Interaction patterns between dentin and adhesive on prepared class V cavities in vitro and in vivo

Tooth-composite bond failure with a universal and an etch-and-rinse adhesive depending on mode and frequency of application

OBJECTIVES

To evaluate the effect of an additional layer of universal adhesive on the interfacial enamel/dentin-composite gap formation in relation to application mode and aging, via spectral domain optical coherence tomography (SD-OCT) and scanning electron microscopy (SEM).

METHODS

In vitro class V cavities in 114 caries-free premolars were restored by applying one or two layers of a universal adhesive (Scotchbond Universal, SBU) in self-etch (se) and etch-and-rinse (er) mode or the reference adhesive OptiBond FL (OFL-er). The restorations were imaged by SD-OCT (six groups, n = 8) and SEM (n = 3) directly after filling (t1), water storage (t2, 24 h), embedding (t3), and thermo-mechanical loading (t4, TCML). The interfacial gaps were quantified using 26 parameters and analyzed using principal component analysis and linear mixed effect models.

RESULTS

Gap formation at enamel and dentin was significantly influenced by the adhesive, the application mode and number of layers (p < 0.001). This was due to the influence of the SBU-er mode (p < 1e-05), which showed significantly more gap formation and a greater range of variation with double application when compared to SBU-se and OFL. The fewest interfacial gaps occurred with one or two applications of OFL-er and one layer of SBU-er.

SIGNIFICANCE

Adhesive application mode and the number of adhesive layers are relevant factors in the tooth-composite bond failure. Double application worsened the adaptation of SBU to freshly prepared dentin conditioned with phosphoric acid.

Improving Properties of an Experimental Universal Adhesive by Adding a Multifunctional Dendrimer (G-IEMA): Bond Strength and Nanoleakage Evaluation

A vast number of adhesive formulations exist currently. However, available adhesives still have several drawbacks such as increased hydrophilicity, polymerization deficiency, potential cytotoxicity and limited monomer interdiffusion within dentin. To improve material properties, a Bisphenol A-free adhesive containing a novel dendrimer G(2)-isocyanatoethyl methacrylate (G-IEMA) in replacement of Bis-GMA was made and tested. Sound human molars were sectioned to expose mid-coronal dentin, which was bonded using four adhesives—Futurabond, Scotchbond Universal and experimentals EM1 and EM2. The experimental adhesive EM2 contained G-IEMA, while EM1 had Bis-GMA. Groups were further allocated to two different adhesive strategies: etch-and-rinse (20 s etching) or self-etch. Immediate (24 h) microtensile bond strength to dentin (n = 5) was tested using a universal testing machine (1 mm/min, 5 kN; Shimadzu AGS-X Autograph, Tokyo, Japan), while the ultrastructure of the interface (n = 2) was assessed using scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). Nanoleakage expression was evaluated using silver nitrate penetration and posterior SEM-EDS analysis (n = 3). Linear mixed models/Generalized models were used for inferential statistics (5% significance level). Bond strength results did not depend on the adhesive choice, although differences were found between strategies (p < 0.001). Regarding nanoleakage, when applied in an etch-and-rinse mode, experimental adhesives scored lower nanoleakage means than Futurabond and Scotchbond Universal. The novel adhesive shows interesting interfacial properties, with favorable nanoleakage results and a bond strength to dentin that matches current commercial adhesives.

