The long-term consequence of salivary contamination at various stages of adhesive application and clinically feasible remedies to decontaminate

Partial glass-ceramic posterior restorations with margins beyond or above the cemento-enamel junction: An observational retrospective clinical study

PURPOSE

This observational retrospective clinical study aimed to investigate the survival and success rates of partial indirect lithium disilicate restorations with margins extending above or beyond the cementoenamel junction (CEJ).

METHODS

The study included patients who underwent partial indirect lithium disilicate restorations with immediate dentin sealing (IDS) between January 2008 and October 2018. All the restorations were placed in a single general dental practice following a standardized protocol. The impact of various predictive variables on the survival rates was assessed. Moreover, modified United States Public Health Service (USPHS) criteria were used to evaluate the survival quality.

RESULTS

Totally 1146 partial indirect lithium disilicate restorations in 260 patients were evaluated over an average period of 7.5 years. The cumulative survival and success rates were 97.3% and 95.3%, respectively. Margins extending beyond the cemento-enamel junction did not increase the risk of success or survival failure (P > 0.05). Patients with a high risk of caries, male sex, or non-vital teeth had a significantly higher risk of restoration failure (P < 0.05). Restorations with longer clinical service times exhibited marginally lower clinical quality (P < 0.001).

CONCLUSIONS

Partial indirect glass-ceramic restorations demonstrated survival and success rates of 97.3% and 95.3%, respectively, over an extended period. However, a higher risk of restoration failure existed in patients with a high caries risk for (pre)molars that had undergone endodontic treatment and in males. In terms of the risk of success or survival failure, comparable results were obtained for the positions of the restoration margin in relation to the cemento-enamel junction.

A comparison of different cleaning approaches for blood contamination after curing universal adhesives on the dentine surface

OBJECTIVE

This study compared the effectiveness of various cleaning approaches, including spray rinsing, repreparing with diamond burs, and using phosphoric acid or sodium hypochlorite alone or with polyphenols (resveratrol or myricetin), in removing blood contamination from the dentine after adhesive light-curing.

METHODS

The contact angles of the treated surfaces were measured and scanning electron microscopy/ energy dispersive X-ray spectroscopy observation was performed. The bond strength and nanoleakage were assessed, and in situ zymography was performed before and after aging. Interactions between matrix metalloproteinase (MMP)-9 and polyphenols were evaluated using molecular dynamics and rhMMP-9 inhibition analyses. The destruction of sodium hypochlorite on collagen and the resistance of polyphenols-treated dentine collagen to enzymolysis were evaluated using the hydroxyproline (HYP) assay. The effect of polyphenols on dentine collagen crosslinking was assessed by Fourier Transform Infrared Spectroscopy.

RESULTS

The repreparation group had the lowest contact angle compared to the other groups. The spray rinsing group had the lowest bond strength and highest amounts of nanoleakage. Cleaning with phosphoric acid or sodium hypochlorite alone removed the blood contaminants and parts of the adhesive; moreover, applying polyphenols further improved the bond strength and decreased nanoleakage and MMP activity after aging. Both polyphenols inhibited rhMMP-9 activity and promoted collagen crosslinking. Sodium hypochlorite showed the maximum HYP release when used alone, which was decreased after adding polyphenols.

SIGNIFICANCE

Phosphoric acid or sodium hypochlorite cleaning can remove blood contamination from the dentine surface after adhesive curing, and the addition of polyphenols can improve the durability of dentine bonding.

A scoping review of the influence of clinical contaminants on bond strength in direct adhesive restorative procedures

OBJECTIVE

Clinical contamination during direct adhesive restorative procedures can affect various adhesive interfaces differently and contribute to bulk failure of the restorations. This review aims to summarise the current knowledge on the influence of a variety of clinical contaminants on the bond strength at various adhesive interfaces during adhesive restorative procedures and identify gaps in the literature for future research.

DATA AND SOURCES

An electronic database search was performed in PubMed and EMBASE to identify articles that investigated the influence of contaminants on direct restorative bonding procedures. A data-charting form was developed by two researchers to capture the key characteristics of each eligible study.

STUDY SELECTION

The initial search yielded 1,428 articles. Fifty-seven articles published between 1 Jan 2007 and 25 Oct 2023 were included in the final review. Thirty-three of the articles examined the influence of saliva contamination, twelve articles examined the influence of blood contamination, and twenty-five articles examined the influence of other contaminants.

CONCLUSION

Saliva contamination exerted less influence on the decrease in bond strength when self-etch systems were used, compared to when etch-and-rinse systems were used. Blood contamination adversely affected the bond strength at the interface between resin composite and dentine, and resin composite and resin-modified glass ionomer cement. Treating contaminated surfaces with water spray for 10-30 s followed by air drying could be effective in recovering bond strength following saliva and blood contamination.

CLINICAL SIGNIFICANCE

This scoping review provides a valuable overview of the range of potential clinical contaminants that can influence the bond strength between different interfaces in direct adhesive restorative procedures. Additionally, it identifies potential decontamination protocols that can be followed to restore and enhance bond strength.

Effect of contamination and decontamination methods on the bond strength of adhesive systems to dentin: A systematic review

INTRODUCTION

In a suitable condition, it is important to perform any dental restorative procedure using an operatory field isolated. Then, the aim of this study was to compare the bond strength of composite restorations to dentin affected by any contamination agent through a systematic review.

