A novel dentin bonding scheme based on extrafibrillar demineralization combined with covalent adhesion using a dry-bonding technique

Constructing the Enamel-Like Dentin Adhesion Interface to Achieve Durable Resin-Dentin Adhesion

Enamel adhesion is acknowledged as durable; however, achieving long-lasting dentin adhesion remains a formidable challenge due to degradation of exposed collagen matrix after acid-etching of dentin. The idea of developing an enamel-like adhesion interface holds great promise in achieving enduring dentin adhesion. In this study, we constructed an enamel-like adhesion interface using a rapid remineralization strategy comprising an acidic primer and a rapid remineralization medium. Specifically, the acidic primer of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) and epigallocatechin-3-gallate (EGCG) nanocomplex (MDP@EGCG primer) was utilized to partially demineralize dentin within 30 s, and the MDP@EGCG nanocomplex showed a strong interaction with exposed collagen, enhancing collagen remineralization properties. Then, the rapid remineralization medium containing polyaspartate (Pasp) stabilized amorphous calcium and phosphorus nanoclusters (rapid Pasp-CaP) was applied to modified dentin collagen for 1 min, which caused rapid collagen remineralization within a clinically acceptable time frame. This strategy successfully generated an inorganic rough and porous adhesive interface resembling etched enamel, fundamentally addressed issues of collagen exposure, and achieved durable dentin adhesion in vitro and in vivo while also ensuring user-friendliness. It exhibited potential in prolonging the lifespan of adhesive restorations in clinical settings. In addition, it holds significant promise in the fields of caries and dentin sensitivity treatment and collagen-based tissue engineering scaffolds.

Caries-Prone Primary Teeth: A Hidden Reason and Prophylactic Treatment in the Viewpoint of Materials Science

Dental caries, the most prevalent chronic disease across all age groups, has a high prevalence, particularly among children. However, there is no specific and effective treatment for the prevention of caries in primary teeth (Pr.T.), which stems from a lack of knowledge regarding the basic nature of the tooth surface. Herein, we observed that the adhesion energies of the caries-related bacteria Streptococcus mutans and Streptococcus sanguinis to Pr.T were approximately 10 and 5.5 times higher than those to permanent teeth (Pe.T). A lower degree of mineralization and more hydrophilic characteristics of the Pr.T enamel account for this discrepancy. Accordingly, we proposed that the on-target modification of both hydroxyapatite and organic components on Pr.T by dual modification would render a sufficient hydration layer. This resulted in an approximately 11-time decrease in bacterial adhesion energy after treatment. In contrast, a single hydroxyapatite modification on Pe.T and young permanent teeth (Y.Pe.T) was sufficient to achieve a similar effect. Theoretical simulation further verified the rationality of the approach. Our findings may help understand the reason for Pr.T being caries-prone and provide references for treatment using resin restorations. This strategy offers valuable insights into daily oral hygiene and dental prophylactic treatment in children.

Promotion of Dentin Biomimetic Mineralization and Bonding Efficacy by Interfacial Control of an Experimental Citric Acid Dental Etching Agent

Resin-bonded restorations are the most important caries treatment method in clinical practice. Thus, improving the durability of dentin bonding remains a pressing issue. As a promising solution, guided tissue remineralization can induce the formation of apatite nanocrystals to repair defects in the dentin bonding interface. In this study, we present an experimental 20 wt % citric acid (CA) dental etching agent that removes the smear layer. After CA-etching, approximately 3.55 wt % residual CA formed a strong bond with collagen fibrils, reducing the interfacial energy between the remineralizing solution and dentin. CA helped achieve almost complete intrafibrillar and extrafibrillar mineralization after 24 h of mineralization. CA also significantly promoted poly(amidoamine)-induced dentin biomimetic mineralization. The elastic modulus and microhardness of remineralized dentin were restored to that of sound dentin. The remineralized interface reduced microleakage and provided a stronger, longer-lasting bond than conventional phosphate acid-etching. The newly developed CA dental etching agents promoted rapid dentin biomimetic mineralization and improved bonding efficacy through interfacial control, representing a new approach with clinical practice implications.