Dentin Bonding and SEM Analysis of a New Experimental Universal Adhesive System Containing a Dendrimer

Due to their polymerization characteristics, hyper-branched dendrimers have lately shown to be promising candidates for use in dental materials. In this study, a new dental adhesive system was prepared, using a dendrimer derived from 2-isocyanatoethyl methacrylate (G-IEMA), and its adhesive properties were investigated. The exposed dentin was treated with four universal adhesives (UAs): SBU (Scotchbond Universal^™), FUT (Futurabond M+^™), AE1 (experimental adhesive with Bis-GMA) and AE2 (experimental adhesive with G-IEMA), using Etch & Rinse (ER) or Self Etch (SE) protocols. Composite build-ups were prepared and stored for 24 h at 37 °C in distilled water. Composite/dentin beams were prepared with cross-sectional areas of 1 ± 0.3 mm² and µTBS (Micro-tensile bond strength) test was performed at 0.5 mm/min. Failures modes were evaluated by stereomicroscopy, and bonding interfaces were observed by scanning electron microscopy (SEM). Statistical analysis of µTBS data was performed using General Linear (GLM) and Linear Mixed Models (LMM). The effect of adhesive type on µTBS was significant (p = 0.010), with AE1 presenting significantly higher µTBS than SBU (p = 0.019). No other differences between adhesives were observed. ER showed significantly better results than SE (p = 0.019), and no significant interactions between the adhesives and protocols were determined. Results obtained so far pinpoint the emergence of a new paradigm in the dental materials field, as G-IEMA can be used successfully as an alternative to Bis-GMA.

Morphology of the Dentin-resin Interface yielded by Two-step Etch-and-rinse Adhesives with Different Solvents

AIM

The study aimed to analyze the morphology of the dentin-resin interface yielded by two-step etch-and-rinse adhesive systems with different solvents and compositions.

MATERIALS AND METHODS

A total of 32 dentine disks were prepared and randomly assigned to four groups of one-bottle etch-and-rinse adhesive systems containing different solvents: group I, Adper Scotchbond-IXT™ (ethanol/water); group II, XP-Bond™ (tertiary butanol); group III, Prime and Bond NT^® (acetone); and group IV, One Coat bond® (5% water). Adhesive systems were applied onto dentin disks, which were then thermal cycled, divided into two hemi-disks (n = 16), and prepared for field-emission scanning electron microscopy to examine the dentin-resin interdiffusion zone. Microphotographs were scanned and data were processed. Data were compared with analysis of variance multivariant test after Kolmogorov-Smirnov and Shapiro-Wilk tests using Statistic Package for the Social Sciences.

RESULTS

The adhesive layer thickness average found was group I: 45.9 ± 13.41 urn, group II: 20.6 ± 16.32 urn, group III: 17.7 ± 11.75 urn, and group IV: 50.7 ± 27.81 urn. Significant differences were found between groups I and IV and groups II and III (p < 0.000). Groups I (3.23 ± 0.53 μm) and II (3.13 ± 0.73 μm) yielded significantly thicker hybrid layers than groups III (2.53 ± 0.50 μm) and IV (1.84 ± 0.27 μm) (p < 0.003). Group III presented a less homogeneous hybrid layer, with some gaps. Tag length average was greater in groups II (111.0 ± 36.92 μm) and IV (128.9 ± 78.38 μm) than in groups I (61.5 ± 18.10 μm) and III (68.6 ± 15.84 μm) (p < 0.008).

CONCLUSION

Adhesives systems with different solvents led to significant differences in the dentin-resin interface morphology. Solvents role in adhesives bond strength should be considered together with the other adhesive system components.

CLINICAL SIGNIFICANCE

The adhesive containing tertiary butanol, in addition, seems to originate a good-quality hybrid layer and long, entangled tags and also appears to have greater ability to originate microtags, which may indicate higher bond strength.

Influence of solvents and composition of etch-and-rinse and self-etch adhesive systems on the nanoleakage within the hybrid layer

AIM

The goal of this study was to evaluate nanoleakage within the hybrid layer yielded by etch-and-rinse and self-etch adhesive systems, with different solvents and compositions.

MATERIALS AND METHODS

Four adhesives were applied onto 20 human dentin disks: group A: Adper Scotchbond 1XT(™) (3M ESPE), group B: One Coat Bond(®) (Coltène Whaledent), group C: AdheSE(®) (Ivoclar Vivadent) and group D: Xeno-V(®) (Dentsply). The samples were immersed in aqueous ammoniacal silver nitrate for 24 hour, prepared and observed under field-emission scanning electron microscopy with backscattered electrons. Microphotographs were scanned and data were processed. The mean value and standard deviation were calculated. Kruskal- Wallis and Mann-Whitney tests were used (p < 0.05).

