Adhesion to tooth structure: A critical review of “macro” test methods

Does surface priming increase the bond strength of orthodontic brackets? An experimental study

OBJECTIVE

To evaluate the effects of metal primer II (MP II) on the shear bond strength (SBS) of orthodontic brackets bonded to teeth and bis-acryl composite provisional material (Bis-Acryl).

MATERIAL AND METHODS

Twenty extracted human premolars specimens and 20 premolar shaped Bis-Acryl specimens were obtained and randomly divided into two surface groups. The first group consisted of human premolars (T) bonded to brackets in the conventional way while in the second (T-MP) MP II was applied on the bracket base before bonding. Similarly, one group of provisional material (PM) was prepared according to conventional treatment and another with the application of MP-II metal bonder (PM-MP). In all cases Ortho-brackets (Victory Series, 3 M) were bonded employing Transbond XT resin cement. Then the brackets were debonded under shear and the results were statistically analyzed by two-way analysis of variance and Holm Sidak at α = .05. The debonded surfaces of all specimens were examined by light microscopy and the Adhesive Remnant Index (ARI) was recorded.

RESULTS

The SBS results exhibited significant differences er (p < .001). For both the T and TM the application of MP-II increased the SBS compared to respective control groups (p < .001). The T-C group was found inferior compared to PM-C (p < .001) and the same is true for the comparison between T-MP and PM-MP (p < .001). ARI indexes demonstrated that the tooth groups were characterized by a predominantly adhesive failure at the resin-dentin interface. In contrast, the control group for provisional crowns (PM-C) showed a predominantly cohesive failure mode, which moved to predominantly adhesive after the application of MP II.

CONCLUSION

The application of MP II enhances the SBS on both, human enamel and provisional crown materials.

Bond strength and marginal adaptation of resin composites and correlations with clinical results

OBJECTIVES

Due to innumerable confounding factors and a high number of types and brands of dental restorative materials, the clinical performance of restorative materials are sought predicted by various in vitro tests. However, only few such tests have been found to correlate well with clinical findings. Thus, the present study determined the in vitro dentin bond strength and marginal adaptation of Class II restorations and correlated the results to their clinical outcomes.

METHODS

Dentin bond strength (µTBS and µSBS) and marginal gap formation of Class II restorations (replica technique and SEM) were measured after 24 h and 6 m water storage using eight combinations of adhesive and resin composite. Clinical outcomes (mean survival time, Hazard Ratio, annual failure rate; n = 10.695) were gained from a data set of a retrospective multicenter study of direct restorations.

RESULTS

Significant differences were found for dentin bond strength and marginal gap formation between the restorative material groups, and negative effects of long-term storage were observed. µTBS correlated significantly with certain clinical outcomes of Class I restorations, while µSBS correlated with certain clinical outcomes of Class II, III, IV and V restorations. Marginal gap formation in enamel and number of paramarginal fractures correlated with certain clinical outcomes of Class II restorations.

SIGNIFICANCE

Using the same restorative materials in vitro as in vivo, gave significant, but weak correlations between in vitro bond strength or marginal adaptation and clinical outcomes, lending support to the use of in vitro tests in early stages of material selection.

Effect of desensitizing agents on the resin bond strength to sound dentin

This study aimed to evaluate the effect of dentin hypersensitivity treatments on immediate and long-term shear bond strength (SBS) of composite restorations. Ninety non-carious extracted human molars were cut to expose dentin, which was embedded in acrylic resin, and randomly divided into three groups (n = 30/group) according to surface treatment: 1) no treatment (C and C*; control); 2) silver diamine fluoride with potassium iodide (SDF/KI and SDF/KI*; Riva Star); and 3) nano-hydroxyapatite (nHAp and nHAp*; PrevDent). The specimens were etched through the etch-and-rinse technique, followed by universal adhesive application and resin composite cylinders (2.38 mm in diameter × 3.5 mm high). The SBS was tested immediately (24 h after the restoration) and after thermocycling (*) (5000 cycles, 5 °C to 55 °C) at a 0.5 mm/min crosshead speed using a universal testing machine. A stereomicroscope was used to evaluate the mode of failure, and representative scanning electron microscopy (SEM) images were also acquired. Data normality was verified, and two-way ANOVA and Tukey's post hoc tests were performed for multiple comparisons (α = 0.05). The control group presented the highest SBS (27.10 MPa), while SDF/KI* had the lowest values (6.87 MPa). nHAp-based desensitizer exhibited higher SBS than SDF/KI for both immediate (22.6 MPa) and thermocycled (19.03 MPa) conditions. No intragroup difference was evidenced between immediate and thermocycled samples for any group. Most specimens for the C and nHAp groups presented mixed failure, while the SDF/KI groups presented comparable adhesive and mixed failures. The SBS of adhesive restorations after the application of desensitizing agents is material dependent, where SDF/KI reduces SBS values below the acceptable minimum bond strength, while the nHAp application meets the minimally required bond strength.

Effect of universal adhesives and self-etch ceramic primers on bond strength to glass-ceramics: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

To simplify dental procedures, multicomponent products such as universal adhesives and self-etch ceramic primers have been recommended for glass-ceramic bonding; however, studies have shown a wide range of results.

PURPOSE

The purpose of this systematic review and meta-analysis was to analyze the in vitro bond strength promoted by hydrofluoric acid+silane-containing universal adhesives and a self-etch ceramic primer to glass-ceramics and compare it with that of conventional treatments.

MATERIAL AND METHODS

A systematic search was conducted in the PubMed/Medline, Scopus, LILACS, and ISI Web of Science databases up to April 2021. In vitro studies assessing the resin-mediated bond to glass-ceramics by using a self-etch ceramic primer and hydrofluoric acid+silane-containing universal adhesives and/or compared with traditional hydrofluoric acid+glass-ceramic primers were included. Selection of studies, data extraction, and risk-of-bias analysis were performed. Statistical analysis was performed by using a review management software program using a random effects model (α=.05).

RESULTS

A total of 33 studies were included in the qualitative analysis and 26 studies in the quantitative analysis. Bond strength to lithium disilicate ceramic was higher when a hydrofluoric acid+glass-ceramic primer was used than when using a hydrofluoric acid+silane-containing universal adhesive (P<.05), except when 9% to 10% acid concentration was used in combination with static aging (P=.100). A self-etch ceramic primer promoted bond strength values to lithium disilicate that were similar to those of the hydrofluoric acid+glass-ceramic primer (P>.100).

CONCLUSIONS

Hydrofluoric acid+silane-containing universal adhesive was not as effective as the hydrofluoric acid+glass-ceramic primer in promoting bond strength to glass-ceramic. Bond strength values generated by a self-etch ceramic primer to glass-ceramic were similar to those generated by the conventional treatment.

Shear bond strength between standard or modified zirconia surfaces and two resin cements incorporating or not 10-MDP in their matrix

OBJECTIVE

This study aimed first to compare the shear bond strength between zirconia samples luted to enamel with a 10-MDP- containing resin cement (Panavia F2.0, Kuraray, Japan) and those luted with a resin cement using a separated 10-MDP monomer-containing bottle (Panavia V5, Kuraray, Japan). The second objective was to evaluate the bond stability after 150 days of aging in water, between enamel and zirconia ceramic surface enhanced with a glass-ceramic coating.