METHODS

This systematic review was performed following the PRISMA 2020 guidelines. The literature search was conducted until September 2022 by scanning the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts evaluated the bond strength of resin-based materials to permanent human dentin contaminated with blood or saliva were selected for full-text review. The risk of bias was assessed by the RoBDEMAT tool.

RESULTS

A total of 3750 papers resulted from the search from all databases. After the full-text reading, a total of 62 articles remained for the qualitative analysis. The contamination agents used were blood, saliva, and hemostatic agents. A great variety of protocols were used to contaminate the dentin surface, and the contamination process occurred in several steps of the bonding process, including before and after the etching process, after the primer application and after the adhesive application. Also, several decontamination procedures were tested, including reapplication of the etching material, rinsing with water, chlorhexidine or sodium hypochlorite and reapplication of the adhesive system.

CONCLUSION

Any contamination with blood or saliva impaired the bond strength of resin-based materials to dentin. Decontamination procedures including water-spray and reapplication of the bonding system could revert the impairment produced by the saliva or blood contamination. The use of hemostatic agents as a method of blood decontamination is not recommended.

CLINICAL SIGNIFICANCE

Clinicians should avoid contamination during a bonding procedure, otherwise, a reduction in the bond quality is expected.

Effects of an MDP-based surface cleaner on dentin structure, morphology and nanomechanical properties

OBJECTIVE

To analyze the effect of Katana™ Cleaner (KC) in nanomechanical and triboscopic properties of etched dentin.

METHODS

Dentin disks from human third molars were prepared. Two main groups of study were established in function of the etching conditioning, phosphoric acid (PA) and Clearfil SE Bond primer (CSEB). Four subgroups were tested within each group: i) untreated dentin (UD), ii) etched dentin (ED) [(PAED/CSEB)], iii) etched dentin contaminated with saliva (PAED+S)/(CSEB+S), and iv) etched and contaminated dentin treated with KC (PAED+S+KC)/(CSEB+S+KC). Nano-DMA testing and imaging, atomic force microscopy (AFM) analysis and nanoroughness (SRa) measurements were obtained. Field emission scanning electron microscopy (FESEM) images were also acquired.

RESULTS

Phosphoric acid etched dentin samples and those specimens contaminated with saliva (PAED+S) attained the highest SRa values, that decreased after Katana™ Cleaner application (PAED+S+KC). In the group of dentin treated with CSEB primer, all subgroups performed similar, except in CSEB+S that attained the highest SRa values. The treatment with KC restored the original values of complex modulus of the untreated dentin. KC application produced the lowest and the highest tan delta values on PAED and CSEB groups, respectively.

CONCLUSION

Katana™ Cleaner provided equally mature dentin surfaces after any of the etching methods. Tan delta increased when Katana™ Cleaner was applied on the dentin surface previously etched and contaminated with saliva, regardless the kind of etchant, thus facilitating the dissipation of energy for elastic recoil during loading.

CLINICAL SIGNIFICANCE

Katana™ Cleaner application after saliva contamination originated similar low roughness levels, regardless the type of etching method. Both complex and storage moduli were similar, after Katana™ Cleaner application, in any case.

Evaluation of different decontamination procedures on bond strength to sound and caries affected dentin using "no-wait" universal adhesive

BACKGROUND

Current study aimed to evaluate the effect of different decontamination procedures on micro-shear bond strength (μSBS) of sound (SoD) and caries-affected dentin (CAD) of two universal adhesives after blood-saliva contamination.

METHODS

One hundred and eighty bovine anterior teeth were prepared and allocated into the respective groups according to tested dentin substrates [SoD, CAD], universal adhesives [Clearfil Bond Universal Quick (UBQ), All-Bond-Universal (ABU)], adhesive contamination stage [none, contamination before and after adhesives light-curing], and according to decontamination procedures [no decontamination, water rinsing, adhesive rebond, Ethylenediaminetetraacetic acid (ETDA) and chlorhexidine (CHX) application]. Universal adhesives were applied according to manufacturer instructions in self-etch (SE) bonding mode. Four composite microrods were built for each tooth. Specimens were kept in distilled water for 24 hours at 37°C before testing μSBS. Four-way ANOVA and Tukey HSD tests were used for data analysis.

RESULTS

A statistically significant difference between contamination stages of both universal adhesives at different decontamination procedures for SoD and CAD. Highest μSBS was recorded for UBQ control group at SoD, while the least was recorded for light-cured ABU upon water rinsing decontamination procedure of CAD.

CONCLUSIONS

Proper cavity isolation is mandatory to avoid possible contamination which can dramatically affect μSBS. CHX is a potent cavity decontaminant that can restore different dentin substrates bond strength. EDTA presents a promising substitute. UBQ adhesive showed better bonding performance than ABU to both dentin substrates. Application of regular cavity decontamination approaches is highly advised in daily practice to avoid possible detrimental effect of accidental cavity contamination.

Interface between Periodontal Tissues and Dental Materials: Dynamic Changes and Challenges

Periodontal tissues play an important role in the correct aesthetics, function and comfort of the dentition [...]