Resin composite adhesion to dentin using different curing lights and adhesive systems applied under electric current

Effect of Different Application Modalities on the Bonding Performance of Adhesive Systems to Dentin: A Systematic Review and Meta-Analysis

Diverse types of dental adhesives exhibit different cytotoxic outcomes on cells in vitro. Currently, no standard adhesive application technique has so far been decisive for clinicians for better durability of resin-dentin bonds of adhesive systems. The purpose of this study was to systematically review the literature to evaluate the bonding performance of adhesive systems to dentin by using different application modalities. The systematic research strategy was conducted by two reviewers among multiple databases: PubMed, Scopus, Web of Science, Embase, and Scielo. In vitro studies reporting the effects of additional steps for the application of adhesive systems on the bond strength to dentin were selected. Meta-analysis was performed using Review Manager Software version 5.3.5 using the random effects model. The methodological quality of each in vitro study was assessed according to the parameters of a previous systematic review. The electronic research through different databases generated a total of 8318 references. After the examination of titles and abstracts, a total of 106 potentially relevant studies accessed the full-text evaluation phase. After full-text examination, 78 publications were included for the qualitative analysis, and 68 studies were included in the meta-analysis. Regarding the etch-and-rinse adhesive systems, the application modalities that improved the overall bond strength were the application of a hydrophobic resin layer (p = 0.005), an extended application time (p < 0.001), an application assisted by an electric current (p < 0.001), a double-layer application (p = 0.05), the agitation technique (p = 0.02), and the active application of the adhesive (p < 0.001). For self-etch adhesive systems, the techniques that improved the overall bond strength were the application of a hydrophobic resin layer (p < 0.001), an extended application time (p = 0.001), an application assisted by an electric current (p < 0.001), a double-layer application (p < 0.001), the agitation technique (p = 0.01), and the active application of the adhesive (p < 0.001). The in vitro evidence suggests that the application of adhesive systems using alternative techniques or additional strategies may be beneficial for improving their bond strength to dentin. The application modalities that favored the overall bond strength to dentin were an extended application time, a double-layer application, an application assisted by an electric current, the active application of the adhesive, and the application of a hydrophobic resin layer. Worth mentioning is that some techniques are intended to increase the degree of the conversion of the materials, and therefore, improvements in the biocompatibility of the materials can be expected.

Iontophoresis effects of two-step self-etch and total-etch systems on dentin permeability and sealing of composite restoration under simulated pulpal pressure

BACKGROUND

Studies demonstrated the bond strength enhancement and the decrease in degradation of the adhesive interface after applying either self-etch adhesives or two-step, etch-and-rinse adhesives under an electric field. However, the presence of dentinal fluid driven by the pulpal pressure in vivo is a profounding factor affecting both the sealing ability and bond strength of adhesives. This study aimed to evaluate the effect of three-step etch-and-rinse and two-step self-etch adhesives when applied with iontophoresis under simulated pulpal pressure on the permeability of dentin, resin infiltration, and the sealing ability of resin composite.

METHODS

The experiments were done on 32 recently extracted premolars, randomly assigned into four groups (n = 8) according to two adhesive systems (SBMP and SE), applied following the manufacturer's instructions (control) for two groups or with iontophoresis for the others (SBMPi and SEi). For the iontophoresis, the anodal current was applied at 75 μA for 20 s through the cavity electrode during the bond. The fluid flow rate of dentin was recorded after cavity preparation (smear-layer-covered dentin; T1), bonding (T2), and composite restoration (T3) during the maintained pulpal pressure of 20 mm Hg. The flow rates were expressed as a percentage relative to the initial smear-layer-covered value for each specimen. Results were analyzed using repeated measures ANOVA. Scanning electron microscopy (SEM) was performed to observe the resin/dentin interface.

RESULTS

There were no significant increases in the mean flow rates from T1 to T3 in the SBMP (P = 0.355), while these changes in the SE were significant between T1 (100%) and T2 (166.77%) and T1 and T3 (221.16%) (P = 0.002; one-way RM ANOVA; Holm-Sidak test). For the iontophoresis groups, the mean flow rates decreased significantly from T1 to T2 and T1 to T3 of both SBMPi (T2 = 86.43, and T3 = 79.53; P < 0.001) and SEi groups (T2 = 87.96, and T3 = 81.48; P = 0.004). The iontophoresis of both adhesives produced the optimal resin infiltration with improved quality of the hybrid layer and resin tags.