MATERIALS AND METHODS

80 specimens composed of ceramic cylinders and enamel disks were obtained, within eight experimental groups (n = 10). 60 zirconia cylinders (Katana STML zirconia, Kuraray, Japan) were assigned to 3 groups according to their surface treatment: milled/sintered surface (ZRCT), tribochemical silica-coating (Cojet™ Sand, 3 M ESPE, Seefeld, Germany) (ZRTC), and glass-ceramic coating (IPS e.max Zirpress) (ZRZP). 20 cylinders of lithium disilicate had a milled surface (IPS e.max CAD, Ivoclar-Vivadent, Schaan, Liechtenstein) (ECAD). The cylinders of each group were further divided into two subgroups according to the resin cement used: Panavia F2.0 (-PF) and Panavia V5 (-PV). All specimens were stored in distilled water for 150 days before shear bond strength (SBS) tests. The fracture mode was analyzed, and data were statistically computed (two-way ANOVA, post hoc Tukey test, p < 0.05, SPSS, IBM, v26).

RESULTS

The ECAD-PF group recorded the highest SBS values (31.75 ± 2.2), and the ZRCT-PF group recorded the lowest values (5.59 ± 1.1). The two-way ANOVA test showed that ceramic surface treatment had a statistically significant effect on SBS (F (3,72) = 38.95, p < 0.001) while the type of ARC did not (F (1,72) = 2.40, p = 0.126). Tukey's post hoc test revealed no statistical difference between the ZRZP and the ZRTC or ECAD groups.

CONCLUSION

Within the limitations of this study, the PV resin achieved similar shear bond strength results between tribocoated zirconia and enamel compared to the one for glass-ceramic and enamel. Furthermore, a long-term durable bond, similar to the glass-ceramic one, was achieved with the heat pressed ceramic coated specimens. Thus, this new surface treatment could be recommended for anterior cantilever bridges for its fracture resistance and bonding ability.

Reliability of an Innovative Slab Shear versus Microtensile Bond Strength Test: Mechanical and Finite Element Analysis

OBJECTIVE

 The aim of this study was to evaluate the efficiency of slab shear bond strength test (Slab_SBS) versus the microtensile in evaluation of the bond strength of different substrates.

MATERIALS AND METHODS

 Forty-eight extracted caries-free human third molars were utilized for teeth specimens' preparation. After flattening of all molars' occlusal table, the specimens were divided into two groups based on the type of utilized restorative material: nanohybrid resin composite and resin-modified glass ionomer (RMGI). Each group was further subdivided into three subgroups according to the subsequently applied bond strength test and specimen width; microtensile bond strength test (μTBS), Slab_SBS [2 mm] and Slab_SBS [3 mm]. Both testing methods were additionally applied on CAD/CAM specimens, nanohybrid resin composite blocks (composite-to-composite), and ceramic blocks (ceramic-to-ceramic). CAD/CAM specimens were prepared and cemented and then sectioned and subdivided as followed for teeth specimens' preparation. Pretest failures (PTF), bond strength, and failure mode of each specimen were recorded. Representative three-dimensional (3D) finite element analysis (FEA) models were developed to simulate μTBS and Slab_SBS specimens. Data were statistically analyzed using Shapiro-Wilk test and Weibull analysis.

RESULTS

 Pretest failures were only noted in the μTBS subgroups. Slab_SBS provided comparable bond strength to the μTBS of all substrates with adhesive mode of failure.

CONCLUSION

 Slab_SBS is easier to prepare with consistent and predictable outcome with no pretest failures during specimen preparation and better stress distribution.

Effect of Combined Application of Hydrofluoric and Phosphoric Acids and Active Irrigation with a Microbrush on Shear Bond Strength of Lithium Disilicate Ceramics to Enamel

Background

This study assessed the effect of combined application of hydrofluoric (HF) acid and phosphoric acid (PA) and active irrigation (AI) with a microbrush on shear bond strength (SBS) of lithium disilicate (LDS) ceramics to enamel.

Materials and Methods

This in vitro study was conducted on 40 extracted teeth that received enamel preparation with a #12 cylindrical bur. Forty IPS e.max LT rods (3mm diameter, 6mm height) were fabricated and randomly assigned to four groups (n = 10) for surface treatment with 5% HF (group 1), 5% HF and AI with a microbrush for 20 seconds (group 2), 5% HF and 32% PA (group 3), and 5% HF and 32% PA plus AI with a microbrush for 20 seconds (group 4). Silane and Choice 2 cement were used for bonding rods to enamel. The SBS was measured by a universal testing machine. Data were analyzed by two-way analysis of variance (ANOVA), Bonferroni, and Chi-square tests (alpha = 0.05).

Results

Group 4 had the highest SBS, and group 1 had the lowest SBS (P < 0.05). Group 2 had a significantly higher SBS than group 1, and group 4 had a significantly higher SBS than group 3. AI with a microbrush significantly increased the SBS (P < 0.05), but the application of PA caused no significant change in SBS (P > 0.05). The interaction effect of PA and AI on SBS was not significant (P > 0.05).

Conclusion

The application of PA in addition to 5% HF acid caused no significant change in the SBS of LDS ceramic to enamel. However, AI with a microbrush significantly increased the SBS.

Effect of bioactive glass particles on mechanical and adhesion properties of resin cements

PURPOSE

The aim of this study is to evaluate the mechanical and adhesive properties of three different resin cements with bioactive glass (BAG) incorporated in two different ratios.

METHODS

BAG was added to different resin cements (3M Rely-X Ultimate, GC Link Ace, and GC Link Force) in different ratios (5% and 10% by weight). The three-point flexural strength, microhardness, and bond strength properties were evaluated. The fracture types of the groups were then analyzed using a stereo microscope. The data were analyzed using a multifactorial analysis of variance and Tukey's post-hoc tests (α < 0.05).

RESULTS

The addition of BAG reduced the flexural strength of the resin cements (P < 0.05).The effect of BAG addition on the Vickers microhardness value was significantly different for each cement group (P < 0.05). In addition, with the exception of the GC link force group (10% BAG addition), the BAG addition decreased the bond strength of cements to dentin in all the groups (P = 0.171).

CONCLUSIONS

The results of this study confirmed that different resin cements comprising different ratios of BAG exhibited different flexural strength, hardness, and bond-strength properties. Since the bond strength values increased with the addition of 10% BAG in the GC Link Force cement group, the effects of different BAG compositions could be worth investigating in future studies.

Optimizing Dental Bond Strength: Insights from Comprehensive Literature Review and Future Implications for Clinical Practice

This review examines the modifying factors affecting bond strength in various bonding scenarios, particularly their relevance to the longevity of dental restorations. Understanding these factors is crucial for improving clinical outcomes in dentistry. Data were gathered from the PubMed database, ResearchGate, and Google Scholar resources, covering studies from 1992 to 2022. The findings suggest that for dentin-resin bonds, minimizing smear layers and utilizing MMP inhibitors to prevent hybrid layer degradation are essential. In the case of resin-resin bonds, reversing blood contamination is possible, but preventing saliva contamination is more challenging, underscoring its critical importance during clinical procedures. Additionally, while pretreatment on ceramics has minimal impact on bond strength, the influence of specific colorings should be carefully considered in treatment planning. This comprehensive review highlights that although established practices recognize significant bond strength factors, ongoing research provides valuable insights to enhance the clinical experience for patients. Once confirmed through rigorous experimentation, these emerging findings should be swiftly integrated into dental practice to improve patient outcomes.

Does extended air-drying time improve bond strength of universal adhesives to enamel?

