Adhesion/decalcification mechanisms of acid interactions with human hard tissues

The Effect of Different Conditioning Agents on Dentin Roughness and Collagen Structure

OBJECTIVES

To assess the impact of various organic and inorganic acids on the roughness, demineralization and collagen secondary structures of human dentin, and to compare these effects with those of traditional agents, specifically phosphoric acid (PA) and ethylenediaminetetraacetic acid (EDTA).

METHODS

Coronal dentin discs (n=10) were examined by optical profilometry (roughness) and ATR-FTIR before and after conditioning with 32% PA, 3% nitric acid (NA), 20% citric acid (CA), 20% phytic acid (IP6) or 17% EDTA. Spectra data were processed to quantify dentin demineralization (DM%) and percentage area of amide I curve-fitted components of β-turns, 310-helix, α-helix, random coils, β-sheets, and collagen maturation (R) index. Statistical analysis was performed by one-way ANOVA or Kruskal-Wallis for DM% and roughness parameters, and paired t-test/Wilcoxon test for amide I components at significance level set at α=0.05.

RESULTS

All treatments resulted in increased roughness parameters, with the most significant changes occurring primarily with PA, while EDTA exhibited the least changes. DM% was NA>PA>IP6>CA>EDTA in a descending order. Regarding amide I components, NA demonstrated a significant reduction in β-turns, 310-helices α-helices and an increase in β-sheets and random coils. PA resulted in reduction in β-turns, α-helices and an increase in β-sheets, whilst CA and IP6 did not cause significant changes. The collagen maturation index increased only with IP6 treatment.

CONCLUSIONS

The effect on dentin roughness parameters, demineralization and collagen secondary structures varied based on the type of dentin surface treatment.

CLINICAL SIGNIFICANCE

Understanding the impact of acids on the intrinsic properties of dentin is clinically essential for gaining insights into how these effects influence adhesion to dentin, the long-term stability of resin-based restorations, and the success of remineralization therapies.

Micro-shear bond strength of a novel resin-modified glass ionomer luting cement (eRMGIC) functionalized with organophosphorus monomer to different dental substrates

Objectives

This study aims to assess and compare the micro-shear bond strength (μSBS) of a novel resin-modified glass-ionomer luting cement functionalized with a methacrylate co-monomer containing a phosphoric acid group, 30 wt% 2-(methacryloxy) ethyl phosphate (2-MEP), with different substrates (dentin, enamel, zirconia, and base metal alloy). This assessment is conducted in comparison with conventional resin-modified glass ionomer cement and self-adhesive resin cement.

Materials and methods

In this in vitro study, ninety-six specimens were prepared and categorized into four groups: enamel (A), dentin (B), zirconia (C), and base metal alloys (D). Enamel (E) and dentin (D) specimens were obtained from 30 human maxillary first premolars extracted during orthodontic treatment. For zirconia and metal alloys, 48 disks were manufactured using IPS e.max ZirCAD through dry milling and Co-Cr powder alloy by selective laser milling. Each group was further subdivided into three subgroups (n = 8) according to the luting cement used: (1) Fuji PLUS resin-modified glass ionomer luting cement (FP) as a control cement, (2) modified control cement (eRMGIC), and (3) RelyX U 200 (RU 200) self-adhesive resin cement. The two-way analysis of variance and Tukey's HSD were used to assess the data obtained from measuring the μSBS of the samples.

Results

The results of this study showed that the mean μSBS values of eRMGIC were statistically higher compared to FP in all tested groups (p < 0.001). The mean μSBS results of eRMGIC were non-significantly different from those recorded by RU 200 for all substrates except for the dentin substrate, where the RU200 cement produced significantly higher strength (p < 0.001). The failure modes were limited to a combination of mixed and adhesive failures without pure cohesive failure.

Significance

The functionalization of FP with an organophosphorus co-monomer (2-MEP) directly affects the adhesion performance of the functionalized cement, which may be utilized to develop a new type of acid-base cement. It exhibited a performance comparable to that of resin-based cement and should serve well under different clinical conditions.

Effect of varying functional monomers in experimental self-adhesive composites: polymerization kinetics, cell metabolism influence and sealing ability

The aim was to evaluate the effects of adding different functional monomers to experimental self-adhesive composites (SACs) on polymerization kinetics, cell metabolic activity, and sealing ability. SACs were formulated using urethane dimethacrylate as the base monomer and triethylene glycol dimethacrylate. Additionally, 10 wt.% of distinct functional monomers were added - 10-methacryloyloxydecyl dihydrogen phosphate, glycerol phosphate dimethacrylate (GPDM), 2-hydroxyethyl methacrylate (HEMA) or hydroxyethyl acrylamide (HEAA). ATR-FTIR was used to determine real-time polymerization kinetics (20 min,n= 3). The final extrapolated conversion and polymerization rates were determined (DC,max;Rp,max). TheDC,maxvalues were employed to calculate volumetric shrinkage. The MTT assay was performed on MDPC-23 cells using disc extracts at different concentrations (n= 8). Class V cavities were prepared in 60 sound human molars, assigned to six groups (n= 10), depending on the composite used and aging type (T0 or TC, if thermocycled for 10 000 cycles). One-way ANOVA, two-way, andKruskal-Wallistests were employed to treat the data (ɑ= 0.05). Varying the functional monomers had a large impact on DC,max, as confirmed by one-way ANOVA (p<0.001). The highest was obtained for HEMA (64 ± 3%). The HEMA and HEAA formulations were found to be significantly more toxic at concentrations below 100%. For microleakage, having a functional monomer or not did not show any improvement, irrespective of margin or aging period (Mann-Whitney U,p> 0.05). Larger functional monomers MDP and GPDM affected polymerization properties. Conversely, their acidity did not seem to be detrimental to cell metabolic activity. Regarding sealing ability, it seems that the functional monomers did not bring an advantage to the composites. Varying the functional monomer in SACs had a clear impact on the polymerization kinetics as well as on their cytotoxic potential. However, it did not confer better microleakage and sealing. Claiming self-adhesiveness based only on functional monomers seems dubious.

Bonding performance of glass ionomer cement to carious dentin treated with different surface treatment protocols using silver diamine fluoride

This study investigated the influence of silver diamine fluoride (SDF) on the shear bond strength (SBS) to artificial carious dentin and GIC restorations with various SDF application protocols. Artificial caries were prepared on human dentin discs using bacteria model. These samples were randomly allocated to five groups (n = 10/group) according to the following treatment: (1) control group (CD): no treatment (2) CSR: dentin conditioner, SDF, and rinsing (3) CS: dentin conditioner and SDF (4) SRC: SDF, rinsing and dentin conditioner, and (5) SC: SDF and dentin conditioner. The treated-dentin surface was bonded with GIC and subjected to SBS test. Mean SBS was analyzed using one-way ANOVA. Surface morphology and elemental contents after surface treatment were examined (n = 3/group) by scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDX). There was no significant difference in the mean SBS among CD (2.45 ± 0.99 MPa), CSR (1.76 ± 0.65 MPa), and SRC (2.64 ± 0.95 MPa). Meanwhile, the mean SBS of CS (0.35 ± 0.21 MPa) was significantly lower than the control and SRC group. SEM/EDX demonstrated deeper silver penetration in CSR and CS groups when compared to SRC and SC groups. SDF-modified GIC restorations resulted in significantly lower bond strength in CS and SC groups. The findings suggested treating the carious dentin surface with CSR and SRC protocol. SDF-treated carious dentin should be rinsed off prior to restore with GIC.

A randomized clinical study of the performance of self-etching adhesives containing HEMA and 10-MDP on non-carious cervical lesions: A 2-year follow-up study

OBJECTIVE

To evaluate the association of HEMA and 10-MDP in the clinical performance of self-etching adhesives in the restoration of NCCLs during 2-years.