RESULTS

All the adhesives showed nanoleakage within the hybrid layer: Adper Scotchbond 1XT(™) (218.5 µm ± 52.6 µm), One Coat Bond(®) (139.6 µm ± 79.0 µm), AdheSE(®) (92.7 µm ± 64.8 µm) and Xeno-V(®) (251.0 µm ± 85.2 µm). AdheSE(®) yielded less nanoleakage than Adper Scotchbond-1XT(™) (p = 0.003) and than Xeno-V(®) (p = 0.007). No other statistically significant differences were detected.

CONCLUSION

Two-step self-etch adhesive system (AdheSE(®)) might contribute for lower nanoleakage deposition and thus better performance in dentin adhesion.

CLINICAL SIGNIFICANCE

The two-step self-etch adhesive system showed the lowest nanoleakage deposition compared with the other adhesive systems evaluated, which seems to indicate a better behavior when a restoration is performed in dentin and possibly can lead to a durable adhesion along time.

Effect of Operator-specific Handling on Tooth-composite Interface and Microleakage Formation

After calibration of the restoration procedure, three operators experienced differences in tooth-composite interface morphology and microleakage formation. These differences reflect technique-sensitivity of the etch-and-rinse adhesive. The lowest microleakage on dentin was related to an enhanced interface integrity. After additional application of an adhesive component, sealing of the enamel and dentin was partially enhanced, but microleakage formation did not decrease. These results are helpful in the comparative evaluation of other bonding systems.

Adhesive performance of dentin bonding agents appliedin vivo andin vitro. Effect of intrapulpal pressure and dentin depth

The purpose of this study was to evaluate the influence of intrapulpal pressure and dentin depth on bond strengths of an etch-and-rinse and a self-etching bonding agent to dentin in vitro and in vivo. Twenty-four pairs of premolars were randomly divided into four groups (n = 6) according to the dentin bonding agent, Single Bond and Clearfil SE Bond, and intrapulpal pressure, null or positive. Each tooth of the pair was further designated to be treated in vivo or in vitro. The intrapulpal pressure was controlled in vivo by the delivery of local anesthetics containing or not a vasoconstrictor, while in vitro, it was achieved by keeping the teeth under hydrostatic pressure. Class I cavities were prepared and the dentin bonding agents were applied followed by incremental resin restoration. For the teeth treated in vitro, the same restorative procedures were performed after a 6 month-storage period. Beams with 1 mm(2) cross-sectional area were prepared and microtensile tested. Clearfil SE Bond was not influenced by any of the variables of the study, while bond strengths produced in vitro were significantly higher for Single Bond. Overall, lower bond strengths were produced in deep dentin, which reached statistical significance when Single Bond was applied under physiological or simulated intrapulpal pressure. In conclusion, in vitro bonding may overestimate the immediate adhesive performance of more technique-sensitive dentin bonding systems. The impact of intrapulpal pressure on bond strength seems to be more adhesive dependent than dentin morphological characteristics related to depth.

Marginal Permeability of Self-etch and Total-etch Adhesive Systems

Decreased leakage was associated with Adper Scotchbond Multi-Purpose (total etch) and iBond (self-etch) systems in Class V resin composite restorations. All adhesive systems performed best when bonded to enamel compared to dentin surface anatomy. Clinicians should be aware that strict adherence to manufacturer instructions, when using these materials, is of primary importance.