OBJECTIVE

To investigate the effect of extended air-drying time on the microshear bond strength (MSBS) of universal adhesives to enamel.

MATERIALS AND METHODS

The distal and mesial specimens from third molars were wet-ground and randomly assigned to three groups according to adhesives tested (n = 60): Clearfil Bond Universal, Gluma Bond Universal, and G-Premio Bond. The adhesives were applied in etch-and-rinse or self-etch modes, followed by air-drying for 5, 15, or 25 s. Composite buildups were constructed and subjected to the MSBS test after 24-h or thermocycling. MSBS results were evaluated using a four-way ANOVA. The thickness of the adhesive layer and the degree of solvent evaporation were further evaluated.

RESULTS

At 24-h, MSBS of G-Premio Bond significantly improved with the 25 s air-drying in both of the etching modes when compared to the 5 s air-drying. After thermocycling, the extended air-drying did not produce a significant difference on the MSBS, regardless of the application strategy. Extended air-drying (25 s) evaporated almost all of the volatile part of Gluma Bond Universal and G-Premio Bond.

CONCLUSIONS

Extended air-drying times increased solvent evaporation but did not contribute to the bonding effectiveness of the adhesives, regardless of the etching mode.

CLINICAL SIGNIFICANCE

Air-drying applications for more than 5 s had no significant effect on enamel bonding performance of universal adhesives.

Comparison of Shear Bond Strength and Microleakage between Activa™ Bioactive Restorative™ and Bulk-Fill Composites-An In Vitro Study

Bioactive materials have emerged as a promising alternative to conventional restorative materials as part of more conservative dentistry. The aim of this study was to evaluate and compare the shear bond strength (SBS) and microleakage of a new bioactive restorative material, two bulk-fill restorative composites, and a conventional composite at 24 h, 4 weeks, and 8 weeks. Three hundred and sixty molars and premolars were divided into four groups: ACTIVA™ BioACTIVE Restorative™, Filtek™ Bulk-Fill Restorative Composite, Tetric^® N-Ceram Bulk-Fill Composite, and G-aenial^® Composite. The normality of the data was determined with the Kolmogorov-Smirnov test, then the two-way ANOVA and Fisher's test were used for analyzing SBS data, and the Kruskal-Wallis and DSCF tests were conducted to analyze the microleakage. In the SBS test, there were no statistically significant differences between materials (p = 0.587), and the relation between material and time (p = 0.467), time points showed statistically significant differences (p = 0.016). As for the microleakage, statistically significant differences were found for all three time periods (p < 0.05), showing the conventional composite to have the lowest microleakage, followed by the bioactive material, and lastly the two bulk-fill composites. In conclusion, the new bioactive material has similar evaluated properties to bulk-fill composites (bond strength) and conventional composites (bond strength and microleakage) and can be used as an alternative restorative material.

Mechanical Properties of Poly(Alkenoate) Cement Modified with Propolis as an Antiseptic

Background: We assessed the effect of propolis on the antibacterial, mechanical, and adhesive properties of a commercial poly(alkenoate) cement. Methods: The cement was modified with various concentrations of propolis, and antibacterial assays were performed against S. mutans by both MTT assays and agar diffusion tests. The compressive, flexural, and adhesive properties were also evaluated. Results: the modified cement showed activity against S. mutans in both assays, although reductions in compressive (from 211.21 to 59.3 MPa) and flexural strength (from 11.1 to 6.2 MPa) were noted with the addition of propolis, while adhesive strength (shear bond strength and a novel pull-out method) showed a statistical difference (p < 0.05). Conclusion: the antiseptic potential of modified material against S. mutans will allow this material to be used in cases in which low mechanical resistance is required (in addition to its anti-inflammatory properties) when using atraumatic restorative techniques, especially in deep cavities.

Twenty-month Performance of a Universal Bonding System on Simulated-challenged Dentin Substrates Pretreated with Chlorhexidine

OBJECTIVES

Since the use of dentin antiproteolytic agents with universal adhesives (UAs) can potentially degrade the bonding interface, this study evaluated bond strengths with and without chlorhexidine (CHX) on variously altered dentin surfaces for up to 20 months.

METHODS

Human molar specimens (n=20) were categorized by substrates as S=sound, E=eroded, and C=carious, and by pretreatment as W=water or CHX. These specimens were subjected to micro-tensile bond strength (μTBS) testing at 24 hours, 6 months, and 20 months, after 30 seconds of pretreatment with CHX or W, followed by self-etching and bonding (Adper Single Bond Universal, 3M ESPE). Modes of failure were assessed using optical microscopy (40×) and scanning electron microscopy (SEM), and the results were analyzed by 3-way ANOVA and Tukey's statistical tests (α=0.05).

RESULTS

Substrate (p<0.001), pre-treatment (p=0.0413), and time (p<0.0001) were statistically significant. The sound-dentin group in initial time (W=39.27/CHX=40.55) yielded the higher μTBS values (MPa) in comparison with altered substrates pre-treated with CHX (E-CHX=19.84; C-CHX=18.24) after 20 months, which showed the lowest values. Under SEM analysis, heterogeneous patterns appeared in the hybrid layer of the CHX-treated group, particularly in the altered substrates.

CONCLUSIONS

Bond strength to dentin decreased over a period of 20 months using UA with 10-methacryloyloxydecyl-dihydrogen phosphate (MDP) in self-etching mode. Substrates altered by erosion or caries have impaired adhesion and associated clinical use of UA with MDP and CHX should be avoided.

Comparison of Different Universal Adhesive Systems on Dentin Bond Strength

Over the past few decades, adhesive dentistry has advanced significantly. In light of minimal-invasive dentistry, this novel technique advocates a more conservative cavity design that relies on the efficiency of present enamel-dentine adhesives. The study aimed to address the scientific deficit in understanding the long-term bonding performance of universal adhesives and to provide a new clinical solution with desirable bond strength to dentin. The dentin bond strength of three bonding agents, G2-Bond Universal (GC), Clearfil SE Bond (Kuraray), and Scotchbond Universal Plus (3M ESPE), was evaluated following various storage and etching modes. The UltraTester (Ultradent) bond strength testing machine was used to assess shear bond strength. The results showed that thermal cycling and the choice of adhesive system significantly affected the shear bond strength (p = 0.018 and p = 0.001, respectively). Among the three adhesives, Scotchbond Universal Plus had the lowest bond strength value (mean value = 24.78 MPa), while G2-Bond Universal was found to have desirable shear bond strength to dentin compared to the other adhesives, even after one year in the oral environment (mean value = 35.15 MPa). These findings imply that the HEMA-free universal adhesive G2-Bond Universal is the most effective universal adhesive for clinical practices, particularly when applied in the self-etch mode.