MATERIALS AND METHODS

60 restorations were performed in 17 volunteers and randomized into three groups: G1 (n = 20) - Prime and Bond Universal (10-MDP); G2 (n = 20) - Optibond All-in-One (HEMA); and G3 (n = 20) - Clearfil SE (10-MDP and HEMA). No cavity preparation was performed. After 2 years, the restorations were evaluated using the modified USPHS criteria for retention, marginal adaptation/ staining, postoperative sensitivity and secondary caries. The results were analyzed using Fisher's exact test and Kruskal-Wallis test.

RESULTS

All groups showed 100% retention rate, except G1, who lost two restorations (p > 0.05). Regarding marginal adaptation, G1 showed greater deficiency, as only eight restorations (40%) remained intact (p < 0.05). Regarding marginal staining, G1 and G2 showed higher rate, as only 12 restorations (65%) in each one were free of staining (p < 0.05). All groups showed similar results for postoperative sensitivity and secondary caries (p > 0.05).

CONCLUSION

The association of HEMA and 10-MDP monomers in the self-etching adhesives did not influence the clinical performance of the NCCL restorations with respect to retention, postoperative sensitivity, and incidence of secondary caries. However, positively influenced the marginal adaptation and marginal staining at the 2-year follow-up.

CLINICAL SIGNIFICANCE

The association of HEMA and 10-MDP monomers in the self-etching adhesives positively influence the clinical performance of the NCCL restorations with respect to marginal adaptation and marginal staining.

Effect of antimicrobial photodynamic therapy with different photosensitizers and adhesion protocol on the bond strength of resin composite to sound dentin

OBJECTIVES

The aim of this study is to evaluate the influence of the antimicrobial photodynamic therapy with phycocyanin and toluidine blue on the bond strength of resin composite to the sound dentin.

MATERIALS AND METHODS

The samples include 120 tooth blocks taken from 60 human extracted sound third molar teeth. They were randomly divided into 12 groups and disinfected with two different photosensitizers (Phycocyanin and Toluidine blue) activated by 635 nm diode laser for aPDT procedure. Then two different protocols (total-etch and self-etch) of universal adhesive system (G-Premio BOND, GC Dental Products CORP. Japan) were applied. The samples then filled with resin composite (Gradia® Direct, GC Dental Products CORP. Japan). After 10000 cycles of thermocycling, all samples were subjected to the micro shear bond strength (μSBS) test using a universal testing machine (1 mm/min). The data were analyzed with One Way ANOVA.

RESULTS

The effect of aPDT using both photosensitizers (phycocyanin and toluidine blue O) on the bonding strength to dentin was not significant (P>0.05). However, the bonding strength of total etch groups was reduced significantly (P<0.05) after aPDT using both photosensitizers. Phycocyanin self-etch group showed the greatest bonding strength (19.48 ± 3.89 MPa) in comparison to other aPDT groups. No significant reduction after thermocycling in dentin bond strength was observed in all groups (P>0.05), with exception of control total etch groups, which showed significant difference (P<0.05).

CONCLUSION

aPDT using toluidine blue O and phycocyanin has no adverse effect on bonding to sound dentin when using universal adhesive in self-etch protocol.

CLINICAL RELEVANCE

Phycocyanin is more recommended to be used in aPDT in comparison to toluidine blue as a natural photosensitizer.

Is the presence of 10-MDP associated to higher bonding performance for self-etching adhesive systems? A meta-analysis of in vitro studies

OBJECTIVE

The purpose of this systematic review and meta-analysis was to analyze the literature on the bond strength of self-etching (SE) adhesives containing 10-MDP or other acidic functional monomers, comparing the bonding performance of both compositions.

METHODS

This study is registered in PROSPERO (CRD42020175715) and it followed the PRISMA Statement. The literature search was performed in PubMed, Web of Science, SciELO, Scopus, LILACS, IBECS, and BBO from the starting coverage date through 30 June 2021. Study eligibility criteria consisted of in vitro studies that evaluated the bond strength (microtensile, microshear, tensile or shear testing) to sound dentin/enamel of a minimum of two distinct SE systems, with at least one material containing 10-MDP and one other being comprised of a distinct acidic composition. Statistical analyses were carried out with RevMan 5.3.5 and using random-effects models with the significance level at p < 0.05. Also, Bayesian network meta-analysis (NMA) was conducted using MetaInsight V3 tool.

RESULTS

From 740 relevant studies evaluated in full-text analysis, 210 were incorporated to the systematic review and 206 in meta-analysis. The majority of studies was classified as having medium risk of bias (56.7%), followed by low (35.2%) and high (8.1%) risk of bias. Data from a total of 64 adhesive systems were collected, which favored the 10-MDP-based group at both dentin (overall effect: 6.98; 95% CI: 5.61, 8.36; p < 0.00001) and enamel (overall effect: 2.79; 95% CI: 1.62, 3.96; p < 0.00001) substrates. Microtensile testing was more frequently used (73.4%) in the included studies. Adhesives based on 10-MDP showed greater bonding performance than adhesives comprised of monomers such as PENTA, 6-MHP, 4-META, 4-MET, pyrophosphate esters, mixed composition or monomers derived from sulfonic acid (p ≤ 0.01); whereas similar bond strength values were verified between 10-MDP-based materials and those containing PEM-F, acrylamide phosphates, 4-AET, MAC-10, or monomers derived from polyacrylic and phosphonic acids (p ≥ 0.05). Adhesives based on GPDM were the only ones that resulted in greater bonding potential than the 10-MDP-based group (p = 0.03). Dental bonds in dentin were favored with the application of 2-step 10-MDP-based adhesives; whereas in enamel the dental bonds were favored for both 2-steps versions of adhesives, regardless of the presence of 10-MDP. Indirect evidence from NMA revealed that 1-step 10-MDP-free and universal 10-MDP-free adhesives seemed to perform worst in dentin and enamel, respectively.

SIGNIFICANCE

Adhesives containing 10-MDP showed higher bonding performance than materials formulated with other acidic ingredients, although this result relied on the type of mechanical testing, type of the substrate, acidic composition of the adhesive, and the application category of the SE system. This review summarized the effects of the foregoing factors on the adhesion to dental substrates.

Varying 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) level improves polymerisation kinetics and flexural strength in self-adhesive, remineralising composites

OBJECTIVES

To assess the influence of systematically varying concentrations of 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) versus 3% 4-META on the polymerisation kinetics and shrinkage, biaxial flexural strength (BFS) and modulus of remineralising composites.

METHODS

Composites were prepared by adding poly(propylene glycol) dimethacrylate (24 wt%), camphorquinone (1 wt%) and MDP (0%, 5%, 10%, 15% and 20 wt%) or 4-META (3%) to urethane dimethacrylate. These were mixed with glass fillers containing 8 wt% monocalcium phosphate and 4 wt% polylysine (powder-liquid ratio of 3:1). Continuous spectral changes, following 20 s light exposure (37 °C), were assessed with an ATR-FTIR to monitor polymerisation kinetics (n = 3). Final extrapolated conversions (D_C,max) were employed to calculate polymerisation shrinkage. BFS and modulus of 24-h dry stored disc specimens (10 × 1 mm; n = 10) were determined using a ball-on-ring jig setup.

RESULTS

Maximum rate of polymerisation and D_C,max increased linearly from 2.5 to 3.5% s^-1 and 67 to 83%, respectively, upon increasing MDP from 0 to 20 wt%. Values with 3% 4-META were 2.6% s^-1 and 78%. Shrinkage was 3.8 ± 0.3% for all formulations. Raising 4-META or MDP from 0 to 3 versus 5%, respectively, increased strength from 106 to 145 versus 136 MPa. A decreasing trend with higher MDP concentrations was noted. Elastic modulus showed no specific trend upon MDP increase.

