

Our previous studies showed that biomodification of demineralized dentin collagen with proanthocyanidin (PA) for a clinically practical duration improves the mechanical properties of the dentin matrix and the immediate resin-dentin bond strength. The present study sought to evaluate the ability of PA biomodification to reduce collagenase-induced biodegradation of demineralized dentin matrix and dentin/adhesive interfaces in a clinically relevant manner. The effects of collagenolytic and gelatinolytic activity on PA-biomodified demineralized dentin matrix were analysed by hydroxyproline assay and gelatin zymography. Then, resin-/dentin-bonded specimens were prepared and challenged with bacterial collagenases. Dentin treated with 2% chlorhexidine and untreated dentin were used as a positive and negative control, respectively. Collagen biodegradation, the microtensile bond strengths of bonded specimens and the micromorphologies of the fractured interfaces were assessed. The results revealed that both collagenolytic and gelatinolytic activity on demineralized dentin were notably inhibited in the PA-biomodified groups, irrespective of PA concentration and biomodification duration. When challenged with exogenous collagenases, PA-biomodified bonded specimens exhibited significantly less biodegradation and maintained higher bond strengths than the untreated control. These results suggest that PA biomodification was effective at inhibiting proteolytic activity on demineralized dentin matrix and at stabilizing the adhesive/dentin interface against enzymatic degradation, is a new concept that has the potential to improve bonding durability.

Adjunctive application of chlorhexidine and ethanol-wet bonding on durability of bonds to sound and caries-affected dentine

OBJECTIVES

To examine the effect of adjunctive application of chlorhexidine (CHX) and ethanol-wet bonding (EWB) on bond durability and nanoleakage of hydrophobic adhesive to sound (SD) and caries-affected dentine (CAD).

METHODS

Dentine surfaces of molars were etched after caries removal and randomly allocated to four groups (n=12). In Groups 1 and 2, dentine surfaces were saturated with either 2 ml of 100% ethanol or 2 ml of ethanol with 2% CHX for 60s. In Groups 3 and 4, dentine surfaces were saturated with either 15 μL of distilled water or 15 μL of distilled water with 2% CHX for 60s. Two coats of primer, followed by neat resin were applied and light-cured for 40s. Resin composite build-ups were placed and bonded specimens were sectioned for bond strength testing after 24 h and 12 months' storage in artificial saliva. Bond strength data were analyzed using 3-way ANOVA and SNK tests. Interfacial nanoleakage was evaluated after 24 h and 12 months using a field-emission scanning electron microscopy and data were analyzed using Kruskal-Wallis test.

RESULTS

Significant differences were observed for the three factors: "substrate" (p<0.001), "rewetting agents" (p<0.001) and "time" (p<0.001) on bond strength. Incorporation of 2% CHX to EWB preserved bond strength to SD and CAD and reduced interfacial nanoleakage after 12 months. Incorporation of 2% CHX to WWB also preserved bond strength to SD after ageing.

CONCLUSIONS

Incorporation of chlorhexidine to ethanol-wet bonding has an interaction effect on preservation of bond durability to sound and caries-affected dentine.

CLINICAL SIGNIFICANCE

Incorporation of chlorhexidine to ethanol-wet bonding with hydrophobic adhesive enhances the success rate of aesthetic bonded restorations.

Synthesis and evaluation of novel dental monomer with branched carboxyl acid group

To enhance the water miscibility and increase the mechanical properties of dentin adhesives, a new glycerol-based monomer with vinyl and carboxylic acid, 4-((1,3-bis(methacryloyloxy)propan-2-yl)oxy)-2-methylene-4-oxobutanoic acid (BMPMOB), was synthesized and characterized. Dentin adhesive formulations containing 2-hydroxyethyl methacrylate (HEMA), 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (BisGMA), and BMPMOB were characterized with regard to real-time photopolymerization behavior, water sorption, dynamic mechanical analysis, and microscale three-dimensional internal morphologies and compared with HEMA/BisGMA controls. The experimental adhesive copolymers showed higher glass transition temperature and rubbery moduli, as well as improved water miscibility compared to the controls. The enhanced properties of the adhesive copolymers indicated that BMPMOB is a promising comonomer for dental restorative materials.