Assessment of Intra-Oral Repair Systems for Veneered Zirconia and Zirconia Only

The aim of this study was to compare bond strength resin composites to porcelain laminate veneers in the indirect repair method to composite resins used in the direct repair method for cases of porcelain veneer fracture of zirconia-based fixed dental prostheses. In the study, the groups were formed with different percentages of areas to be repaired to mimic porcelain fractures in the mouth. The experimental group of veneered zirconia were as follows: Group A = 100% Zr surface; Group B = 70% Zr, 30% porcelain surface; Group C = 50% Zr, 50% porcelain surface; Group D = 30% Zr, 70% porcelain surface; Group E = 100% porcelain surface. The repairs of the specimens were made using composite resin systems in half of the groups and using porcelain laminate veneers in the other half. Specimens were embedded in acrylic blocks before surface treatments and repairs were applied. After surface conditioning, laminate veneers were applied to the first half of the groups, and composite repair systems were applied to the second half of the groups. After all specimens were aged by thermal cycling, their bond strength values were measured using a Universal Testing Machine, and the obtained data were recorded. The specimens were examined with a stereomicroscope and classified according to failure types (adhesive/cohesive/mixed). Bond strength values were evaluated based on independent-samples t-test statistics. According to the comparisons among the groups, the bond strength of the indirect repairs made with the laminate material was higher than the bond strength of the repairs made with the composite. There was a statistically significant difference in favor of the indirect repair groups among all groups except for Group C. The highest bond strength was found in Group A in the indirect repair method, while the lowest bond was found in the direct repair method in Group E. Adhesive failure was mostly seen in the groups that were repaired with the composite.

Impact of different pretreatments and attachment materials on shear bond strength of indirectly bonded brackets using CAD/CAM transfer trays to monolithic zirconia

OBJECTIVE

Investigating the impact of different pretreatment methods, attachment materials and aging regimens on shear bond strength (SBS) between zirconia and indirectly bonded brackets using CAD/CAM transfer trays.

METHODS

Zirconia substrates were conditioned with silica coated alumina (CoJet) and a) Clearfil Ceramic Primer Plus (CF), b) RelyX Ceramic Primer (RXP), c) Futurabond U (FU). Brackets were virtually placed, transfer tray designed (OnyxCeph) and 3D-printed for indirect bonding with a) Transbond LV (TBL), b) Nexus NX3 (NX3), c) Maximum Cure (MC). SBS testing was performed with a universal testing machine after 24 h, 500 thermal cycles, 90 d. Directly bonded brackets to human enamel using Transbond XT Adhesive served as control. The adhesive remnant index (ARI) was evaluated. Data was analyzed with Shapiro-Wilk, Kruskal-Wallis and Dunn's post-hoc test with Bonferroni correction, Chi² test (p < 0.05), and the Weibull modulus was calculated.

RESULTS

SBS ranged from 0.1 to 15.5 MPa and were influenced mostly by the attachment material. NX3 generally showed the highest values (9.5-15.8 MPa). Initially RXP/TBL and FU/TBL presented the lowest values (4.3/4.8 MPa). Aging regimens reduced SBS of MC irrespective of pretreatment, after 90 d values ranged from 0.1 to 0.9 MPa. ARI 1 was predominant in all MC groups and FU/NX3, 2 and 3 in the other groups. Weibull moduli ranged between 0.15 (MC/RXP/500 TC) and 6.24 (NX3/RXP/500 TC).

SIGNIFICANCE

MC seems not to be suitable for indirect bonding using CAD/CAM transfer trays to zirconia. NX3 showed similar SBS values compared to the control, TBL lower.

Influence of different tooth etchants on bur-cut and uncut enamel

This study aimed to evaluate the effect of pre-etching for two-step self-etch adhesive bonding to bur-cut and uncut enamel. Bur-cut and uncut enamel surfaces were assigned to surface treatments of no etchant (CT), Enamel Conditioner (EC; Shofu, Kyoto, Japan), or K-etchant syringe (KE; Kuraray Noritake Dental, Tokyo, Japan). The bonded samples were thermal cycled and evaluated by microshear bond strength (μSBS). The adhesive interface after acid-base challenge and the conditioned enamel surfaces were morphologically analyzed using scanning electron microscopy (SEM). For bur-cut enamel, EC and KE pre-etching significantly improved μSBS. For uncut enamel, KE showed higher μSBS than EC. SEM observation revealed that only KE removed the prismless layer of the uncut enamel surface. EC could improve enamel bonding and appears to be a substitute for phosphoric acid, especially for bur-cut enamel. However, uncut enamel could not be effectively conditioned by EC with a lower bond strength than KE.

Effect of shape of titanium dioxide nanofillers on the properties of dental composites

The main objective of the present study was to evaluate the effect of the morphology of titanium dioxide nanofillers on the flexural strength and shear bond strength of the dental composite. Spherical and rhombic-shaped nano titanium dioxide fillers were synthesized via solvothermal method and were characterized. Subsequently, these fillers were incorporated into a flowable composite (Filtek^™ Z350 XT Flowable Restorative) at 0.5 wt.% and 1.5 wt.% and the prepared specimens were stored in water for 24 h. The specimens were then evaluated for flexural strength using a universal testing machine. Similarly, the shear bond strength of modified composites to the tooth was evaluated and bond failures were analyzed using stereomicroscope magnification. Incorporation of nanofillers significantly enhanced the flexural strength of flowable composite (p = 0.009) with a significant increase at 0.5wt.% of spherical (p = 0.015) and rhomboidal-shaped fillers (p = 0.010). However, no statistically significant difference in flexural strength was observed among the different shapes of nanofillers. The results of our study did not show a significant effect on the shear bond strength of the composites. Thus the reinforcing ability of titanium dioxide nanofillers on dental composite was confirmed in this study, although the effect of using nanofillers with different morphology was not significant.

Bond strength between temporary 3D printable resin and conventional resin composite: influence of cleaning methods and air-abrasion parameters

OBJECTIVES

The influence of different cleaning methods, air-abrasion parameters, and aging on shear bond strength (SBS) and tensile bond strength (TBS) of 3D resin luted to composite resin.

MATERIALS AND METHODS

Nine hundred resin substrates were 3D printed (D20II, Rapid Shape) and cleaned with either isopropanol (ISO), butyldiglycol-based solution (BUT), or centrifugation (CEN). After 24-h storage in 37 °C water, specimens were air-abraded (mean particle size 50 µm; n = 60) with either alumina at 0.1 MPa (AL0.1) or 0.4 MPa (AL0.4) and glass pearls at 0.1 MPa (GP0.1) and 0.4 MPa (GP0.4) or conditioned with visio.link (control) and luted with PanaviaV5. Initially (24 h, 37 °C water storage) or after aging (10,000 thermal cycles), SBS and TBS were measured, and fracture types were examined. Surface free energy (SFE) and roughness (Ra) were determined after air-abrasion. Kolmogorov-Smirnov, Kruskal-Wallis H, Mann-Whitney U, chi-square, and partial eta-squared were computed.

RESULTS

SBS measurements presented higher values than TBS (p < 0.001-0.033). Within the pretreatment groups, CEN showed the highest SBS and TBS values compared to cleaning with ISO or BUT (p < 0.001-0.040). Pretreatment with GP0.1 displayed the lowest bond strength values (p < 0.001-0.049), and mostly adhesive fractures occurred. The highest Ra values (p < 0.001) were observed for AL0.4 pretreatment.

CONCLUSIONS

Pretreatment with AL0.4 and the control group mainly presented the highest bond strength values. Thermocycling had a positive effect on the bond strength.

CLINICAL RELEVANCE

According to this study, 3D-printed restorations should be pretreated with AL0.4 or with visio.link before adhesive luting, regardless of their cleaning.