SIGNIFICANCE

Whilst final conversion levels were enhanced by 3% 4-META or >5% MDP, trends did not correlate with strength. Peak strengths with 3% 4-META or 5% MDP may therefore be due to acidic monomers providing linkage between the hydrophilic, non-silane treated particles and the polymer matrix.

Influence of Low-Level Laser Modification and Adhesive Application Mode on the Bonding Efficiency of Universal Adhesives to Er:YAG Laser-Ablated Dentin

Introduction: Erbium laser ablation as a method of tooth preparation and conditioning has shown promising results. Although previous studies have adopted various combinations of different laser parameters and several dentin adhesive systems, very few have investigated combining high-level and low-level ER:YAG lasers with Universal adhesives. This study aimed to assess the impact of using low-energy irradiation on the surface micro-topography and shear bond strength (SBS) of universal adhesive (UA) to the erbium:yttrium-aluminum-garnet (Er:YAG) laser-ablated dentin substrate, bonded in etch-and-rinse or self-etch adhesive mode. Methods: Eighty-seven extracted molars were sectioned to expose flat occlusal dentin surface; 60 teeth were divided equally into three groups according to the surface treatment; bur-cutting (B), Er:YAG high-energy laser cutting (L₁ - 200 mJ, 20 Hz, 50 μs pulse), or L₁ followed by low-energy laser modification (L₁ /L₂ - 80 mJ, 10 Hz, 50 μs pulse). Then each group was equally divided into two groups (n=10) according to the mode of application of the universal adhesive; either etch-and-rinse (ER) or self-etching (SE). The samples were subjected to thermocycling (5000 cycle between 5°C and 55°C), and SBS was tested. Two-way ANOVA and Tukey post hoc test were used to analyze the results. The remaining 27 samples were used to investigate the effect of the treatment on the topography of the treated dentin surfaces using a scanning electron microscope (SEM). Results: B/SE recorded the highest SBS (25.48 ± 2.6 MPa) followed by B/ER (23.20 ± 6.8 MPa) and L₁ /L₂ /SE (22.94 ± 4.1 MPa) and with no statistically significant difference between these groups (P >0.05). The lowest SBS results (P <0.05) were recorded for L₁/SE (12.22 ± 3 MPa). No statistical differences were found between the SBS of L₁ /L₂ /ER and L₁ /ER groups or between the SBS of L₁ /L₂ / ER and L₁ /L₂ /SE groups. Conclusion: A subsequent treatment of the Er:YAG laser-ablated dentin with low-energy laser modification mode (LMM) enhances the SBS of the tested UA when applied in SE mode.

Dual-Functionality Evaluation of a Novel Collagen Crosslinking Resin

Current adhesives bond to dentin via a micro-interlocking mechanism within the hybrid layer. Besides such mechanical retention, bonding to dentin would benefit from additional chemical interaction between collagen and resin. This study aims to synthesize a novel light-curable collagen crosslinker methacrylate (MA) functionalized grapeseed extract (GSE) and to assess MAGSE's ability to crosslink dentin collagen in a clinically relevant setting as well as its role in light-cure as a resin. MA functionalization was accomplished by reacting GSE with methacryloyl chloride to obtain MAGSE, which was characterized by ¹H-NMR and Fourier transformed infrared spectroscopy (FTIR). The 6-µm-thick dentin films were microtomed from dentin slabs of third molars. Following demineralization, they were treated for 30 s by 1% MAGSE. Collagen crosslinking and resistance to digestion of MAGSE were evaluated by FTIR, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) assay of films, and scanning electron microscopy (SEM)/transmission electron microscopy (TEM) on slabs. Meanwhile, 1% MAGSE or GSE was added to an experimental adhesive formulated with 2-hydroxyethyl methacrylate and a tricomponent photoinitiator system. Polymerization kinetics were monitored continuously in real time for 10 min using FTIR-attenuated total reflection. The results indicated that MAGSE could bind to dentin collagen and protect it from collagenase degradation as strong as GSE. Dentin collagen treated by 1% MAGSE for 30 s was scarcely digested (1.6 ± 1.6%) after 1 h in 0.1% collagenase, while untreated collagen was completely digested (100.9 ± 20.2%). SEM/TEM images indicated MAGSE efficiently crosslinked dentin collagen in 30 s and rendered it almost inert to digestion under clinically relevant settings. Unlike GSE that hindered light-curing of HEMA, MAGSE accelerated the rate of polymerization and exhibited typical traits of a resin monomer with multiple polymerizable units. In conclusion, a novel collagen crosslinking resin MAGSE is synthesized, which inherits collagen crosslinking ability from GSE and polymerization function from MA. Inclusion of this light-curable collagen crosslinker into adhesives might be a revolutionary way to improve durability of dentin bonding in composite restorations.

The effect of prime-and-rinse approach using MDP micellar solutions on extrafibrillar demineralization and dentin bond performance

OBJECTIVE

This study investigated the effects of prime-and-rinse approach using 10-methacryloyloxydecyl dihydrogen phosphate (MDP) micellar solutions on extrafibrillar demineralization and dentin bond performance of etch-and-rinse adhesive.

METHODS

The micellar solutions were prepared by adding 15% MDP in two ethanol-aqueous (75:25, 55:45 V/V%) solutions, referring to MDP/EtOH₇₅ and MDP/EtOH₅₅. After mid-coronal dentin surfaces were either etched (control) or conditioned with MDP/EtOH₇₅ and MDP/EtOH₅₅ and rinsed, they were applied with adhesive (Adpter Single Bond 2) in dry- or wet-bonding mode and placed with composite resin (Filtek Z350 XT). They were prepared into multiple micro-beams for micro-tensile bond strengths (MTBS) testing after storage in water for 24 h or subjecting to thermocycling. The other pretreated dentin surfaces were analyzed by TF-XRD, ATR-FTIR, HRTEM, FE-SEM, contact angle measurement and nanoindentation testing. The MTBS data was analyzed with two-way ANOVA followed by LSD post-hoc test.

RESULTS

MDP/EtOH₇₅ produced significantly greater MTBS values than MDP/EtOH₅₅ and control after thermocycling aging in dry- or wet-bonding mode (P < 0.05). The ATR-FTIR spectrums shows that ratios of phosphate/monomer (1,034 cm^-1/1,716 cm^-1) on MDP/EtOH₇₅-, MDP/EtOH₅₅-treated dentin surfaces are 0.51 and 0.23, respectively. This is confirmed by HRTEM images and SAED pattern that intrafibrillar minerals were mostly preserved after treatment with MDP/EtOH₇₅. MDP/EtOH₇₅ produced significantly higher elastic modulus and nanohardness on pretreated dentin surface than MDP/EtOH₅₅ (P < 0.05). TF-XRD pattern shows some MDP-Ca salts remained on the primed dentin surface.

SIGNIFICANCE

Prime-and-rinse approach using MDP/EtOH₇₅ micellar solution could produce mostly extrafibrillar demineralization, and greatly increase dentin bond durability in dry- or wet-bonding mode.

Scoping review of trials evaluating adhesive strategies in pediatric dentistry: where do simplified strategies lie?

BACKGROUND

Adhesive restorations allow a conservative approach to caries management and are increasingly used as a restorative option in pediatric dentistry. Placement can be difficult in children because of the cooperation required for multiple bonding steps. Due to this, it is vital to assess if novel, simpler strategies have been featured in clinical trials and if clinical trials are researching the different existing adhesive strategies.