Effect of chitosan and CMCS on dentin after Er:YAG laser irradiation: shear bond strength and surface morphology analysis

OBJECTIVES

The aim of the present study was to evaluate the effect of chitosan and carboxymethyl chitosan (CMCS) on dentin surface morphology and bonding strength after irradiation of Er:YAG laser.

METHODS

Eighty-four laser-irradiated dentin samples were randomly distributed into three groups (n = 28/group) according to different surface conditioning process: deionized water for 60s; 1wt% chitosan for 60s; or 1wt% CMCS for 60s. Two specimens from each group were subjected to TEM analysis to confirm the presence of extrafibrillar demineralization on dentin fibrils. Two specimens from each group were subjected to morphological analysis by SEM. Seventy-two specimens (n = 24/group) were prepared, with a composite resin cone adhered to the dentin surface, and were then randomly assigned to one of two aging processes: storage in deionized water for 24 h or a thermocycling stimulation. The shear bond strength of laser-irradiated dentin to the resin composite was determined by a universal testing machine. Data acquired in the shear bond strength test was analyzed by one-way ANOVA with the Tukey honestly significant difference post hoc test and Independent Samples t-test (α = 0.05).

RESULTS

CMCS group presented demineralized zone and a relatively smooth dentin surface morphology. CMCS group had significantly higher SBS value (6.08 ± 2.12) without aging (p < 0.05). After thermal cycling, both chitosan (5.26 ± 2.30) and CMCS group (5.82 ± 1.90) presented higher bonding strength compared to control group (3.19 ± 1.32) (p < 0.05). Chitosan and CMCS group preserved the bonding strength after aging process (p > 0.05).

CONCLUSIONS

CMCS has the potential to be applied in conjunction with Er:YAG laser in cavity preparation and resin restoration.

Influence of the incorporation of titanium dioxide nanofibers net on bond strength and morphology of a total etching adhesive system

Background

The aim of this study was to evaluate the nanoleakage and microtensile bond strength (μTBS) of an ethanol based-adhesive containing Titanium dioxide (TiO2) nanofibers to dentin.

Material and Methods

TiO2 nanofiber was produced by electrospinning and it was inserted in an ethanol-based adhesive in 0.5, 1.5 and 2.5% by weight. The original adhesive did not receive nanofiber. The middle dentin was exposed by diamond saw under water-cooling and dentin was polished with wet 600-grit SiC abrasive paper. Resin composite build-ups were applied incrementally to the dentin after adhesive application. After storage in distilled water (24 hours/37°C) the teeth were sectioned perpendicularly to the bonded interface and sticks were obtained. Twenty-five sticks per group were tested by μTBS with a crosshead speed of 0.5mm/minute. The average values (MPa) obtained in each substrate were subjected to one-way ANOVA (α=0,05) with the tooth being considered the experimental unit. The nanoleakage pattern was observed in ten sticks per group and analyzed by Chi-square test (α=0,05).

Results

There was no difference in μTBS among the experimental groups. However, there was a statistically significant difference among 2.5 % nanofiber adhesive, 0.5 % nanofibers and control groups, (p=0,028) in relation to nanoleakage.

Conclusions

TiO2 nanofibers in 2.5% of weight inserted in dental adhesive reduced the nanoleakage, but did not improve the μTBS to dentin. Key words:Dentin-bonding agents, nanoleakage, tensile bond strength.

Er:YAG Laser Physical Etching and Ultra-High-Molecular-Weight Cross-Linked Sodium Polyacrylate Chemical Etching for a Reliable Dentin Dry Bonding