Shear Bond Strength of a Direct Resin Composite to CAD-CAM Composite Blocks: Relative Contribution of Micromechanical and Chemical Block Surface Treatment

This study aims to compare the shear bond strength (SBS) of a direct resin composite to CAD-CAM resin composite blocks treated with different surface treatments: micromechanical, chemical or a combination of both. Eight CAD-CAM resin composite blocks, namely Brilliant Crios, Cerasmart 270, Vita Enamic, Grandio block, Katana Avencia, Lava Ultimate, Tetric CAD and Shofu Block HC were chosen. The micromechanical surface treatment protocols tested were hydrofluoric acid, polyacrylic acid or sandblasting, and the chemical one was a universal primer. These treated CAD-CAM blocks were tested to determine the SBS of a light-curing composite resin Z100 bonded to their surface. Two-way ANOVA followed by Tukey’s post hoc test was used to investigate the difference in SBS. Failures were analyzed by Fisher’s exact test. Bonding interfaces were examined by scanning electron microscopy. The micromechanical surface treatments give the highest SBS values: sandblasting appears to be the most efficient procedure for dispersed filler composite blocks, while hydrofluoric acid etching is preferable for polymer-infiltrated ceramic network (PICN) blocks. The use of universal primer does not improve SBS values on dispersed filler composite blocks. For PICN blocks, the use of universal primer significantly increases SBS values when combined with hydrofluoric acid etching.

Adhesion of Resin to Lithium Disilicate with Different Surface Treatments before and after Salivary Contamination—An In-Vitro Study

The salivary contamination occurring at the try-in procedures of lithium disilicate (LDS) can jeopardize their bond strength. Various laboratory reports have concluded that applying 37% phosphoric acid (H₃PO₄) could be considered as a predictable way of removing salivary contaminants. An experimental method that consists of sealing the intaglio of the ceramic restorations with a layer of cured adhesive could allow consequent time saving for dental practitioners. It is, besides, necessary to establish an optimal decontamination protocol. Hence, this study aimed to determine the most efficient surface treatment, before and after salivary contamination, by comparing the adhesion between resin and LDS. In order to do so, five groups of ten specimens (n = 10) each underwent the different types of surface treatments before bonding, followed by 2500 cycles in the thermocycler. A shear bond strength (SBS) test was then conducted on a universal testing machine (YLE GmbH Waldstraße Bad König, Germany), followed by a fracture-type analysis on an optical microscope (Olympus BX53, Shinjuku, Tokyo, Japan). Statistical analysis was set with a level of significance of α = 0.05. The surface treatment significantly affected the SBS results. The decontamination with HF (12.59 ± 2.71 MPa) and H₃PO₄ (13.11 ± 1.03 MPa) obtained the highest values, silanizing only before contamination obtained intermediate values (11.74 ± 3.49 MPa), and silanizing both before and after the salivary contamination (10.41 ± 2.75 MPa) along with applying a bonding agent before contamination (9.65 ± 1.99 MPa) resulted in the lowest values. In conclusion, H₃PO₄ proved to be efficient, thus, allowing the practitioner to avoid the clinical use of HF; it can, therefore, be considered as a valid alternative. Presilanization and resilanization of specimens, along with applying a bonding agent before contamination, did not yield satisfying results.

Effect of mold enclosure and chisel design on fatigue bond strength of dental adhesive systems

To examine the effect of mold enclosure and chisel design on macro shear fatigue bond strengths of dental adhesive systems. The fatigue bond strength testing was conducted with two commercially available dental adhesive systems, (1) OptiBond eXTRa and (2) Scotchbond Universal, for bonding a resin composite (Filtek Supreme Ultra) to both enamel and dentin using a mold enclosure and a non‐mold enclosure with a knife‐edge and two sized notched‐edge chisel assemblies for loading. As a loading reference for the fatigue testing, macro shear bond strengths of the adhesive systems to enamel and dentin were conducted using a mold enclosure and a knife‐edge chisel assembly. The shear bond strengths with the mold enclosure using knife‐edge chisel assembly did not exhibit a significant difference between the adhesive systems for either enamel or dentin. The fatigue bond strengths of bonded specimens demonstrated significant differences when comparing the mold enclosure and non‐mold enclosure, but not between knife‐edge and notched‐edge chisel assemblies. The fatigue bond strengths of dental adhesive systems demonstrated significantly higher values when using mold‐enclosed bonded specimens than a non‐mold enclosure, regardless of type of chisel assembly.

Adhesion to a Zirconia-reinforced Lithium Silicate Ceramic: Effects of Ceramic Surface Treatments and Resin Cements

OBJECTIVE

This study had the objective to test the effect of ceramic surface treatments on the microshear bond strength (μSBS) of different resin cements to a zirconia-reinforced lithium silicate (ZLS).

METHODS AND MATERIALS

ZLS blocks were sectioned, embedded in acrylic resin, and then allocated into nine groups considering two study factors: "ceramic surface treatment" (HF - hydrofluoric acid; EP - self-etching primer; TBS - tribochemical silica coating) and "resin cements" (nMDP - without MDP monomer; MDP - with MDP monomer; SA - self-adhesive). Starch tubes (n=36) were placed on the treated ceramic surface and the cement was applied. Starch tubes were removed after 24 hours of storage, and the specimens were thermocycled (5,000×; 5°C-55°C). Next, the μSBS test was performed using the wire-loop technique, and topographic and failure analyses were performed.

RESULTS

The factors "ceramic surface treatment" and "resin cement" statistically influenced the μSBS results. Considering the surface treatment factor, the TBS produced statistically lower values when the MDP resin cement was applied, being only similar to the MDP plus EP group. For the resin cement factor, no difference was found for nMDP and SA groups, apart from the surface treatments. Failure analysis showed that the groups treated with EP had a greater number of pre-test failures. The surface treatments induced noteworthy topographic alterations when compared to control (no treatment).

CONCLUSION

The ZLS ceramic surface treatment with tribochemical silica coating associated with the MDP-containing resin cement resulted in lower bond strength values.

Impact of different pretreatments and attachment materials on shear bond strength between monolithic zirconia restorations and metal brackets

To investigate the influence of different pretreatment methods, attachment materials and artificial aging on shear bond strength (SBS) between monolithic zirconia and metal brackets. Zirconia substrates were pretreated with silica coated alumina (CoJet) and (1) clearfill ceramic primer plus (CF), (2) RelyX ceramic primer (RXP), (3) Futurabond U (FU). The brackets were bonded with (1) Transbond XT Adhesive (TB), (2) BrackFix Adhesive (BF), (3) bracepaste adhesive (BP). SBS was tested after 24 h, 500 thermal cycles, 90 d at 37 °C with a universal testing machine. SBS values reached from 8.3 to 16.9 MPa. The Weibull moduli ranged between 0.37 (RXP combined with BP after 90 d) and 7.42 (CF combined with TB after 24 h). The pretreatment with FU after 90 d, independent of the attachment material, and RXP with BF resulted in the lowest SBS values 8.3–9.9 MPa, the combination of RXP or CF with TB showed the highest (13.2–16.9 MPa) independent of aging. After FU pretreatment the proportion of ARI 1 and 0 was higher, of ARI 3 lower as after CF and RXP pretreatment. All tested combinations showed sufficiently high SBS values for clinical use. Pretreatment with FU presented the lowest values after 90 days.