METHODS

This review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis adapted for Scoping Reviews (PRISMA-ScR) guidelines. PubMed/Medline, Cochrane Central, Scopus and EMBASE were used for systematic search, using free keywords and controlled search terms. Clinical trials of children requiring a restorative intervention which featured adhesive strategies were included. Only peer-reviewed trials of primary teeth restored with resin composites, published in the last 10-year period were eligible. Data charting was accomplished independently by two reviewers, and studies were summarized according to their date, type, intervention, sample size, observation period, outcomes and conclusions. Quality assessment was performed using Cochrane's Risk of Bias 2.0 tool.

RESULTS

700 potentially relevant references were found, which after a rigorous inclusion scheme, resulted in a total of 8 eligible clinical trials. Out of these, 7 were randomized clinical trials. Most trials featured a split-mouth design and the observation period ranged from 12 to 36 months. The trials evaluated interventions of two self-adhesive composites, two bulk-fill composites, two novel composites, one compomer and eight adhesives from different strategies. Most studies (4/8) included were judged to raise some concerns regarding risk of bias, while two were classified as high risk and two as low.

CONCLUSION

Few studies comparing adhesive strategies were found, especially adhesives in sound substrates. The existing studies do not reflect all current approaches that could be used in pediatric dentistry. Further studies addressing bioactive composites and contemporary adhesives are necessary.

Quantification of Bacterial Colonization in Dental Hard Tissues Using Optimized Molecular Biological Methods

Bacterial infections of root canals and the surrounding dental hard tissue are still a challenge due to biofilm formation as well as the complex root canal anatomy. However, current methods for analyzing biofilm formation, bacterial colonization of root canals and dental hard tissue [e.g., scanning electron microscopy, confocal laser scanning microscopy (CLSM) or determination of colony forming units (CFU)] are time-consuming and only offer a selective qualitative or semi-quantitative analysis. The aim of the present study is the establishment of optimized molecular biological methods for DNA-isolation and quantification of bacterial colonization via quantitative PCR (qPCR) from dental hard tissue. Root canals of human premolars were colonized with Enterococcus faecalis. For isolation of DNA, teeth were then grinded with a cryo mill. Since the hard tissues dentin and especially enamel belong to the hardest materials in the human organism, the isolation of bacterial DNA from root dentin is very challenging. Therefore, treatment steps for the isolation of DNA from grinded teeth were systematically analyzed to allow improved recovery of bacterial DNA from dental hard tissues. Starting with the disintegration of the peptidoglycan-layer of bacterial cells, different lysozyme solutions were tested for efficacy. Furthermore, incubation times and concentrations of chelating agents such as EDTA were optimized. These solutions are crucial for the disintegration of teeth and hence improve the accessibility of bacterial DNA. The final step was the determination of prior bacterial colonization of each root canal as determined by qPCR and comparing the results to alternative methods such as CFU. As a result of this study, optimized procedures for bacterial DNA-isolation from teeth were established, which result in an increased recovery rate of bacterial DNA. This method allows a non-selective and straightforward procedure to quantify bacterial colonization from dental hard tissue. It can be easily adapted for other study types such as microbiome studies and for comparable tissues like bones.

Interface between calcium silicate cement and adhesive systems according to adhesive families and cement maturation

Objectives

This study aimed to evaluate the interface between a calcium silicate cement (CSC), Biodentine and dental adhesives in terms of sealing ability.

Materials and Methods

Microleakage test: 160 standardized class II cavities were prepared on 80 extracted human molars. The cavities were filled with Biodentine and then divided into 2 experimental groups according to the time of restoration: composite resin obturation 15 minutes after Biodentine handling (D0); restoration after 7 days (D7). Each group was then divided into 8 subgroups (n = 5) according to the adhesive system used: etch-and-rinse adhesive (Prime & Bond); self-etch adhesive 2 steps (Optibond XTR and Clearfil SE Bond); self-etch adhesive 1 step (Xeno III, G-aenial Bond, and Clearfil Tri-S Bond); and universal used as etch-and-rinse or self-etch (ScotchBond Universal ER or SE). After thermocycling, the teeth were immersed in a silver nitrate solution, stained, longitudinally sectioned, and the Biodentine/adhesive percolation was quantified. Scanning electron microscopic observations: Biodentine/adhesive interfaces were observed.

Results

A tendency towards less microleakage was observed when Biodentine was etched (2.47%) and when restorations were done without delay (D0: 4.31%, D7: 6.78%), but this was not significant. The adhesives containing 10-methacryloyloxydecyl dihydrogen phosphate monomer showed the most stable results at both times studied. All Biodentine/adhesive interfaces were homogeneous and regular.

Conclusions

The good sealing of the CSC/adhesive interface is not a function of the system adhesive family used or the cement maturation before restoration. Biodentine can be used as a dentine substitute.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Current perspectives on dental adhesion: (1) Dentin adhesion - not there yet

The essential goal of any adhesive restoration is to achieve a tight and long-lasting adaptation of the restorative material to enamel and dentin. The key challenge for new dental adhesives is to be simultaneously effective on two dental substrates of conflicting nature. Some barriers must be overcome to accomplish this objective. While bonding to enamel by micromechanical interlocking of resin tags within the array of microporosities in acid-etched enamel can be reliably achieved and can effectively seal the restoration margins against leakage, bonding effectively and durably to organic and humid dentin is the most puzzling task in adhesive dentistry.

Much of the research and development of dental adhesives has focused on making the clinical procedure more user-friendly by reducing the number of bottles and/or steps. Although clinicians certainly prefer less complicated and more versatile adhesive materials, there is a trade-off between simplification of dental adhesives and clinical outcomes. Likewise, new materials are launched with claims of being novel and having special properties without much supporting evidence.

This review article discusses dental adhesion acknowledging pioneer work in the field, highlights the substrate as a major challenge to obtain durable adhesive restorations, as well as analyzes the three adhesion strategies and their shortcomings. It also reviews the potential of chemical/ionic dental adhesion, discusses the issue of extensively published laboratory research that does not translate to clinical relevance, and leaves a few thoughts in regard to recent research that may have implications for future adhesive materials.

Effect of air-blowing temperature and water storage time on the bond strength of five universal adhesive systems to dentin

The purpose of this study was to evaluate the air-blowing temperature and water storage time on the micro-tensile bond strength (μTBS) of five universal adhesive systems to dentin. The bond strength with two different air-blowing temperatures (60±2ºC and 23±2ºC) was measured after water storage at 37ºC for 24 h and 100 days respectively. The fracture surface on dentin side was observed by scanning electron microscope (SEM). Three-way ANOVA revealed a significant effect of universal system (p<0.001) and air-blowing temperature (p<0.001) on bond strength to dentin except water-storage time (p=0.145). The interaction within three factors was significantly different (p<0.001). It could be concluded that the μTBS of universal systems to dentin was material-depended. The higher and more stable bonding performance of universal systems on dentin could be achieved by air-blowing at 60±2ºC temperature. In addition, the quantity of voids in the adhesive layer of aceton-based universal adhesive was significantly reduced by higher temperature.

Chemistry of novel and contemporary resin-based dental adhesives

The chemistry of resin-based dental adhesives is critical for its interaction with dental tissues and long-term bonding stability. Changes in dental adhesives composition influences the materials' key physical-chemical properties, such as rate and degree of conversion, water sorption, solubility, flexural strength and modulus, and cohesive strength and improves the biocompatibility to dental tissues. Maintaining a suitable reactivity between photoinitiators and monomers is important for optimal properties of adhesive systems, in order to enable adequate polymerisation and improved chemical, physical and biological properties. The aim of this article is to review the current state-of-the-art of dental adhesives, and their chemical composition and characteristics that influences the polymerisation reaction and subsequent materials properties and performance.