Dentin bond interface stability is the key issue of dental adhesion in present clinical dentistry. The concept of selective extrafibrillar demineralization has opened a new way to maintain intrafibrillar minerals to prevent interface degradation. Here, using ultra-high-molecular-weight sodium polyacrylate [Carbopol (Carbo) > 40 kDa] as a calcium chelator, we challenge this concept and propose a protocol for reliable dentin dry bonding. The results of high-resolution transmission electron microscopy revealed periodic bands of 67 nm dentin collagen fibrils after Carbo etching, and the hydroxyproline concentration increasing with prolonged chelating time denied the concept of extrafibrillar demineralization. The results that wet and dry bonding with Carbo-based demineralization produced a weaker bond strength than the traditional phosphoric acid wet adhesion suggested that the Carbo-based demineralization is an unreliable adhesion strategy. A novel protocol of Er:YAG laser physical etching followed by Carbo chemical etching for dentin adhesion revealed that a micro-/nano-level rough, rigid, and non-collagen exposed dentin surface was produced, the micro-tensile bond strength was maintained after aging under dry and wet bonding modes, and in situ zymography and nanoleakage within the hybrid layers presented lower signals after aging. Cell culture in vitro and a rabbit deep dentin adhesion model in vivo proved that this protocol is safe and biocompatible. Taken together, the concept of extrafibrillar demineralization is limited and insufficient to use in the clinic. The strategy of Er:YAG laser physical etching followed by Carbo chemical etching for dentin adhesion produces a bonding effect with reliability, durability, and safety.

EDTA-functionalized silica nanoparticles as a conditioning agent for dentin bonding using etch-and-rinse technique

OBJECTIVE

This study investigated the possibility of using ethylenediaminetetraacetic acid functionalized silica nanoparticles (EDTA-SiO₂) as a dentin-conditioning agent using etch-and-rinse technique to promote the durability of dentin bonding.

METHODS

The SiO₂-EDTA were synthesized by N- [(3- trimethoxysilyl) propyl] ethylenediamine triacetic acid (EDTA-TMS) and SiO₂ (50 nm), then characterized by Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), X-ray photoelectron spectroscopy (XPS) and transmission electron microscopy (TEM). The capacity of SiO₂-EDTA to chelate calcium ions from dentin was examined by inductively coupled plasma-optic emission spectrometry (ICP-OES). The dentin surfaces conditioned with SiO₂-EDTA were detected by field emission scanning electron microscopy (SEM), TEM and microhardness testing. For dentin bonding, dentin surfaces were adopted wet- or dry-bonding technique and bonded with adhesive (Adper^TM Single Bond2) and applied composite resin (Filtek Z350) on them. The durability of dentin bonding was evaluated by mircotensile bond strength test, in-situ zymography and nanoleakage testing.

RESULTS

FTIR, TGA and XPS results showed that SiO₂-EDTA contained N element and carboxyl groups. SEM, TEM and microhardness results indicated that SiO₂-EDTA group created extrafibrillar demineralization and retained more intrafibrillar minerals within dentin surface. In the dentin bonding experiment, SiO₂-EDTA group achieved acceptable bond strength, and reduced the activity of matrix metalloproteinase and nanoleakage along bonding interface.

CONCLUSION

It was possible to generate a feasible dentin conditioning agent (SiO₂-EDTA), which could create dentin extrafibrillar demineralization and improve dentin bond durability.

CLINICAL SIGNIFICANCE

This study introduces a new dentin conditioning scheme based on SiO₂-EDTA to create extrafibrillar demineralization for dentin bonding. This strategy has the potential to be used in clinic to promote the life of restoration bonding.

Evaluation of a novel primer containing isocyanate group on dentin bonding durability

OBJECTIVES

To evaluate the benefits of a novel dentin-bonding primer, namely, isocyanate-terminated urethane methacrylate precursor (UMP), which can form covalent bonds with demineralized dentin collagen.

METHODS

The synthesized and purified UMP monomer was characterized and tested its effects on the degree of conversion (DC) and wettability of an acetone-based dental adhesive. Then UMP primers of different concentrations were formulated and used to prepare adhesive specimens, which were compared with solvent-treated groups. Primer-treated specimens with and without aging were also compared. To evaluate the bonding interface, microtensile strength tests, nano-indentation tests and nanoleakage- eavaluation were performed using a field-emission scanning electron microscope and nano-indenter. Data were analyzed using SPSS 20.0 software with significance set at α = 0.05 using one-way analysis of variance (ANOVA) and two-way ANOVA to characterize the effects of the primer.