CONCLUSIONS

SBMP bonded with or without iontophoresis performed better sealing ability than SE under the same condition. Both adhesives applied with anodal iontophoresis significantly decreased the dentin permeability, contributing to the improved resin infiltration.

Microtensile bond strength of resin composite to dentin using different adhesive systems and directions of electric current

Thisstudy aimed to evaluate the effect of the electric current direction application on the resin composite-dentin bond strength using three adhesive systems. Human molar teeth were distributed according to the adhesive system (two-step self-etch - Clearfil SE Bond, Kuraray [CSE]; one-step self-etch - Single Bond Universal, 3M ESPE [SBU]; and two-step etch-and-rinse - Adper Single Bond 2, 3M ESPE [SB2]), electric current direction (without electric current - control, direct and reverse electric currents - 35µA), and storage time (24h - immediate and 6 months). Resin composite blocks (Filtek Z350XT, 3M ESPE) were bonded to dentin. The teeth/resin composites specimens were stored in distilled water at 37ºC for 24 hours and 6 months for the microtensile bond strength (µTBS) test (n = 10; ~12 sticks for each tooth). Failure patterns were analyzed on a stereomicroscope and classified as cohesive-dentin, cohesive-resin, adhesive or mixed. Adhesive penetration into dentin and hybrid layer formation were evaluated in a scanning electron microscope (n = 6). Data were submitted to a three-way ANOVA followed by Tukey's post hoc test (α = 0.05). There are no differences in µTBS when the adhesive systems were applied under direct and reverse electric currents, but both electric currents increased the µTBS for all adhesive systems. SBU showed the lowest µTBS values for control groups in both storage times and direct electric current in 6 months of storage. The adhesive failure pattern was more frequently observed in all groups. The electric current formed long resin tags for all adhesive systems. Storage for 6 months did not significantly decrease µTBS values. Both directions of electric current (positive and negative charges) at 35µA can increase the µTBS of the adhesive systems tested to dentin.

Electric current effects on bond strength, nanoleakage, degree of conversion and dentinal infiltration of adhesive systems

To evaluate the effect of three adhesive systems applied under electric current on microtensile bond strength (μTBS) and degree of conversion (DC). Molar teeth were restored with the aid of three adhesive systems (Adper Single Bond 2-SB2; Clearfil SE Bond-CSE; and Single Bond Universal-SBU) under different electric current intensities (0 μA; 25 μA; and 50 μA). Composite resin blocks were built up in increments (2 mm) and sectioned into 1 × 1 mm beams. The μTBS was tested after 24 h and 1 y distilled water storages. Samples (n = 10) from 24 h to 1 y storages were immersed in a 50% ammoniacal silver nitrate solution and submitted to scanning electron microscopy. The silver nitrate in the hybrid layer was quantified (ImageJ software). The adhesive systems' dentinal infiltration was analyzed using confocal laser scanning microscopy. Fourier transform near infrared spectroscopy was used to measure the DC. The μTBS data were submitted to two-way ANOVA (time vs. electric current) and Bonferroni's test (α = 0.05). Quantitative nanoleakage data were submitted to two-way ANOVA (electric current vs. adhesive) and Bonferroni's test (α = 0.05). DC data were submitted to one-way ANOVA and Tukey's test (α = 0.05) for each adhesive system. The electric current statistically increased the μTBS for SB2 and CSE in 24 h storage, as well as for SB2, CSE and SBU in 1 y storage. No significant difference was observed between storage time for CSE and SBU. When compared to the control, electric currents (25 μA and 50 μA) showed significantly higher DC mean values for SB2 and SBU, and had no effect on CSE. The electric currents (25 μA and 50 μA) reduced the adhesive system's nanoleakage after 1-year storage, and improved the infiltration of SB2 and CSE. Both electric current intensities improved dentinal interface stability.