Etch-and-rinse vs self-etch mode for dentin bonding effectiveness of universal adhesives

In this study, dentin bond fatigue resistance and interfacial science characteristics of universal adhesives through etch-and-rinse and self-etch modes were investigated. Resin composite was bonded to human dentin with four universal adhesives, namely, Adhese Universal, All-Bond Universal, G-Premio Bond, and Scotchbond Universal Adhesive. The initial bond strengths, bond fatigue strengths, and interfacial science characteristics of the universal adhesives with dentin through etch-and-rinse and self-etch modes were determined. Bond fatigue resistance (initial bond strength and bond fatigue strength) of universal adhesives in etch-and-rinse mode showed no significant difference in contrast to that in self-etch mode and was material-dependent regardless of the etching mode. Although phosphoric acid conditioning of dentin did not have a strong impact on the bond fatigue resistance, surface free energy and parameters of dentin were significantly decreased by etching and by application of universal adhesives regardless of etching mode. Changes in γ_S and γ_S^h for when universal adhesive was applied to etched and ground dentin were significantly different depending on the adhesive. The results suggest that bonding performance of universal adhesives was effective in both etching modes; however, bonding mechanisms may be different for each.

The role of spatial frequency analysis in correlating atomic force microscopy and optical profilometry with self-etch adhesive enamel bond fatigue durability

The purpose of this study was to: (a) evaluate the role of enamel surface roughness on bond fatigue durability and (b) evaluate statistical differences in roughness values based on measurement technique, including the use of spatial filtering for optical profilometry (OP). OptiBond XTR (Kerr Corp), Prime & Bond elect (DENTSPLY Caulk), Scotchbond Universal (3 M Oral Care), and XTR pre-etched with Ultra-Etch phosphoric acid (35%) (Ultradent) self-etch adhesives were used to treat enamel. A flat ground enamel surface was included as a control. Atomic force microscopy (AFM) and OP were used to measure the surface topography of each enamel surface following the application of adhesives. AFM, OP, and filtered OP (FOP) roughness values, where FOP was designed to only include the lateral spatial resolution consistent with AFM roughness values, were collected. Spatial resolution filtering with OriginPro was used to compare line scans from the two imaging techniques and generate the FOP group. These micro- versus nanoscale lateral roughness values were correlated with shear bond and shear fatigue strengths of the adhesives bonded to enamel. Roughness values showed differences based on measurement technique and strong correlations with bond and fatigue strength. The filtered OP group demonstrated the importance of careful usage and reporting of atomic force microscopy and OP metrics in adhesive dentistry. Best practices for surface roughness analysis were also discussed.

Dry-bonding to dentin using alternative conditioners based on iron-containing solutions or nitric acid

OBJECTIVES

To evaluate the effect of experimental conditioners (10-3 solution - 10-3, 6.8% ferric oxalate - FOX, and 1.4% nitric acid - NI) on dentin elastic modulus, flexural strength, bond strength, failure mode, and adhesive interface morphology of two etch-and-rinse adhesives (XP Bond, Dentsply or One-Step, Bisco) applied on etched dry dentin.

METHODS

Sound human third molars were used for the microtensile bond strength test (n = 8), performed at 24 h and after one year of water storage. Failure modes were evaluated by scanning electron microscopy. Dentin bonding interface was analyzed by confocal laser scanning microscopy (n = 3). Adhesive systems were applied on phosphoric acid-etched, wet (positive control) and dry (negative control) dentin, and on etched and dry dentin previously treated with 10-3 (15s), FOX (60s), or NI (15s). Bovine dentin bars (n = 15) were immersed into the conditioning solutions and subjected to a three-point bending test.

RESULTS

XP Bond + 10-3 or NI resulted in lower bond strength than phosphoric acid. One-Step + 10-3 or NI resulted in bond strengths equivalent to the positive control. Experimental conditioners presented no bond strength reduction after one year, regardless of the bonding agent tested. One-Step resulted in more adhesive failures than XP Bond at 24 h, and mixed failures increased after storage. All experimental conditioners promoted hybridization and resin tags formation, except FOX. Dentin elastic modulus was not affected by the conditioners, whereas flexural strength was significantly reduced by FOX.

CONCLUSIONS

Adequate and stable dentin bonds were achieved when the bonding agents were applied on 10-3 or NI-treated dentin. None of the experimental conditioners reduced dentin elastic modulus, but dentin flexural strength was significantly reduced by FOX-conditioning.

Surface morphology and mechanical properties of conventional and self-adhesive resin cements after aqueous aging

The stable long-term performance of resin cement under oral environmental conditions is a crucial factor to obtain a satisfactory success of the allceramic dental restoration. Objective: This study aimed at evaluating and comparing the surface morphology and mechanical property of conventional and self-adhesive resin cement after aqueous aging. Materials and Methods: Disc-shaped specimens of 3 conventional (C1: Multilink N, C2: Duolink, C3: Nexus 3) and 3 self-adhesive (S1: Multilink Speed, S2: Biscem, S3: Maxcem) types of resin cements were subjected to irradiation. After 24 h, the Knoop microhardness of each resin cement was evaluated. The specimens were immersed separately in distilled water and maintained at 37°C. A total of 5 specimens of each resin cement were collected at the following time intervals of immersion: 1, 6, 12 and 18 months. The samples were used to evaluate the Knoop parameters of microhardness, sorption and solubility. The surface morphology of the specimens after 18 months of immersion was observed by scanning electron microscopy. The sorption and solubility data were analyzed by two-way ANOVA. The Knoop microhardness was tested by the ANOVA repeated measures (P<0.05). Results: The sorption and solubility parameters of C1 and S1 exhibited significant fluctuations during the aqueous aging. The hardness of the S1 and S2 specimens decreased significantly after an 18-month water immersion. The S1, S2 and S3 specimens indicated higher filler exposure and stripping and apparent pores and cracks compared to specimens C1, C2 and C3, respectively. Conclusion: The surface of selfadhesive resin cements is more susceptible to aqueous damage than that of the conventional resin cements.

Novel adhesives for distal radius fixation: A biomechanical analysis

Wrist fractures can be difficult to treat due to advanced age of the patient, medical co-morbidities, and comminution of the bone. This study examines the effectiveness of two injectable glass polyalkenoate cements (GPCs), derived from two different glasses (A and B), as minimally invasive treatments for distal radius fractures. Twenty-seven fresh cadaveric radial pairs were tested either in compressive fatigue or to quasi-static compressive failure. The radii tested to failure had one pair fixated with a GPC while the other was left intact. The radii tested under fatigue had one pair fixated with a GPC and the other with a volar locking plate. A wedge osteotomy was used to simulate a severely comminuted fracture. When loaded to failure, the radii fixated with a GPC made from glass A or B were found to be, respectively, at least 57% and 62% as strong as their intact biological pair (95% Confidence Interval, Lower). Using a paired t-test, the radii fixated with either adhesive were found to be significantly stiffer than their biological pairs fixated with a volar locking plate for all cycles of fatigue loading. The adhesives under investigation demonstrate promise as treatment for distal radius fractures. In vivo investigations are warranted to determine the effect that the adhesives have on the bone remodelling process.

Modification of the restoration protocol for resin-based composite (RBC) restoratives (conventional and bulk fill) on cuspal movement and microleakage score in molar teeth

OBJECTIVE

To modify the resin-based composite (RBC) restoration protocol for standardised Class II cavities in third molar teeth restored using conventional RBCs or their bulk fill restorative counterparts. Employing cuspal deflection using a twin channel deflection measuring gauge (during) and microleakage to determine marginal integrity (following) RBC restoration, the modified restoration protocol results were compared with traditional (oblique) restoration of Class II cavities.

METHODS

Thirty-two sound third molar teeth, standardised by size and morphology, were subjected to standardised Class II cavity preparations and randomly allocated to four groups. Restorations were placed in conjunction with a universal bonding system and resin restorative materials were irradiated with a light-emitting-diode light-curing-unit. The cumulative buccal and palatal cuspal movements from a twin channel deflection measuring gauge were summed, the restored teeth fatigued thermally prior to immersion in 0.2% basic fuchsin dye for 24h, before sectioning and examination for microleakage.