Physical-chemical characterization and bond strength to zirconia of dental adhesives with different monomer mixtures and photoinitiator systems light-activated with poly and monowave devices

Introduction: Bonding to crystalline zirconia is currently a challenge. Properly cured adhesives are crucial to optimize this bond, and that in turn is influenced by the initial mobility of the system, as well as by the reactivity of the initiators. Aim: This study aimed to characterize adhesives containing monomer mixtures of different viscosities and double and triple photoinitiator systems; and to evaluate the bonding to Y-TZP zirconia, when adhesives were light-activated with monowave or polywave light-curing units (LCU). Materials and methods: Adhesives were formulated at a 1:1 weight proportion of Bis-GMA/TEGDMA or Bis-GMA/Bis-EMA. To these mixtures 0.5 wt% of CQ, 0.5–1.0 wt% of DABE, 0.5–1.0 wt% of DPIHP, or 0.5–1.0 wt% of TAS-Sb were added and used as photoinitiator systems. A total of ten adhesives were prepared. Resin composite cylinders were cemented on zirconia slices and 6000 thermal cycles were performed. Degree of conversion (DC), sorption (SO) and solubility (SL) after 7 days of water storage, and microshear bond strength (µSBS) were evaluated. Data were analyzed with three-way ANOVA and Tukey’s HSD (α = 0.05). Results: Bis-GMA/Bis-EMA combined with either CQ/DABE or CQ/DABE/TAS-Sb presented the highest DC, and no significant differences were observed for LCUs (p = .298). CQ/DABE < CQ/DABE/TAS-Sb ≈ CQ/DABE/DPIHP and the polywave LCU showed smaller overall SO (p < .05). Bis-GMA/TEGDMA with CQ/DABE cured with the polywave LCU presented the lowest SO. SL varied as follows: CQ/DABE/TAS-Sb < CQ/DABE/DPIHP < CQ/DABE (p < .001). For µSBS, only the factor photoinitiator system was significant (p = .045). All mean values were above 30 MPa, with higher values being observed for BIS-GMA/TEGDMA and CQ/DABE. Conclusion: It can be concluded that the adhesive containing CQ/DABE/TAS-Sb as coinitiator of Bis-GMA/Bis-EMA mixtures produced a material with higher DC and lower SL, while bond strength values were similar to the ones obtained by CQ/DABE.

A critical analysis of research methods and experimental models to study root canal fillings

Canal filling materials and techniques have been one of the most studied topics in Endodontics. A simple search using the mesh term "root canal filling" in PubMed revealed more than 11,000 articles, an impressive number that is much higher than "root canal disinfection" (5,544 articles) or even the popular "root canal preparation" (8,527 articles). The overriding importance attributed to root filling procedures is not merely intuitive. It derived from the appealing relevance given by the appearance of the white lines in common radiographs grounded on retrospective clinical data that had identified the quality of a root filling as one of the major causes of treatment failure (lack of healing). Since the publication of the Washington study, impressive efforts have been made for the release of new materials and techniques, as well as, for the development of a plethora of laboratory methods to assess the quality of root filling procedures. This narrative review aims to address and discuss the most relevant laboratory methods to assess the root canal filling. Since filling quality improvements have not translated into higher success rates, as reported in longitudinal clinical studies, more than to deliver a simple methodology-based review, this paper aims to present an in-depth critical view on the assessment of laboratory methods used to study the filling materials and techniques. Recent data indicate that the long-term dimensional stability/degradation over time of endodontic sealers plays a central role in the treatment outcome. In this context, laboratory methods should be developed focusing on predicting, at least to some degree, the long-term clinical behaviour of root canal fillings, rather than simply ranking different materials or techniques.

Simulating the Intraoral Aging of Dental Bonding Agents: A Narrative Review

Despite their popularity, resin composite restorations fail earlier and at higher rates than comparable amalgam restorations. One of the reasons for these rates of failure are the properties of current dental bonding agents. Modern bonding agents are vulnerable to gradual chemical and mechanical degradation from a number of avenues such as daily use in chewing, catalytic hydrolysis facilitated by salivary or bacterial enzymes, and thermal fluctuations. These stressors have been found to work synergistically, all contributing to the deterioration and eventual failure of the hybrid layer. Due to the expense and difficulty in conducting in vivo experiments, in vitro protocols meant to accurately simulate the oral environment’s stressors are important in the development of bonding agents and materials that are more resistant to these processes of degradation. This narrative review serves to summarize the currently employed methods of aging dental materials and critically appraise them in the context of our knowledge of the oral environment’s parameters.

Riboflavin and Its Effect on Dentin Bond Strength: Considerations for Clinical Applicability-An In Vitro Study

Bioactive collagen crosslinkers propose to render the dentin hybrid layer less perceptive to hydrolytic challenge. This study aims to evaluate whether bond strength of dental resin composite to dentin benefits from riboflavin (RB)-sensitized crosslinking when used in a clinically applicable protocol. A total of 300 human dentin specimens were prepared consistent with the requirements for a macro-shear bond test. RB was applied on dentin, either incorporated in the primer (RBp) of a two-step self-etch adhesive or as an aqueous solution (RBs) before applying the adhesive, and blue light from a commercial polymerization device was used for RB photoactivation. Bonding protocol executed according to the manufacturer’s information served as control. Groups (n = 20) were tested after 1 week, 1 month, 3 months, 6 months or 1 year immersion times (37 °C, distilled water). The different application methods of RB significantly influenced bond strength (p < 0.001) with a medium impact (η²_p = 0.119). After 1 year immersion, post hoc analysis identified a significant advantage for RB groups compared to RBp (p = 0.018), which is attributed to a pH-/solvent-dependent efficiency of RB-sensitized crosslinking, stressing the importance of formulation adjustments. We developed an application protocol for RB-sensitized crosslinking with emphasis on clinical applicability to test its performance against a gold-standard adhesive, and are confident that, with a few adjustments to the application solution, RB-sensitized crosslinking can improve the longevity of adhesive restorations in clinics.

Effect of Argon Plasma Surface Treatment on Repair of Resin Composite Aged Two Years

OBJECTIVES

To evaluate the effect of argon plasma treatment (PLA) when combined with sandblasting (SAN), silanization (SIL), and hydrophobic bonding resin (HBR) on the shear bond strength (SBS) of a two-year water-aged resin composite bonded to a newly placed composite after 24 hours and one year of water-storage.

METHODS AND MATERIALS

Thirty-six light-cured composite plates (20mm x 20mm x 4mm thick) were obtained and stored at 37°C in distilled water for 2 years. These aged plates were distributed into 6 groups (n=6) according to the surface treatment: no treatment (Negative Control); SAN+SIL+HBR (Positive Control); SAN+PLA+SIL+HBR; PLA+ SIL+HBR; PLA+SIL; PLA+HBR. Fresh resin composite cylinders were built up using silicone molds (hole: 1.5 mm high x 1.5 mm diameter) positioned over the aged plates. Half of the SBS samples were stored in distilled water for 24 hours and loaded until failure, while the other half were stored for 1 year before being tested. Data were submitted to two-way analysis of variance and post-hoc Tukey Test (preset alpha of 0.05).

RESULTS

Positive Control, SAN+PLA+SIL+HBR and PLA+SIL+HBR groups presented higher SBS means at the 24 hour evaluation. After 1 year of water storage, all groups demonstrated significant SBS reduction, with the SAN+PLA+SIL+HBR group presenting the highest SBS.

CONCLUSIONS

Resin plasma treatment in combination with other surface treatments can improve the SBS of composite repairs after one year of water storage. The SBS of the composite repair was not stable over time regardless of the surface treatment.

Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength

The aim of this in vitro study was to assess the effect of two different adhesive application methods on shear dentin bond strength (ISO 29022) using three various adhesive systems. A mid-coronal section of 77 intact third human molars with fully developed apices was made to create flat bonding substrates. The materials used in the study were Excite F (Ivoclar Vivadent), Prime&Bond Universal (Dentsply Sirona) and G-Premio Bond (GC). The application of each adhesion system was performed in two different ways. In the first group, the bonding agent was light cured immediately after the application (conventional method), while in the second group the adhesive and composite were cured concurrently (“co-curing” method). A total of 180 specimens were prepared (3 adhesives × 2 method of application × 30 specimens per experimental group), stored at 37 °C in distilled water and fractured in shear mode after 1 week. Statistical analysis was performed using ANOVA and Weibull statistics. The highest bond strength was obtained for Prime&Bond conventional (21.7 MPa), whilst the lowest bond strength was observed when co-curing was used (particularly, Excite F 12.2 MPa). The results showed a significant difference between conventional and co-curing methods in all materials. According to reliability analysis, the co-curing method diminished bond reliability. Different application techniques exhibit different bond strengths to dentin.

Is the bond strength of zirconia-reinforced lithium silicate lower than that of lithium disilicate? A systematic review and metaanalysis

PURPOSE

This study systematically reviewed the literature to compare the bond strength of resin composites with that of zirconia-reinforced lithium silicate (ZLS) and lithium disilicate (LD).

STUDY SELECTION

This review was structured based on the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA 2020) statement. This study was registered at the International Prospective Register of Systematic Reviews (CRD42021256900). Studies were searched via PubMed, Web of Science, and Google Scholar databases without language or publication year limits. In vitro studies that evaluated the bond strength of the resin composites to ZLS and LD were included. The risk of bias in all the included articles was evaluated. Statistical analyses were performed using the Review Manager software (version 5.3, Cochrane Collaboration, Oxford, UK).

RESULTS

Of the 90 potentially related articles, the full texts of 16 articles were evaluated after screening. Finally, sevenstudies were included in the qualitative synthesis and meta-analysis. All the studies presented a medium risk of bias. The results showed no significant difference in bond strength between the ZLS and LD groups (P = 0.94, mean difference=0.08, and 95% confidence interval=-1.93 to 2.10). However, a significant difference was found in the subgroup analysis considering different types of aging treatments (P = 0.0008) and different types of bond strength tests (P < 0.00001).

CONCLUSION

The bond strength of resin composites was found to be similar to that of ZLS and LD, but different aging treatments and bond strength tests exhibited varying effects on the bond strength.

Micro versus Macro Shear Bond Strength Testing of Dentin-Composite Interface Using Chisel and Wireloop Loading Techniques

Shear bond strength (SBS) testing is a commonly used method for evaluating different dental adhesive systems. Failure mode analysis provides valuable information for better interpretation of bond strength results. The aim of this study was to evaluate the influence of specimen dimension and loading technique on shear bond strength and failure mode results. Eighty macro and micro flowable composite cylindrical specimens of 1.8 and 0.8 mm diameter, respectively, and 1.5 mm length were bonded to dentinal substrate. Four study groups were created (n = 20): Macroshear wireloop, Gp1; Microshear wireloop, Gp2; Macroshear chisel, Gp3; and Microshear chisel, Gp4. They were tested for SBS using chisel and wireloop loading devices followed by failure mode analysis using digital microscopy and SEM. Two- and one-way ANOVA were used to compare stress at failure values of different groups while the Kruskal–Wallis test was used to compare between failure modes of the tested groups. Gp4 recorded the highest mean stress at failure 54.1 ± 14.1 MPa, and the highest percentage of adhesive failure in relation to the other groups. Specimen dimension and loading technique are important parameters influencing the results of shear bond strength. Micro-sized specimens and chisel loading are recommended for shear testing.

Effects of application method on shrinkage vectors and volumetric shrinkage of bulk-fill composites in class-II restorations

OBJECTIVES

Upon initial proximal wall construction, the favorable C-factor of class-II cavities may become unfavorable. This study investigated the application method on bulk-fill resin composite polymerization shrinkage.

METHODS

Occluso-proximal class-II cavities were prepared in 40 molars and bonded with a self-etch adhesive (Adhese Universal). The study groups varied according to the resin composite application: group-1: bulk application, Tetric EvoCeram Bulk Fill (TBF); group-2: proximal wall construction (TBF) and occlusal cavity filling (TBF); group-3: thin flowable liner layer, Tetric EvoFlow Bulk Fill (TEF) and bulk filling (TBF); group-4: flowable liner (TEF), proximal wall (TBF), occlusal cavity (TBF); and group-5: bulk application, SDR (3 mm) and capping layer (TBF, 1 mm). Each resin composite increment was scanned twice using micro-CT (uncured, cured 40 s) at a resolution of 16 µm. Shrinkage vectors and volumetric polymerization shrinkage were evaluated and statistically analyzed (one-way ANOVA). SEM images were used to investigate the tooth-restoration interface.

RESULTS

Shrinkage vectors differed significantly among the groups and were greatest in gp5-fl/SDR (47.6 µm), followed by gp1-TBF (23.8 µm) and least in gp5-fl/SDR+TBF (11.1 µm). Volumetric shrinkage varied significantly with the use of SDR (gp5-fl/SDR: 2.6%) and TEF (gp4-fl/TEF: 2.5%) to TBF (gp4-fl/TEF+wl/TBF: 0.6%) in the incremental application.

SIGNIFICANCE

Building a proximal resin composite wall yielded smaller shrinkage vectors than the bulk application. Applying a thin flowable liner decreased the shrinkage vectors, even more when building a proximal wall. A thin flowable liner is recommended when building a proximal resin composite wall.

Effect of surface treatments and flash-free adhesive on the shear bond strength of ceramic orthodontic brackets to CAD/CAM provisional materials

OBJECTIVES

To evaluate the effect of surface treatments and flash-free adhesive on the shear bond strength of ceramic orthodontic brackets bonded to materials used for the fabrication of CAD/CAM provisional crowns.

MATERIALS AND METHODS

Specimens (n = 160) from each provisional material (CAD-Temp and C-Temp) were categorized into four groups according to the surface treatment methods: C (no surface treatment), HP (37% H₃PO₄), DB (mechanical roughening by diamond bur), and SB (mechanical roughening by blasting). Maxillary central incisor ceramic brackets (Clarity™ Advanced ceramic brackets, 3 M Unitek) were bonded to the conditioned provisional materials according to the used adhesive system (n = 20), APC PLUS or APC flash-free. All specimens were evaluated for shear bond strength testing (SBS) and the adhesive remnant index (ARI). Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

C-Temp significantly recorded higher SBS than CAD-Temp (24.0 and 16.0 MPa, respectively) (p < 0.001). DB and SB groups utilizing flash-free adhesive significantly recorded higher SBS (18.2 and 24.0 MPa, respectively) (P < 0.05) compared to other groups in the tested materials. Higher ARI scores were recorded in CAD-Temp and flash-free adhesive.

CONCLUSIONS

Mechanical surface treatments and flash-free adhesive would enhance SBS of ceramic orthodontic brackets to CAD/CAM provisional materials. The higher ARI scores reported with CAD-Temp and flash-free adhesive reduce chair time for excess removal.

CLINICAL RELEVANCE

Bonding of orthodontic brackets to provisional restorations is a challenge for orthodontists in adult comprehensive cases that could be improved by an appropriate provisional material, surface treatments, and adhesive system.