Effect of hydration variability on hybrid layer properties of a self-etching versus an acid-etching system

The hypothesis tested in this study was that the self-etching system (Clearfil SE Bond, CSE) is less sensitive to surface moisture variability than the system that uses a separate acid-etching step (Single Bond, SB). Eighteen dentin specimens were bonded to composite using CSE or SB. Three different surface moisture conditions per bonding type (overwet, w; dry, d; and visibly moist, n [normal]) were applied prior to bonding dentin to composite. One cross section of each sample was analyzed with lines of nanoindentations crossing perpendicular to the bonding interface. An additional set of bonded samples was fixed and cross sectioned before the hybrid layer thickness was measured in scanning electron microscopy. The nanoindentations revealed significant differences in indentation modulus (E(i)) and hardness (H) for the hybrid layer comparing SBn, E(i) = 2.7(+/-1.6); H = 0.24(+/-0.1) GPa with SBd, E(i) = 0.9(+/-0.7); H = 0.9(+/-0.05) GPa, respectively, while CSE showed no differences among the groups. A significantly greater demineralized zone below the hybrid layer was found for SBd. The hybrid layer was wider for both CSEd and SBd. In conclusion the hypothesis was verified; CSE exhibited no significant changes of hybrid layer properties (E(i), H) at different hydration conditions, while SB had significant differences, especially after air-drying.

Resin penetration through submicrometer hiatus structures: A SEM and CLSM study

The purpose of this study was to confirm the existence of submicrometer hiatus structures and to examine the degree of resin penetration through these formations. Dentin disks 2.0 mm in thickness were sectioned from 48 human molars with the use of a microtome saw. Three different fifth-generation (total-etch, combined primer/resin) dentin adhesive systems were used to bond a light-cured, resin-based composite to the dentin disks (n = 16 each group). Bonded disks from the three groups were then sectioned. Half of each group was examined with the use of a scanning electron microscope (SEM) (n = 8), and the other half with the use of a confocal laser scanning microscope (CLSM) (n = 8). The frequency of submicrometer hiatus formation was recorded and documented with associated imaging techniques. Resin penetration within submicrometer hiati were observed in 41.7% (10/24) of SEM specimens and 83.3% (20/24) of CLSM specimens. The location and size of these structures were found to be quite uniform. Submicrometer hiati approximated 200 microm in each of the three dentin bonding systems examined. Resin penetration through submicrometer hiati does not appear to be an artifact of desiccation. These structures were clearly identified within the hybrid layer of each dentin adhesive system used in this study.

Evaluation of silver methenamine method for nanoleakage

OBJECTIVES

The aim of this study was to evaluate nanoleakage patterns following silver methenamine staining of restorations bonded with a total-etch single bottle system, a self-etching primer system and a total-etch single bottle system after collagen depletion.

METHODS

The dentin bonding systems used in this study were Prime and bond 2.1 (PB) and Clearfil SE Bond (CSEB). Cavities were made in grounded labial surfaces of 15 extracted bovine lower incisors, randomly divided into 3 Groups. Group 1 (PB), Group 2 (CSEB) and Group 3 (PB/SH) PB after collagen depletion with sodium hypochlorite (SH). The specimens were restored, sectioned and submitted to silver methenamine staining, polished and observed with low-vacuum back-scattered SEM. One way ANOVA and multiple-comparison Tukey's test were used for statistical analysis of the leakage scores.

RESULTS

PB presented significantly greater silver deposition and a distinct pattern when compared to CSEB. No silver deposition was detected for PB after collagen depletion.

SIGNIFICANCE

The dentine bonding systems tested were unable to prevent nanoleakage when used according to the manufacturers' instructions; however, CSEB presented a lower level of silver deposition. Collagen depletion prior to PB application may prevent nanoleakage occurrence in dentine walls. Silver methenamine staining may be a useful method for detection of nanoleakage in dentine when the collagen fibrils remain exposed within the hybrid layers.