RESULTS

Teeth restored using conventional RBC materials had significantly higher mean total cuspal movement values compared with bulk fill resin restorative restoration (all p<0.0001). Teeth restored with Admira Fusion and Admira Fusion x-tra had significantly the lowest microleakage scores (all p<0.001) compared with Tetric EvoCeram and Tetric EvoCeram Bulk Fill restored teeth. The microleakage scores for the range of RBC materials tested were significantly reduced (all p<0.001) when the modified RBC restoration protocol was employed compared with the traditional Class II restoration technique.

SIGNIFICANCE

Modification of the RBC restoration protocol of some conventional RBCs and bulk fill resin restoratives significantly improve bond integrity and could be translated as a validation of the limited clinical studies available on bulk fill materials in the dental literature where Class II cavities perform less well than Class I cavities following extended follow-up.

CLINICAL SIGNIFICANCE

The results of the current study add further weight to experimental protocols employing cuspal movement (during) and cervical microleakage (following) RBC restoration of standardised cavities in natural dentition to provide an indication of polymerization shrinkage stress at the tooth/RBC restoration interface in a 'clinically meaningful context'.

Etching Efficacy of Self-Etching Functional Monomers

Besides chemically interacting with hard tooth tissue, acidic functional monomers of self-etch adhesives should etch the prepared tooth surface to dissolve the smear layer and to provide surface micro-retention. Although the etching efficacy of functional monomers is commonly determined in terms of pH, the pH of adhesives cannot accurately be measured. Better is to measure the hydroxyapatite (HAp)-dissolving capacity, also considering that functional monomers may form monomer-Ca salts. Here, the etching efficacy of 6 functional monomers (GPDM, phenyl-P, MTEGP, 4-META, 6-MHP and 10-MDP) was investigated. Solutions containing 15 wt% monomer, 45 wt% ethanol, and 40 wt% water were prepared. Initially, we observed enamel surfaces exposed to monomer solution by scanning electron microscopy (SEM). X-ray diffraction (XRD) was employed to detect monomer-Ca salt formation. Phenyl-P exhibited a strong etching effect, while 10-MDP-treated enamel showed substance deposition, which was identified by XRD as 10-MDP-Ca salt. To confirm these SEM/XRD findings, we determined the etching efficacy of functional monomers by measuring both the concentration of Ca released from HAp using inductively coupled plasma-atomic emission spectroscopy (ICP-AES) and the amount of monomer-Ca salt formation using ³¹P magic-angle spinning (MAS) nuclear magnetic resonance (NMR). ICP-AES revealed that the highest Ca concentration was produced by phenyl-P and the lowest Ca concentration, almost equally, by 4-META and 10-MDP. Only 10-MDP formed 10-MDP-Ca salts, indicating that 10-MDP released more Ca from HAp than was measured by ICP-AES. Part of the released Ca was consumed to form 10-MDP-Ca salts. It is concluded that the repeatedly reported higher bonding effectiveness of 10-MDP-based adhesives must not only be attributed to the more intense chemical bonding of 10-MDP but also to its higher etching potential, a combination the other functional monomers investigated lack.

Influence of application method on surface free-energy and bond strength of universal adhesive systems to enamel

The aim of the present study was to determine the influence of different adhesive application methods and etching modes on enamel bond effectiveness of universal adhesives using shear bond strength (SBS) testing and surface free-energy (SFE) measurements. The adhesives Scotchbond Universal, All-Bond Universal, Adhese Universal, and G-Premio Bond were used. Prepared bovine enamel specimens were divided into four groups, based on type of adhesive, and subjected to the following surface treatments: (i) total-etch mode with active application; (ii) total-etch mode with inactive application; (iii) self-etch mode with active application; and (iv) self-etch mode with inactive application. Bonded specimens were subjected to SBS testing. The SFE of the enamel surfaces with adhesive was measured after rinsing with acetone and water. The SBS values in total-etch mode were significantly higher than those in self-etch mode. In total-etch mode, significantly lower SBS values were observed with active application compared with inactive application; in contrast, in self-etch mode there were no significant differences in SBS between active and inactive applications. A reduction in total SFE was observed for active application compared with inactive application. The interaction between etching mode and application method was statistically significant, and the application method significantly affected enamel bond strength in total-etch mode.

Tissue integrity, costs and time associated with different agents for histological bone preparation

The selection of an appropriate demineralizing solution in pathology laboratories depends on several factors such as the preservation of cellularity, urgency of diagnostic and financial costs. The aim of this study was to test different decalcification bone procedures in order to establish the best value of these in formalin-fixed and paraffin-embedded samples. Femurs were removed from 13 adult male Wistar rats to obtain 130 bone disks randomly divided into five groups that were demineralized in different concentrations of nitric acid (Group I); formic acid (Group II); acetic acid (Group III); EDTA, pH7.4 (Group IV) and Morsés solution (Group V). Serial, 3-μm-thick sections were obtained and stained with hematoxylin-eosin to calculate the percentage of osteocyte-occupied lacunae. The sections were also stained with Masson's trichrome in conjunction with picrosirius red under polarized light followed by a semi-quantitative analysis to verify the adjacent muscle-to-bone integrity and preservation of collagen fibres. The highest percentage of osteocyte-occupied lacunae was found with 10% acetic acid solution (95.64 ± 0.95%) and Group I (nitric acid) demanded the shorter time (0.8-5.7days). Of all solutions, 5% nitric acid incurred the lowest cost to achieve complete demineralization compared with other solutions (p < .001). Group IV (EDTA) had the highest integrity of muscle and collagen type I and III (P < 0.01). Demineralization with 10% acetic acid was the most effective at preserving bone tissue, while 5% EDTA was the best at maintaining collagen and adjacent muscle to bone. In conclusion, nitric acid at 5% showed the most efficient result as it balanced both time and cost as a demineralizing solution.

Hydrolytic Stability of Self-etch Adhesives Bonded to Dentin

Functional monomers chemically interact with hydroxyapatite that remains within submicron hybrid layers produced by mild self-etch adhesives. The functional monomer 10-MDP interacts most intensively with hydroxyapatite, and its calcium salt appeared most hydrolytically stable, as compared with 4-MET and phenyl-P. We investigated the hypothesis that additional chemical interaction of self-etch adhesives improves bond stability. The micro-tensile bond strength (μTBS) of the 10-MDP-based adhesive did not decrease significantly after 100,000 cycles, but did after 50,000 and 30,000 cycles, respectively, for the 4-MET-based and the phenyl-P-based adhesives. Likewise, the interfacial ultrastructure was unchanged after 100,000 thermocycles for the 10-MDP-based adhesive, while that of both the 4-MET- and phenyl-P-based adhesives contained voids and less-defined collagen. The findings of this study support the concept that long-term durability of adhesive-dentin bonds depends on the chemical bonding potential of the functional monomer.

Development of a Self-etch Adhesive for Resin-modified Glass Ionomers

The favorable self-adhesiveness of resin-modified glass ionomers (RMGIs) might be even further improved if the time-consuming and technically sensitive etch-and-rinse pre-treatment step with polyalkenoic acids could be avoided. We undertook this study to assess the effectiveness of an experimental self-etch adhesive for RMGIs that does not need to be rinsed off. Ultrastructural analysis and micro-tensile bond strength testing to enamel and dentin of a RMGI restorative material and a RMGI adhesive were performed after 4 different surface pre-treatments: no conditioning; 25% polyalkenoic acid; an experimental self-etch adhesive; and 37.5% phosphoric acid followed by the experimental self-etch adhesive. The use of an experimental self-etch adhesive increased the bond strength of RMGIs, especially after an additional conditioning step. Interfacial analysis showed the formation of a thin hydroxyapatite-containing hybrid layer. The self-etch technique enhances the user-friendliness of RMGIs and lowers their technique-sensitivity, while maintaining desirable characteristics of the conventional etch-and-rinse approach with polyalkenoic acids.