Bond strength of composite resin to enamel: assessment of two ethanol wet-bonding techniques

OBJECTIVE

Ethanol wet-bonding (EWB) technique has been stated to decrease degradation of resin-dentin bond. This study evaluated the effect of two EWB techniques on composite resin-to-enamel bond strength.

MATERIALS AND METHODS

Silicon carbide papers were used to produce flat enamel surfaces on the buccal faces of forty-five molars. OptiBond FL (OFL) adhesive was applied on enamel surfaces in three groups of 15 namely: Enamel surface and OFL (control);Protocol 1 of the EWB technique: absolute ethanol was applied to water-saturated acid-etched enamel surfaces for 1 minute before the application of ethanol-solvated hydrophobic adhesive resin of OFL 3 times;Protocol 2: progressive ethanol replacement; water was gradually removed from the enamel matrix using ascending ethanol concentrations before OFL application. Composite build-ups were made and the specimens were stored for 24 hours at 37°C and 100% relative humidity. Shear bond strength test was performed using a universal testing machine at 1 mm/min crosshead speed. Fracture patterns were evaluated microscopically. Data were analyzed with one-way ANOVA and Fisher's exact test (α=0.05).

RESULTS

There were no significant differences in bond strength between the groups (P=0.73). However, regarding failure patterns, the highest cohesive enamel fractures were recorded in groups 2 and 3.

CONCLUSION

In this study, although both methods of EWB did not influence immediate bond strength of composite resin to enamel, the majority of failure patterns occurred cohesively in enamel.

Pre-treatment of radicular dentin by self-etch primer containing chlorhexidine can improve fiber post bond durability

We evaluated whether the pre-treatment of radicular dentin by ED Primer containing different concentrations of chlorhexidine can improve the bond durability of fiber post to radicular dentin. Experimental ED primers containing different concentrations of chlorhexidine (0%, 0.5% and 1.0%) were prepared. Thirty extracted maxillary anterior teeth were divided into 3 groups, each group corresponding to different chlorhexidine concentrations. Fiber posts were cemented in endodontically treated teeth with experimental ED primers and Panavia F. The bonded teeth were transversally sectioned into six slices and then were processed for thin slice push-out test 24 h later or after 18-months water storage. Eighteen-month storage resulted in significant bond strength reduction of all groups (p<0.05). The bond strength reduction of 1.0% group was significantly lower than that of control group and 0.5% group (p<0.05). In conclusion, the incorporation of 1.0% chlorhexidine into ED primer can extend the bond longevity of fiber post to radicular dentin.

Dentine bonding agents comprising calcium-silicates to support proactive dental care: Origins, development and future

The origin of ion-releasing dentine bonding agents lies in a change in attitude regarding the qualities demanded of a restorative dental material. The objectives of this paper are to review recent studies on novel hybrid adhesives comprising bioactive fillers based on information from original research papers, reviews, and patent literatures. Literature searches of free text and MeSH terms were performed by using MedLine (PubMed), Web of Science, Scopus, Scielo and the Cochrane Library (6th November, 2013). Reference lists of primary research reports and eligible systematic reviews were cross-checked in an attempt to identify additional studies. Experimental methacrylate-based adhesives, either when incorporating calcium/sodium phosphate-phyllosilicates or calcium silicate cements, demonstrated to promote therapeutic/protective effects on the micro-mechanical and ultramorphological properties of resin bonded-dentine interfaces associated with mineral deposition over time. Further randomized control trials are needed in order to confirm these initial results in vivo.