The effect of a self-etching primer on the continuous demineralization of dentin

Self-etching primers (SEP), used for adhesion of resin restorations, contain an acidic monomer that is not rinsed off after application; therefore, residual acid could further demineralize dentin, jeopardizing adhesion. This study evaluated whether dentin demineralization continues after a 20-s application of a SEP and also after polymerization of the adhesive. Surface recession was measured, using atomic force microscopy (AFM), between the masked surface and dentin etched with SEP (Clearfil SE Bond) or phosphoric acid (pH 1.94) immediately, 5 min, 2 h or 12 h after application. AFM-based nanoindentations were performed to determine mechanical property profiles across resin-bonded interfaces of two sequence groups: SG 1, where the adhesive was applied and polymerized immediately after application of the primer and specimens were immersed in Hank's solution after 5 min, 2 h and 12 h; or SG 2, where specimens were placed in an incubator before the application of the adhesive, for the same time periods. Significant surface recession occurred over time for all groups, except for SEP before desiccation. Nanoindentations yielded decreased hardness and elastic modulus below the hybrid layer after application of the initial primer, even after polymerization of the adhesive. The results reveal a demineralized dentin zone below the hybrid layer formed by the SEP, not fully protected by the adhesive, which could jeopardize bond strength.

Tooth-composite interface from specific and nonspecific adhesive restorative systems

The aim of this in vitro study was to do a morphological comparison of tooth/composite interface by means of three composite systems: (1) a specific formulated primer adhesive and Organically Modified Ceramics (ORMOCER) composite, (2) an universal self-etching adhesive and the same ORMOCER composite, (3) and the same universal adhesive used for Group 2 and a fine-particle hybrid resin composite. The rational for this study was based on the recommendations from manufacturers that nonspecific dentin bonding agents can be used with ORMOCER. Twenty-one Class II cavities were prepared in extracted third molars. Seven randomly assigned teeth were restored with one of the three methods according to the instructions provided by the manufacturer. Following completion of the restorations, the teeth were sectioned and evaluated by means of scanning electron microscopy for evaluation of interfacial morphology and light microscopy for the determination of microleakage. The last was scored as being present or absent. The best results were observed using method 1, in which a special primer adhesive and ORMOCER composite was used. In this group there were statistically significant fewer gaps in enamel (4.7+/- 7.5%) and dentin (22.8 +/- 7.4%) compared to the other two groups (Group 2: enamel 21.1 +/- 8.3% and dentin 66.3 +/- 17.3%; and Group 3: enamel 40.6 +/- 35.2% and dentin 89.4 +/- 13.3%). The interfaceof method 2, universal self-etching adhesive and ORMOCER, was of a lesser quality than Group 1. Within the limitations of this study the recommendation is made to use the ORMOCER tested in this experiment with the matching specifically formulated primer adhesive system. A lack of adhesion as well as microleakage, were prominent features for Groups 2 and 3. From the data of this study the practitioner is cautioned not to indiscriminately exchange specific dentin bonding agents for nonspecific ones. Considering the shear endless number of possible combinations and the numerous different tests that would be required to test these all, selection of different combinations will remain a theoretical exercise.

The influence of the dentin smear layer on adhesion: a self-etching primer vs. a total-etch system

OBJECTIVE

To determine the effect of dentin smear layers created by various abrasives on the adhesion of a self-etching primer (SE) and total-etch (SB) bonding systems.

METHODS

Polished human dentin disks were further abraded with 0.05 micro m alumina slurry, 240-, 320- or 600-grit abrasive papers, # 245 carbide, # 250.9 F diamond or # 250.9 C diamond burs. Shear bond strength (SBS) was evaluated by single-plane lap shear, after bonding with SE or SB and with a restorative composite. Smear layers were characterized by thickness, using SEM; surface roughness using AFM; and reaction to the conditioners, based on the percentage of open tubules, using SEM.

RESULTS

Overall, SBS was lower when SB was used than when SE was used. SBS decreased with increasing coarseness of the abrasive in the SE group. Among burs, the carbide group had the highest SBS, and 320- and 240-grit papers had SBS close to the carbide group. Surface roughness and smear layer thickness varied strongly with coarseness. After conditioning with SE primer, the tubule openness of specimens abraded by carbide bur did not differ from 240- or 320-grit paper, but did differ from the 600-grit.