Six-month Follow-up of Cervical Composite Restorations Placed With a New Universal Adhesive System: A Randomized Clinical Trial

Purpose: The objective of this double-blind, randomized clinical trial was to evaluate the six-month clinical performance of a new universal adhesive (Xeno Select, Dentsply) in noncarious cervical lesions (NCCLs) using two evaluation criteria: World Dental Federation (FDI) and the US Public Health Service (USPHS).

Methods and Materials: A total of 124 restorations were randomly placed in 31 patients according to the following groups: ER-D = etch-and-rinse/dry dentin; ER-M = etch-and-rinse/moist dentin; SE-et = selective enamel etching; and SET = self-etch. The composite resin EVOLUX (Dentsply) was placed incrementally. The restorations were evaluated after one week (baseline) and at six months using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α=0.05).

Results: Fifteen restorations were lost or fractured at six months (one for ER-D, three for ER-M, five for SE-et, and six for SET) (p&gt;0.05 at six-month recall). When ER (ER-D and ER-M) was compared with SE (SE-et and SET) there was a significant difference in the retention rate after six months (p=0.001). Marginal staining and postoperative sensitivity to air were only observed in three (one for ER-M and two for SET) and two restorations (two for ER-D) in both evaluation criteria (p&gt;0.05), respectively. Forty-seven restorations were considered to have minor discrepancies in marginal adaptation at the six-month recall using the FDI criteria (13 for ER-D, 10 for ER-M, 11 for SE-et, and 13 for SET; p&gt;0.05 between groups). However, for all groups, a significant difference was detected when baseline and six-month data were compared (p&lt;0.05).

Conclusions: The six-month clinical behavior of Xeno Select Universal Adhesive depends on the bonding strategy used. The universal adhesive did not fulfill the American Dental Association criteria for full approval when used in the self-etch mode.

Effect of nanolayering of calcium salts of phosphoric acid ester monomers on the durability of resin-dentin bonds

To investigate the contribution of nanolayering on resin-dentin bond durability, two phosphoric acid ester resin monomers, 10-methacryloyloxy-decyl-dihydrogen-phosphate (10-MDP) or its analog, methacryloyloxy-penta-propyleneglycol-dihydrogen-phosphate (MDA), were examined for their affinity for mineralized dentin powder in a column chromatography setup. Hydroxyapatite (HA) powder was dispersed in experimental primers consisting of 10-MDP or MDA solvated in ethanol/water and examined with FTIR, (31)P MAS-NMR and XPS. Light-curable 10-MDP or MDA primers were used for bonding to dentin, and examined after 24h or one-year of water-aging by TEM for evidence of nanolayering, and for microtensile bond strength evaluation. Primer-bonded dentin was examined by thin-film XRD to identify short-range order peaks characteristic of nanolayering of resin monomer-Ca salts. Although 10-MDP had better affinity for mineralized dentin than MDA, both monomers completely eluted from the mineralized dentin powder column using ethanol-water as mobile phase, indicating that the adsorption processes were reversible. This finding was supported by chemoanalytic data. XRD of 10-MDP-bonded dentin showed three diffraction peaks hat were absent from MDA-bonded dentin. Nanolayering was identified by TEM in 10-MDP-bonded dentin, but not in MDA-bonded dentin. Significant drop in bond strength (in MPa) was observed for both groups after one-year of water-aging compared with 24-h: 10-MDP group from 48.3±6.3 to 37.4±4.6; MDA group from 50.7±5.0 to 35.7±3.8 (P<0.05), with no significant difference between the two groups at the same time-point. Because both functional monomer-primed, resin-bonded dentin exhibited similar bond strength decline after water-aging, presence of nanolayering is unlikely to contribute to the overall resin-dentin bond durability.

STATEMENT OF SIGNIFICANCE

The durability of resin-dentin bonds in 10-MDP containing self-etching adhesives has been anecdotally attributed to the presence of nanolayering of 10-MDP-calcium salts in the resin-dentin interface. Results of the present work indicate that such a claim cannot be justified. Complete elution of the phosphoric acid ester monomer from mineralized dentin powder in the column chromatography experiments using ethanol-water mobile phase to simulate the solvent mixture employed in most 10-MDP-containing dentin adhesives further challenges the previously proposed adhesion-decalcification concept that utilizes chemical bonding of phosphoric acid ester monomers to apatite as a bonding mechanism in 10-MDP containing dentin adhesives.

Effect of calcium salt of 10-methacryloyloxydecyl dihydrogen phosphate produced on the bond durability of one-step self-etch adhesive

Five experimental 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-based one-step self-etch adhesives were designed by varying amounts of MDP. The aim of this study was to examine the effect of the quantity of calcium salt of MDP (MDP-Ca) salt produced by demineralization on the bond durability between experimental one-step adhesives and enamel or dentin. Bond strengths of experimental adhesives to the enamel and dentin were measured, before and after 30,000×thermocycling. The fractured enamel and dentin samples as well as the fractured adhesive surfaces obtained during adhesion test were analyzed by a scanning electron microscope and energy-dispersive X-ray microscope. An increase in the amount of MDP-Ca salt to above 37.2 mg/g drastically decreased the dentin bond strength and changed the fracture type during the thermocycling process. In contrast, the enamel bond strength remained unchanged, although the fracture type changed to an interfacial failure with increasing the amount of MDP-Ca salt to 78.3 mg/g.

The effect of washing water temperature on resin-dentin micro-shear bond strength

BACKGROUND

The purpose of this study was to evaluate the effect of washing water temperature on the micro-shear bond strength (μSBS) of composite resin to dentin using a two-step etch-and-rinse system and a two-step self-etching system.

MATERIALS AND METHODS

In this in vitro study, the intact dentins of buccal and lingual surfaces of healthy third molars were exposed. Dentin surfaces were rinsed with different temperatures of distilled water (20 s) before applying Single Bond (SB) or Clearfil SE Bond(SE). After applying the adhesive, composite cylinders (0.8 mm diameter and 1 mm length) were bonded to the teeth surfaces. After storing the specimens in 37°C distilled water for 48 h and thermocycling, μSBS test was done. Data were analyzed using analysis of variance, post hoc Tukey tests, paired samples t-test, and Fisher exact test (α = 0.05).

RESULTS

Temperature and interaction of temperature and type of bonding agent affected the bond strength. The bond strength of SB groups was significantly higher at 50°C washing than 5°C (P = 0.003) and 22°C (P = 0.019), but no significant difference was observed between SE groups. The bond strength of SE was significantly higher at 22°C than that of SB (P = 0.031), whereas the bond strength of SB was significantly higher at 50°C than that of SE (P = 0.007).

CONCLUSION

The use of high-temperature washing water is an appropriate method to enhance bond strength in etch-and-rinse systems.

Interference of functional monomers with polymerization efficiency of adhesives

The degree of conversion (DC) of camphorquinone/amine-based adhesives is affected by acidic functional monomers as a result of inactivation of the amine co-initiator through an acid-base reaction. During bonding, functional monomers of self-etch adhesives chemically interact with hydroxyapatite (HAp). Here, we tested in how far the latter interaction of functional monomers with HAp counteracts the expected reduction in DC of camphorquinone/amine-based adhesives. The DC of three experimental adhesive formulations, containing either of the two functional monomers [10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) or 4-methacryloxyethyl trimellitic acid anhydride (4-META)] or no functional monomer (no-FM; control), was measured with and without HAp powder added to the adhesive formulations. Both the variables 'functional monomer' and 'HAp' were found to be significant, with the functional monomer reducing the DC and HAp counteracting this effect. It is concluded that the functional monomers 10-MDP and 4-META interfere with the polymerization efficiency of adhesives. This interference is less prominent in the presence of HAp, which would clinically correspond to when these two functional monomers of the adhesive simultaneously interact with HAp in tooth tissue.