RESULTS

Treatment with the UMP primer promoted the DC and wettability of the adhesive on the demineralized dentin surface (P < 0.05); it also increased the bond strength of the aged dentin bonding interface (P < 0.05). Nanoleakage was reduced; the bonding interface became more stable, and the continuity and strength of the hybrid layer improved (P < 0.05) following UMP treatment. The application of 5 mM UMP as a primer for dentin bonding could lead to a stable bonding interface and long-lasting bonding effects.

SIGNIFICANCE

The use of 5 mM UMP primer developed in this study could improve dentin bonding durability and has excellent clinical application prospects.

Enhancing bioactivity and stability of polymer-based material-tissue interface through coupling multiscale interfacial interactions with atomic-thin TiO2 nanosheets

Stable and bioactive material-tissue interface (MTF) basically determines the clinical applications of biomaterials in wound healing, sustained drug release, and tissue engineering. Although many inorganic nanomaterials have been widely explored to enhance the stability and bioactivity of polymer-based biomaterials, most are still restricted by their stability and biocompatibility. Here we demonstrate the enhanced bioactivity and stability of polymer-matrix bio-composite through coupling multiscale material-tissue interfacial interactions with atomically thin TiO2 nanosheets. Resin modified with TiO2 nanosheets displays improved mechanical properties, hydrophilicity, and stability. Also, we confirm that this resin can effectively stimulate the adhesion, proliferation, and differentiation into osteogenic and odontogenic lineages of human dental pulp stem cells using in vitro cell-resin interface model. TiO2 nanosheets can also enhance the interaction between demineralized dentinal collagen and resin. Our results suggest an approach to effectively up-regulate the stability and bioactivity of MTFs by designing biocompatible materials at the sub-nanoscale.

Electronic Supplementary Material

Supplementary material (further details of fabrication and characterization of TiO2 NSs and TiO2-ARCs, the bioactivity evaluation of TiO2-ARCs on hDPSCs, and the measurement of interaction with demineralized dentin collagen) is available in the online version of this article at 10.1007/s12274-022-5153-1.

In Search of Novel Degradation-Resistant Monomers for Adhesive Dentistry: A Systematic Review and Meta-Analysis

This study aimed to assess whether degradation-resistant monomers included in experimental dental adhesives can improve long-term bond strength compared to conventional monomers. This study followed the latest PRISMA guidance (2020). The search for the systematic review was carried out in four electronic databases: PubMed/Medline, Scopus, SciELO and EMBASE, without restrictions on the year of publication and language. The last screening was conducted in July 2022. Interventions included were in vitro studies on experimental dental adhesives that tested short-term and long-term bond strength, but also water sorption and solubility data when available, in extracted human molars. Meta-analyses were performed using Rstudio v1.4.1106. A summary table analyzing the individual risk of bias was generated using the recent RoBDEMAT tool. Of the 177 potentially eligible studies, a total of 7 studies were included. Experimental monomers with acrylamides or methacrylamide−acrylamide hybrids in their composition showed better results of aged bond strength when compared to methacrylate controls (p < 0.05). The experimental monomers found better sorption and solubility compared to controls and were significantly different (p < 0.001). It is possible to achieve hydrolytically resistant formulations by adding novel experimental monomers, with chemical structures that bring benefit to degradation mechanisms.

Evaluation of structural integrity effect on adhesion strength of root dentin with a multi-functional irrigation strategy

OBJECTIVES

To evaluate effects of a novel auxiliary irrigation strategy, proanthocyanidin (PA) + carboxymethyl chitosan/amorphous calcium phosphate (CMC/ACP) nanocomplexes, on maintaining the organic-inorganic structural integrity and hence optimizing the adhesion strength of root dentin.

MATERIALS AND METHODS

Dentin specimens (n = 150) were prepared and subjected to the classical irrigating strategy with or without PA and CMC/ACP. The ultrastructure and biomechanical behaviour of dentin were characterized by scanning electron microscopy and atomic force microscope, respectively. Forty single root-canal premolars were employed for push-out bond strength testing. Besides, the antibacterial effects against Enterococcus faecalis were evaluated with confocal laser scanning microscopy. Statistical differences were verified with one-way ANOVA and Tukey's post-tests.