Effect of accelerated aging on the bonding performance of fluoridated adhesive resins

The purpose of this study was to investigate the dentin bond durability of a one-step, fluoride-containing, glass ionomer-based adhesive system, Reactmer Bond (RB), and that of a two-step, fluoride-containing, self-etch adhesive system, Clearfil Protect Bond (CPB). Enamel was removed from the occlusal surfaces of teeth, and flat dentin surfaces were entirely covered with a composite resin following the application of an adhesive material (n=10). After specimens were sectioned into rectangular sticks of 0.87 ± 0.03 mm(2), the sticks were randomly assigned into two accelerated aging time period groups: 1 week or 1 year. Microtensile bond strengths were determined. Bond strength of RB increased significantly after 1 year (1 week=27.80 ± 10.57 MPa versus 1 year=36.93 ± 14.38 MPa) (p<0.05). In contrast, there was no significant difference in bond strength between the two time periods for CPB (1 week=51.74 ± 17.8 MPa versus 1 year=56.03 ± 18.85 MPa) (p>0.05). Both fluoride-containing adhesives seemed to demonstrate reliable bonding performance after 1 year of accelerated aging in water.

Biomimetic promotion of dentin remineralization usingl-glutamic acid: inspiration from biomineralization proteins

The decalcified dentin layer was remineralized in two days using the cooperative effect of PAA and Glu.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Carbodiimide inactivation of MMPs and effect on dentin bonding

The use of protein cross-linking agents during bonding procedures has been recently proposed to improve bond durability. This study aimed to use zymography and in situ zymography techniques to evaluate the ability of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) cross-linker to inhibit matrix metalloproteinase (MMP) activity. The hypotheses tested were that: (1) bonding procedures increase dentin gelatinolytic activity and (2) EDC pre-treatment prevents this enzymatic activity. The zymographic assay was performed on protein extracts obtained from dentin powder treated with Optibond FL or Scotchbond 1XT with or without 0.3M EDC pre-treatment. For in situ zymography, adhesive/dentin interfaces were created with the same adhesives applied to acid-etched dentin slabs pre-treated or not with EDC conditioner. Zymograms revealed increased expression of dentin endogenous MMP-2 and -9 after adhesive application, while the use of EDC as a primer inactivated dentin gelatinases. Results of in situ zymograpy showed that hybrid layers of tested adhesives exhibited intense collagenolytic activity, while almost no fluorescence signal was detected when specimens were pre-treated with EDC. The correlative analysis used in this study demonstrated that EDC could contribute to inactivate endogenous dentin MMPs within the hybrid layer created by etch-and-rinse adhesives.

Dentin biomodification: strategies, renewable resources and clinical applications

OBJECTIVES

The biomodification of dentin is a biomimetic approach, mediated by bioactive agents, to enhance and reinforce the dentin by locally altering the biochemistry and biomechanical properties. This review provides an overview of key dentin matrix components, targeting effects of biomodification strategies, the chemistry of renewable natural sources, and current research on their potential clinical applications.

METHODS

The PubMed database and collected literature were used as a resource for peer-reviewed articles to highlight the topics of dentin hierarchical structure, biomodification agents, and laboratorial investigations of their clinical applications. In addition, new data is presented on laboratorial methods for the standardization of proanthocyanidin-rich preparations as a renewable source of plant-derived biomodification agents.

RESULTS

Biomodification agents can be categorized as physical methods and chemical agents. Synthetic and naturally occurring chemical strategies present distinctive mechanism of interaction with the tissue. Initially thought to be driven only by inter- or intra-molecular collagen induced non-enzymatic cross-linking, multiple interactions with other dentin components are fundamental for the long-term biomechanics and biostability of the tissue. Oligomeric proanthocyanidins show promising bioactivity, and their chemical complexity requires systematic evaluation of the active compounds to produce a fully standardized intervention material from renewable resource, prior to their detailed clinical evaluation.

SIGNIFICANCE

Understanding the hierarchical structure of dentin and the targeting effect of the bioactive compounds will establish their use in both dentin-biomaterials interface and caries management.