Distinct decalcification process of dentin by different cariogenic organic acids: Kinetics, ultrastructure and mechanical properties

OBJECTIVES

We studied artificial dentin lesions in human teeth generated by lactate and acetate buffers (pH 5.0), the two most abundant acids in caries. The objective of this study was to determine differences in mechanical properties, mineral density profiles and ultrastructural variations of two different artificial lesions with the same approximate depth.

METHODS

0.05M (pH 5.0) acetate or lactate buffer was used to create 1) 180μm-deep lesions in non-carious human dentin blocks (acetate 130h; lactate 14days); (2) demineralized, ∼180μm-thick non-carious dentin discs (3 weeks). We performed nanoindentation to determine mechanical properties across the hydrated lesions, and micro X-ray computed tomography (MicroXCT) to determine mineral profiles. Ultrastructure in lesions was analyzed by TEM/selected area electron diffraction (SAED). Demineralized dentin discs were analyzed by small angle X-ray scattering (SAXS).

RESULTS

Diffusion-dominated demineralization was shown based on the linearity between lesion depths versus the square root of exposure time in either solution, with faster kinetics in acetate buffer. Nanoindentation revealed lactate induced a significantly sharper transition in reduced elastic modulus across the lesions. MicroXCT showed lactate demineralized lesions had swelling and more disorganized matrix structure, whereas acetate lesions had abrupt X-ray absorption near the margin. At the ultrastructural level, TEM showed lactate was more effective in removing minerals from the collagenous matrix, which was confirmed by SAXS analysis.

CONCLUSIONS

These findings indicated the different acids yielded lesions with different characteristics that could influence lesion formation resulting in their distinct predominance in different caries activities, and these differences may impact strategies for dentin caries remineralization.

Microstructures, mechanical properties and cytotoxicity of low cost beta Ti-Mn alloys for biomedical applications

The microstructures, mechanical properties and biocompatibility of low cost β-type Ti-(6-18)Mn alloys were investigated after solution treatment. Ti-9 Mn exhibits the best combination of tensile strength and elongation among the fabricated alloys, and its performance is comparable to or superior to those of Ti-6Al-4V ELI (Ti-64 ELI) in terms of every parameter evaluated. A hardness of 338 HV, a Young's modulus of 94 GPa, a 0.2% proof stress of 1023 MPa, an ultimate tensile strength of 1048 MPa and elongation of 19% were obtained for Ti-9 Mn. Furthermore, the cell viability and metallic ion release ratios are comparable to those of commercially pure titanium, making this alloy promising for biomedical applications. The Young's modulus is also lower than that of Ti-64 ELI (110 GPa), which can possibly reduce the stress shielding effect in implanted patients.

STATEMENT OF SIGNIFICANCE

This study evaluates mechanical and biological performance of low cost solution treated β-type Ti-(6, 9, 13 and 18 mass%)Mn alloys. It includes alloys containing a Mn content range higher than most previously published works (which is around or lower than 8 mass%). Furthermore, the effects of the ω phase and the β phase stability of the alloys over some mechanical properties and microstructures are discussed. Ion release behavior under simulated body fluids and cell viability are also evaluated. For the case of the Ti-9 Mn, a mechanical and biological performance that is comparable to or superior than that of the widely used Ti-6Al-4V ELI and commercially pure Ti was observed.

Effect of Phosphoric Acid Pre-etching on Fatigue Limits of Self-etching Adhesives

The purpose of this study was to use shear bond strength (SBS) and shear fatigue limit (SFL) testing to determine the effect of phosphoric acid pre-etching of enamel and dentin prior to application of self-etch adhesives for bonding resin composite to these substrates. Three self-etch adhesives—1) G- ænial Bond (GC Corporation, Tokyo, Japan); 2) OptiBond XTR (Kerr Corp, Orange, CA, USA); and 3) Scotchbond Universal (3M ESPE Dental Products, St Paul, MN, USA)—were used to bond Z100 Restorative resin composite to enamel and dentin surfaces. A stainless-steel metal ring with an inner diameter of 2.4 mm was used to bond the resin composite to flat-ground (4000 grit) tooth surfaces for determination of both SBS and SFL. Fifteen specimens each were used to determine initial SBS to human enamel/dentin, with and without pre-etching with a 35% phosphoric acid (Ultra-Etch, Ultradent Products Inc, South Jordan, UT, USA) for 15 seconds prior to the application of the adhesives. A staircase method of fatigue testing (25 specimens for each test) was then used to determine the SFL of resin composite bonded to enamel/dentin using a frequency of 10 Hz for 50,000 cycles or until failure occurred. A two-way analysis of variance and Tukey post hoc test were used for analysis of SBS data, and a modified t-test with Bonferroni correction was used for the SFL data. Scanning electron microscopy was used to examine the area of the bonded restorative/tooth interface. For all three adhesive systems, phosphoric acid pre-etching of enamel demonstrated significantly higher (p&lt;0.05) SBS and SFL with pre-etching than it did without pre-etching. The SBS and SFL of dentin bonds decreased with phosphoric acid pre-etching. The SBS and SFL of bonds using phosphoric acid prior to application of self-etching adhesives clearly demonstrated different tendencies between enamel and dentin. The effect of using phosphoric acid, prior to the application of the self-etching adhesives, on SBS and SFL was dependent on the adhesive material and tooth substrate and should be carefully considered in clinical situations.

Bulk fill restoratives: to cap or not to cap--that is the question?

OBJECTIVES

To assess the cuspal deflection and cervical microleakage scores of standardised large mesio-occlusal-distal (MOD) cavities filled with different restoration protocols: (1) conventional resin restoratives, (2) bulk fill flowable base materials 'capped' with a conventional dimethacrylate resin-based composite (RBC) or (3) bulk fill resin restorative materials.

METHODS

Standardised MOD cavities were prepared in sixty-four sound maxillary premolar teeth and randomly allocated to eight groups. Restorations were placed in conjunction with a universal bonding system and resin restorative materials were irradiated with a quartz-tungsten-halogen light-curing-unit. Restoration protocol (eight oblique increments of conventional resin restorative, bulk fill flowable base and two occlusal 'capping' RBC increments (three increments in total) or bulk fill resin restorative (two increments)) was the dependent variable. A twin channel deflection measuring gauge measured the buccal and palatal cuspal deflections. Teeth were thermally fatigued, immersed in a 0.2% basic fuchsin dye for 24h, sectioned and examined for cervical microleakage score.

RESULTS

Post hoc Tukey's tests highlighted significant differences in the mean total cuspal deflection values between resin restoratives (p < 0.0001) and restoration protocol (p < 0.005). In general (albeit product dependently), an increase in mean total cuspal deflection and concomitant decrease in cervical microleakage score was evident for bulk fill flowable base materials with occlusal 'capping' RBC increments (restoration protocol 2) compared with bulk fill resin restoratives (restoration protocol 3).

CONCLUSIONS

Not all bulk fill flowable materials or bulk fill resin restoratives behave in a similar fashion when used to restore standardised MOD cavities in maxillary premolar teeth and material selection is vital in the absence of clinical data.

CLINICAL SIGNIFICANCE

Poorly performing bulk fill flowable materials or bulk fill restoratives can be identified using the cuspal deflection and cervical microleakage protocol which could save the complications encountered clinically when restoring Class II restorations.