RESULTS

The organic-inorganic structural integrity of root dentin was repaired with the synergetic use of PA and CMC/ACP. Correspondingly, the bond stability between the root canal wall and the AH-Plus sealer was significantly reinforced (P < 0.05). Meanwhile, the tissue biomechanical properties and antibacterial behaviour were enhanced compared to that of control group (P < 0.05).

CONCLUSIONS

The synergistic utilization of PA and CMC/ACP can preserve the structural integrity of root dentin, contributing to optimizing the sealing effects of root canal. Moreover, the novel irrigation strategy demonstrated a favourable antimicrobial activity.

CLINICAL RELEVANCE

The combination of PA and CMC/ACP can serve as a promising auxiliary irrigation strategy to optimize the outcomes of chemical preparation, enhance the sealing effects of root canal and hence improve the success rate of treatment.

The roles of 10-methacryloyloxydecyl dihydrogen phosphate and its calcium salt in preserving the adhesive-dentin hybrid layer

OBJECTIVES

10-Methacryloyloxydecyl dihydrogen phosphate (MDP) has been regarded as the most effective dentin-bonding monomer for more than 20 years. Although the dentin-bonding promoting effect of MDP has been well demonstrated, the mechanisms by which it benefits the stably of collagen within the adhesive-dentin hybrid layer are not currently fully understood. The objective of this study was to investigate the roles of MDP and its calcium salt in preserving the adhesive-dentin hybrid layer.

METHODS

MDP-conditioned collagen was investigated by Fourier-transform infrared spectroscopy, Ultraviolet-visible spectroscopy, and molecular docking. The structural changes to the dentin surface upon acid-etching and MDP-conditioning were observed by SEM. X-ray diffraction and nuclear magnetic resonance were used to investigate the chemical interactions between MDP and HAp. The collagen-protecting effects of MDP and its Ca salt were investigated using in-situ zymography, rhMMP-9 colorimetric assay, hydroxyproline assay, and molecular docking.

RESULTS

MDP forms a stable collagen-phosphate complex through hydrogen bonding with the collagen in dentin. Furthermore, it generates MDP-Ca salts that are deposited on the dentin collagen scaffold, protecting it from degradation. Moreover, both free MDP and the MDP-Ca salt inhibit matrix metallopeptidase and exogenous proteases, with the inhibitory effect of the calcium salt being significantly stronger than that of the free form.

SIGNIFICANCE

MDP-based adhesives preserve the collagen within the hybrid layer by simultaneously improving collagen's resistance to exogenous enzymes and inhibiting MMP activity, both of which contribute to the longevity of dentin-resin bonding.

Interactions of two phosphate ester monomers with hydroxyapatite and collagen fibers and their contributions to dentine bond performance

OBJECTIVES

To evaluate the interactions of two phosphate ester monomers [10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and dipentaerythritol penta-acrylate phosphate (PENTA)] with hydroxyapatite and collagen and understand their influence on dentine bonding.

METHODS

Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, nuclear magnetic resonance, ultraviolet-visible, and molecular docking were applied for separately evaluating the interactions of two monomers with hydroxyapatite and collagen. Hydrophilicity tests and morphological observation were employed to characterize pretreated dentine. Microtensile bond strength (μTBS) and nanoleakage were investigated to evaluate the bonding performance. Hydroxyproline assay, in situ zymography, and matrix metalloproteinase-9 (MMP-9) activity assay were used to confirm the MMP inhibition.

RESULTS

Chemoanalytic characterization confirmed the interactions of 10-MDP and PENTA with hydroxyapatite and collagen. The interactions of PENTA were weaker than 10-MDP. PENTA possessed better dentine tubule sealing after etching than 10-MDP. Dentine treated with PENTA was more hydrophilic than 10-MDP. 10-MDP and PENTA treating significantly increased the initial μTBS than the control group without primer conditioning. μTBS decreased significantly during aging, and the decrease was more severe in the PENTA group than 10-MDP. The 10-MDP and PENTA groups exhibited relatively less fluorescence than the control. The relative inhibition percentages of MMP-9 decreased in the order of 10-MDP-Ca salt, 10-MDP and PENTA. The 10-MDP, PENTA, and 10-MDP-Ca salt groups showed significantly lower hydroxyproline contents than the control.