Novel fluoro-carbon functional monomer for dental bonding

Among several functional monomers, 10-methacryloxydecyl dihydrogen phosphate (10-MDP) bonded most effectively to hydroxyapatite (HAp). However, more hydrolysis-resistant functional monomers are needed to improve bond durability. Here, we investigated the adhesive potential of the novel fluoro-carbon functional monomer 6-methacryloxy-2,2,3,3,4,4,5,5-octafluorohexyl dihydrogen phosphate (MF8P; Kuraray Noritake Dental Inc., Tokyo, Japan) by studying its molecular interaction with powder HAp using solid-state nuclear magnetic resonance ((1)H MAS NMR) and with dentin using x-ray diffraction (XRD) and by characterizing its interface ultrastructure at dentin using transmission electron microscopy (TEM). We further determined the dissolution rate of the MF8P_Ca salt, the hydrophobicity of MF8P, and the bond strength of an experimental MF8P-based adhesive to dentin. NMR confirmed chemical adsorption of MF8P onto HAp. XRD and TEM revealed MF8P_Ca salt formation and nano-layering at dentin. The MF8P_Ca salt was as stable as that of 10-MDP; MF8P was as hydrophobic as 10-MDP; a significantly higher bond strength was recorded for MF8P than for 10-MDP. In conclusion, MF8P chemically bonded to HAp. Despite its shorter size, MF8P possesses characteristics similar to those of 10-MDP, most likely to be associated with the strong chemical bond between fluorine and carbon. Since favorable bond strength to dentin was recorded, MF8P can be considered a good candidate functional monomer for bonding.

Influence of chlorhexidine digluconate on the clinical performance of adhesive restorations: a 3-year follow-up

OBJECTIVES

The aim of this clinical study was to evaluate the long-term clinical performance of non-carious Class V restorations with and without application of chlorhexidine digluconate to acid-etched dentine.

METHODS

After the approval of the Ethics and Informed Consent Committee, 70 non-carious cervical lesions were selected and randomly assigned into two groups, according to the split mouth design. The control group was restored with a two-step etch-and-rinse adhesive (Adper Single Bond 2) following manufacturer's instructions; whereas in the experimental group 2% chlorhexidine digluconate solution was applied to acid etched dentine for 30s after etching and prior to the adhesive application. All lesions were restored with a nanofilled composite resin (Filtek Supreme XT) and polymerized with a light-curing unit operating at 600mW/cm(2). Clinical performance was recorded after 1 week, 6, 12, and 36 months using modified Ryge/USPHS criteria in terms of retention, marginal discoloration, marginal integrity, post-operative sensitivity, and secondary caries incidence. Data were analyzed using Chi-Square, Fisher's exact test and McNemar tests (α=.05).

RESULTS

After 36 months the control group showed a success rate of 88% in comparison to 76% of experimental group; however, no statistically difference between them was found (p=.463). Moreover, no statistical differences were observed between groups in the criteria post-operative sensitivity, marginal discoloration, marginal integrity, and secondary caries incidence between the two groups.

CONCLUSION

The addition of 2% chlorhexidine digluconate conditioning step does not improve the clinical durability of adhesive restorations.

Cariogenic bacteria degrade dental resin composites and adhesives

A major reason for dental resin composite restoration replacement is related to secondary caries promoted by acid production from bacteria including Streptococcus mutans (S. mutans). We hypothesized that S. mutans has esterase activities that degrade dental resin composites and adhesives. Standardized specimens of resin composite (Z250), total-etch (Scotchbond Multipurpose, SB), and self-etch (Easybond, EB) adhesives were incubated with S. mutans UA159 or uninoculated culture medium (control) for up to 30 days. Quantification of the BisGMA-derived biodegradation by-product, bishydroxy-propoxy-phenyl-propane (BisHPPP), was performed by high-performance liquid chromatography. Surface analysis of the specimens was performed by scanning electron microscopy (SEM). S. mutans was shown to have esterase activities in levels comparable with those found in human saliva. A trend of increasing BisHPPP release throughout the incubation period was observed for all materials and was more elevated in the presence of bacteria vs. control medium for EB and Z250, but not for SB (p < .05). SEM confirmed the increased degradation of all materials with S. mutans UA159 vs. control. S. mutans has esterase activities at levels that degrade resin composites and adhesives; degree of degradation was dependent on the material's chemical formulation. This finding suggests that the resin-dentin interface could be compromised by oral bacteria that contribute to the progression of secondary caries.