SIGNIFICANCE

Even though affected by different surface preparation methods, SE yielded higher SBS than SB. The higher SBS and thin smear layer of the carbide bur group, suggests its use when self-etching materials are used in vivo. Overall, the 320-grit abrasive paper surface finish yielded results closer to that of the carbide bur and its use is recommended in vitro as a clinical simulator when using the SE material.

The effect of NaOCl dentin treatment on nanoleakage formation

The term "nanoleakage" has been introduced to explain a penetration pathway within hybrid layers of the dentin-composite junction in the absence of gap formation. This phenomenon is argued in the literature to be a risk factor for the quality of the dentin bonding. NaOCl is a well-known agent used to remove collagen layers that are exposed after acid etching. The purpose of this study was to determine the influence of an NaOCl treatment of dentin to the formation of nanoleakage. Class V cavities were prepared in 40 human molars with the cervical margins located in dentin. After etching with phosphoric acid, 20 samples were treated with 10% NaOCl for 60 s, and 20 samples were used as control. Composite restorations were placed using two different bonding systems. The specimen were exposed in silver nitrate solution and then in developer. After embedding, the teeth were sectioned, dried, coated with gold, and analyzed by SEM. For all the specimen in the control group, backscatter images indicated a silver penetration within the hybrid layer. There was no penetration of silver detectable in the teeth that were treated with NaOCl. We conclude that the removal of the collagen layer by using NaOCl avoids the formation of nanoleakages with the materials tested.

The effect of fluoridated and non-fluoridated rewetting agents on in vitro recurrent caries

OBJECTIVE

This study examined the in vitro caries inhibiting potential of fluoridated and non-fluoridated rewetting agents that are applied to acid-etched enamel and dentine before the use of a water-free, dentine adhesive.

MATERIALS AND METHODS

Twelve caries-free premolars were divided into three groups of four teeth each. 2 x 3 x 1.5 mm cavities were prepared on the mesial and distal surfaces of each tooth, with half of the cavosurface margin in enamel and half in root dentine. In Group I (control), One-Step (Bisco, Schaumburg, USA) was applied without etching or rewetting agents. In Group II, cavities were acid-etched, rinsed, dried, and rewetted with Aqua-Prep (Bisco), a non-fluoridated rewetting agent, and then bonded with One-Step. Treatment for Group III was similar to Group II, except that Aqua-Prep F (Bisco), a fluoridated rewetting agent was used. Bonded cavities were restored with a non-fluoride-containing flowable composite (AEliteFlo, Bisco). Artificial carious lesions were induced in these specimens, from which multiple 100+/-20 microm thick longitudinal sections were prepared, yielding 16 specimens per group for evaluation with polarised light microscopy (PLM) and microradiography (MRG). Representative sections were processed for transmission electron microscopy (TEM) examination and scanning transmission electron microscopy/energy dispersive X-ray (STEM/EDX) analyses.

RESULTS

The differences in demineralisation of dentine among the groups were not statistically significant for 'relative' lesion depth (p > 0.05, ANOVA, Student-Neuman-Keuls test), but highly significant for 'relative' lesion area (p < 0.001). Wall lesions were consistently present in Group I, while inhibition zones were invariably observed in Group III. 87.5% of Group II specimens exhibited neither wall lesion nor inhibition zone. TEM showed that remnant dentine apatite crystallites within the inhibition zones in Group III were larger and denser than those present within the corresponding wall lesions. STEM/EDX analyses confirmed the presence of calcium, phosphorus and fluorine in these plate-like crystallites.

CONCLUSION

When used with a water-free, single-bottle dentine adhesive, a non-fluoridated rewetting agent is able to reduce, but cannot completely prevent recurrent caries. The use of a fluoridated rewetting agent is useful under the situation when microleakage occurs, by providing the additional benefit of fluoride-induced demineralisation inhibition.