CONCLUSIONS

Although PENTA adsorbed on hydroxyapatite, it did not form a stable calcium salt. The interactions of 10-MDP with hydroxyapatite and collagen are different than those of PENTA.

CLINICAL SIGNIFICANCE

The sealing of dentinal tubules by PENTA and the inhibition of MMP by 10-MDP and its calcium salts contribute to improving the dentine bonding durability.

A mussel glue-inspired monomer-etchant cocktail for improving dentine bonding

OBJECTIVES

The humid oral environment adversely affects the interaction between a functionalised primer and dentine collagen after acid-etching. Robust adhesion of marine mussels to their wet substrates instigates the quest for a strategy that improves the longevity of resin-dentine bonds. In the present study, an etching strategy based on the incorporation of biomimetic dopamine methacrylamide (DMA) as a functionalised primer into phosphoric acid etchant was developed. The mechanism and effect of this DMA-containing acid-etching strategy on bond durability were examined.

METHODS

Etchants with different concentrations of DMA (1, 3 or 5 mM) were formulated and tested for their demineralisation efficacy. The interaction between DMA and dentine collagen, the effect of DMA on collagen stability and the collagenase inhibition capacity of the DMA-containing etchants were evaluated. The effectiveness of this new etching strategy on resin-dentine bond durability was investigated.

RESULTS

All etchants were capable of demineralising dentine and exposing the collagen matrix. The latter strongly integrated with DMA via covalent bond, hydrogen bond and Van der Waals' forces. These interactions significantly improve collagen stability and inhibited collagenase activity. Application of the etchant containing 5 mM DMA achieved the most durable bonding interface.

CONCLUSION

Dopamine methacrylamide interacts with dentine collagen in a humid environment and improves collagen stability. The monomer effectively inactivates collagenase activity. Acid-etching with 5 mM DMA-containing phosphoric acid has the potential to prolong the longevity of bonded dental restorations without compromising clinical operation time.

CLINICAL SIGNIFICANCE

The use of 5 mM dopamine methacrylamide-containing phosphoric acid for etching dentine does not require an additional clinical step and has potential to improve the adhesive performance of bonded dental restorations.

Dry bonding to dentin: Broadening the moisture spectrum and increasing wettability of etch-and-rinse adhesives

OBJECTIVE

To determine whether the effect of dentin moisture on the etch-and-rinse bonding may be minimized by dry-bonding protocols utilizing aqueous or ethanolic dimethyl sulfoxide (DMSO) pretreatments.

METHODS

H₃PO₄-etched mid-coronal dentin surfaces from human molars were randomly blot- or air-dried for 30 s and pretreated with DMSO/H₂O or DMSO/EtOH solutions. Untreated samples served as control. Moisture control was performed by either blot- or air-drying. Samples were bonded with a multistep etch-and-rinse adhesive. Restored crown segments (n = 8/group) were stored in distilled water for 24 h and sectioned for microtensile bond strength testing. Resin-dentin beams (0.8 mm²) were tested under tension until fracture (0.5 mm/min) after 24 h and two years of storage in artificial saliva at 37 °C. SEM nanoleakage evaluation was performed on aged samples. Collagen wettability was also measured by sessile drops of the hydrophilic and hydrophobic bonding resins (n = 8/group). Data were examined by factorial ANOVA followed by the Tukey test (α = 0.05).

RESULTS

Dry bonding to untreated collagen produced inferior immediate and long-term bond strengths than wet bonding (p < 0.05). Regardless of initial hydration and moisture control, DMSO-dry bonding produced initially higher and stable bond strengths after aging (p < 0.05). DMSO-pretreated groups presented improved collagen wettability with lower silver uptake (p < 0.05).

SIGNIFICANCE

Despite the common belief that etch-and-rinse adhesives must be applied onto moist collagen, DMSO-dry bonding protocols not only improved bonding performance and hybrid layer integrity, but also brought more versatility to collagen hybridization by reducing overdrying-related issues.