Effect of dentin biomodification using naturally derived collagen cross-linkers: one-year bond strength study

Purpose. This study investigated the long-term resin-dentin bond strength of dentin biomodified by proanthocyanidin-rich (PA) agents. Materials and Methods. Forty molars had their coronal dentin exposed, etched, and treated for 10 minutes with 6.5% grape seed extract (GSE), 6.5% cocoa seed extract ethanol-water (CSE-ET), 6.5% cocoa seed extract acetone-water (CSE-AC), and distilled water (CO). Samples were restored either with One-Step Plus (OS) or Adper Single-Bond Plus (SB). Bond strength test was performed immediately or after 3, 6, and 12 months. Results. Higher μTBS were observed for GSE immediately (SB- 62.9 MPa; OS- 51.9 MPa) when compared to CSE-ET (SB- 56.95 MPa; OS- 60.28 MPa), CSE-AC (SB- 49.97 MPa; OS- 54.44 MPa), and CO (SB- 52.0 MPa; OS- 44.0 MPa) (P < 0.05). CSE outcomes were adhesive system and solvent dependant. After 12 months storage SB results showed no difference among treatment types (GSE- 57.15 MPa; CSE/ET- 54.04 MPa; CSE/AC- 48.22 MPa; CO- 51.68 MPa; P = 0.347),while OS results where treatment dependent (GSE- 42.62 MPa; CSE/ET- 44.06 MPa; CSE/AC- 41.30 MPa; CO- 36.85 MPa; P = 0.036). Conclusions. GSE and CSE-ET agents provided enhanced immediate adhesion and stabilization to demineralized dentin after long-term storage, depending on adhesive system.

Long-term bonding effectiveness of simplified etch-and-rinse adhesives to dentin after different surface pre-treatments

OBJECTIVE

To evaluate the effect of 2% chlorhexidine (CHX) and 30% proanthocyanidin (PA) application on the immediate and long-term bond strength of simplified etch-and-rinse adhesives to dentin.

MATERIALS AND METHODS

One hundred twenty extracted human molar teeth were ground to expose the flat dentin surface. The teeth were equally divided into six groups according to the adhesives used, either Tetric N Bond or Solobond M and pretreatments given either none, CHX, or PA. Composite cylinder was bonded to each specimen using the respective adhesive technique. Half the samples from each group (n = 10) were then tested immediately. The remaining samples were tested after 6 month storage in distilled water.

RESULTS

The mean bond strength of samples was not significantly different upon immediate testing being in the range of 8.4(±0.7) MPa. The bond strength fell dramatically in the control specimens after 6 month storage to around 4.7(±0.33) MPa, while the bond strength was maintained in the samples treated with both CHX and PA.

CONCLUSION

Thirty percent PA was comparable to 2% CHX with respect to preservation of the resin dentin bond over 6 months.

Strategies to prevent hydrolytic degradation of the hybrid layer-A review

OBJECTIVE

Endogenous dentin collagenolytic enzymes, matrix metalloproteinases (MMPs) and cysteine cathepsins, are responsible for the time-dependent hydrolysis of collagen matrix of hybrid layers. As collagen matrix integrity is essential for the preservation of long-term dentin bond strength, inhibition of endogenous dentin proteases is necessary for durable resin-bonded restorations.

METHODS

Several tentative approaches to prevent enzyme function have been proposed. Some of them have already demonstrated clinical efficacy, while others need to be researched further before clinical protocols can be proposed. This review will examine both the principles and outcomes of techniques to prevent collagen hydrolysis in dentin-resin interfaces.

RESULTS

Chlorhexidine, a general inhibitor of MMPs and cysteine cathepsins, is the most tested method. In general, these experiments have shown that enzyme inhibition is a promising approach to improve hybrid layer preservation and bond strength durability. Other enzyme inhibitors, e.g. enzyme-inhibiting monomers, may be considered promising alternatives that would allow more simple clinical application than chlorhexidine. Cross-linking collagen and/or dentin matrix-bound enzymes could render hybrid layer organic matrices resistant to degradation. Alternatively, complete removal of water from the hybrid layer with ethanol wet bonding or biomimetic remineralization should eliminate hydrolysis of both collagen and resin components.

SIGNIFICANCE

Understanding the function of the enzymes responsible for the hydrolysis of hybrid layer collagen has prompted several innovative approaches to retain hybrid layer integrity and strong dentin bonding. The ultimate goal, prevention of collagen matrix degradation with clinically applicable techniques and commercially available materials may be achievable in several ways.

Accelerated fatigue of dentin with exposure to lactic acid

Composite restorations accumulate more biofilm than other dental materials. This increases the likelihood for the hard tissues supporting a restoration (i.e. dentin and enamel) to be exposed to acidic conditions beyond that resulting from dietary variations. In this investigation the fatigue strength and fatigue crack growth resistance of human coronal dentin were characterized within a lactic acid solution (with pH = 5) and compared to that of controls evaluated in neutral conditions (pH = 7). A comparison of the fatigue life distributions showed that the lactic acid exposure resulted in a significant reduction in the fatigue strength (p ≤ 0.001), and nearly 30% reduction in the apparent endurance limit (from 44 MPa to 32 MPa). The reduction in pH also caused a significant decrease (p ≤ 0.05) in the threshold stress intensity range required for the initiation of cyclic crack growth, and significant increase in the incremental rate of crack extension. Exposure of tooth structure to lactic acid may cause demineralization, but it also increases the likelihood of restored tooth failures via fatigue, and after short time periods.

Biomimetic remineralization of dentin

OBJECTIVES

Remineralization of demineralized dentin is important for improving dentin bonding stability and controlling primary and secondary caries. Nevertheless, conventional dentin remineralization strategy is not suitable for remineralizing completely demineralized dentin within hybrid layers created by etch-and-rinse and moderately aggressive self-etch adhesive systems, or the superficial part of a caries-affected dentin lesion left behind after minimally invasive caries removal. Biomimetic remineralization represents a different approach to this problem by attempting to backfill the demineralized dentin collagen with liquid-like amorphous calcium phosphate nanoprecursor particles that are stabilized by biomimetic analogs of noncollagenous proteins.

METHODS

This paper reviewed the changing concepts in calcium phosphate mineralization of fibrillar collagen, including the recently discovered, non-classical particle-based crystallization concept, formation of polymer-induced liquid-precursors (PILP), experimental collagen models for mineralization, and the need for using phosphate-containing biomimetic analogs for biomimetic mineralization of collagen. Published work on the remineralization of resin-dentin bonds and artificial caries-like lesions by various research groups was then reviewed. Finally, the problems and progress associated with the translation of a scientifically sound concept into a clinically applicable approach are discussed.

RESULTS AND SIGNIFICANCE

The particle-based biomimetic remineralization strategy based on the PILP process demonstrates great potential in remineralizing faulty hybrid layers or caries-like dentin. Based on this concept, research in the development of more clinically feasible dentin remineralization strategy, such as incorporating poly(anionic) acid-stabilized amorphous calcium phosphate nanoprecursor-containing mesoporous silica nanofillers in dentin adhesives, may provide a promising strategy for increasing of the durability of resin-dentin bonding and remineralizing caries-affected dentin.