The effect of bacterial cellulose nanocrystals on the shear bond strength of resin modified glass ionomer cement to dentin

Background

The present study aimed to investigate the effect of bacterial cellulose nanocrystals (BCNC) on the shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC) to dentin.

Material and Methods

A total of 48 freshly extracted intact third molars were randomly divided into four main groups with three different concentrations (0.3%, 0.5% and 1% wt) of BCNC with RMGIC and control group without BCNC. These specimens were kept in distilled water at 37° C for 24h. Shear bond strength was examined, using the universal testing machine. Kruskal-Wallis test and Dunn`s post-hoc test were applied for analysis of data. P<0.05 was considered as the level of significance.

Results

The addition of a 1%wt of BCNC to the RMGIC led to a significant increase in the shear bond strength (7.17 ± 2.14) compared to the control group (2.09 ± 1.80) (P=0.007). The shear bond strength was improved up to 343%.

Conclusions

It was found that the incorporation of 1% wt BCNC to the RMGICs enhanced the SBS properties of the RMGIC significantly. Modifying RMGIC with BCNC might be advantageous in terms of improving the restorative material. Key words:Bacterial cellulose nanocrystals, RMGIC, Shear bond strength.

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.

Curvature-dependent shear bond strength of different attachment materials for orthodontic lingual indirect bonding

To evaluate the shear bond strength (SBS) of different attachment materials used for lingual bonding, the influence of artificial aging and the radii of curvature of the enamel surface on SBS, 192 third molars were photographed to determine the radius of curvature of the oral surface. After phosphoric acid etching a cylindrical test piece was bonded to the oral enamel using a mold that was filled with a chemically curing (Maximum Cure, Transbond IDB Premix) or a dual-curing (Nexus NX3, RelyX Unicem2) attachment material. SBS was tested after 24 h, 500 thermal cycles or 90 days at 37 °C with a universal testing machine. Computed tomography scans were performed to determine the bonded surface and calculate SBS. Values ranged from 8.3 to 20.9 MPa. RelyX Unicem2 showed the highest SBS values at baseline, 500 thermal cycles and after 90 days (p < 0.001). Ninety days of wet storage significantly reduced SBS of Maximum Cure (p = 0.028). The radius of curvature correlated positively with SBS (r_s = 0.204, p = 0.005). The SBS of all attachment materials was sufficient for clinical use, even after artificial aging. RelyX Unicem2 showed almost twice as high SBS values as the other attachment materials.

Adhesion of veneering porcelain to cobalt-chromium dental alloys processed with casting, milling, and additive manufacturing methods: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Selective laser melting (SLM) additive manufacturing (AM) technologies provide an alternative to conventional casting and milling procedures in fabricating metal-ceramic dental prostheses. However, the quality of porcelain bond strength to the SLM AM cobalt-chromium (Co-Cr) metal framework of a dental restoration is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to identify in vitro studies that reported the porcelain bond strength to SLM AM Co-Cr dental metal alloys and compare the porcelain bond strength values to cast, milled, and additively manufactured Co-Cr dental alloys.

MATERIAL AND METHODS

An electronic systematic review was performed in different databases: MEDLINE/PubMed, EMBASE, World of Science, Cochrane, and Scopus. A manual search was also conducted. Studies that reported the porcelain bond strength to SLM Co-Cr metal alloys and in the English language were included. Two investigators evaluated the quality assessment of the studies by applying the JBI critical appraisal checklist for quasi-experimental studies (nonrandomized experimental studies). A third investigator was consulted to resolve lack of consensus. Two subgroups were created based on the test used, 3-point bend and shear bond strength tests. The porcelain bond strength of cast, milled, and AM Co-Cr dental alloys were compared. The I2 statistic and its associated P value were used to assess the heterogeneity between studies. The Eger test was used for determining significance of the funnel pots.

RESULTS

A total of 216 studies were collected from the electronic and manual searches. After independently evaluating the titles and abstracts by the reviewers, 26 articles were identified. Three of these were excluded after full-text revision. The porcelain bond strength comparison between the cast and AM alloys for the 3-point bend subgroup revealed a significant result for overall effect (P<.001) favoring the SLM method with considerable heterogeneity (I2=83%, P<.001). Furthermore, the porcelain bond strength comparison between cast and milled alloys for the shear bond strength subgroup revealed a significant test for overall effect (P=.04) favoring milled procedures with a nonsignificant unimportant heterogeneity (I2= 0%, P<.47) and for the 3-point bend subgroup (P<.001) favoring milled specimens with a significant considerable heterogeneity (I2=79%, P<.001).

CONCLUSIONS

The metal manufacturing method had no effect on the porcelain bond strength to Co-Cr dental metal alloys.

Influence of reduced application time on bonding durability of universal adhesives to demineralized enamel

OBJECTIVES

This study aimed to assess the effect of application time on the microshear bond strength (μSBS) of three universal adhesives in demineralized and sound enamel before and after aging.

MATERIALS AND METHODS

Bovine teeth (192) were prepared where buccal surfaces were ground and divided into two groups (sound enamel and demineralized enamel). The specimens in each group were divided into 12 subgroups by combining 3 adhesive agents (All-Bond Universal, Scotchbond Universal, and Tokuyama Universal Bond) × 4 adhesion strategy. Each adhesive was applied with either prolonged (PA) or reduced (RA) application time in etch-and-rinse or self-etch mode. Bonded composites were subjected to μSBS testing after 24-h or 2-year water storage. The results were evaluated using four-way ANOVA and Tukey's post-hoc test (α = 0.05).

RESULTS

The μSBS of adhesives to sound enamel in both etching modes was mostly similar to demineralized enamel, regardless of application time and aging time. At 24-h, all adhesives with PA in self-etch mode showed higher μSBS when compared with RA, except Tokuyama Universal Bond, but after 2-year aging, no significant difference was found in μSBS between RA and PA. The μSBS of adhesives with PA in etch-and-rinse mode depended on used adhesive and enamel condition compared to RA, regardless of μSBS testing time.

CONCLUSIONS

PA of adhesives did not reveal a significant difference in μSBS to enamel, regardless of substrate type and etching mode.

CLINICAL RELEVANCE

After 2-year aging, the bond strength of universal adhesives presented no significant difference between PA and RA treatments.

Performance of a Universal Bonding System Associated With 2% Digluconate Chlorhexidine in Carious and Eroded Dentin

CLINICAL RELEVANCE

Carious and eroded dentin represent clinical challenges. The use of a universal bonding system, in a self-etching mode, associated with chlorhexidine (CHX) seems to not improve its longevity. This may be attributed to the competition for calcium between the bonding agent functional monomer and CHX.

SUMMARY

Adhesion between zirconia and resin cement: A critical evaluation of testing methodologies

This study aimed to analyze different methodologies (tensile, microtensile, shear, microshear, and interfacial toughness) for evaluation of the bond strength between zirconia (Y-TZP) and resin cement. Zirconia ceramic blocks (VITA in-Ceram® YZ, VITA Zahnfabrik, Germany) were obtained, substrate surfaces were air-abraded with aluminum oxide (50 μm) for 10 s (2 bar pressure, distance: 10 mm, angle: 90°). Then, the specimens were washed with distilled water, dried, and coated with Clearfil Ceramic Primer that was actively applied with a microbrush for 20 s. The specimens were then cemented with resin cement under a load of 750 g, followed by photo-polymerization (40 s on each surface). After cementation, the specimens were aged in thermocycling (8000 cycles, 5-55 °C, 30 s for each bath) and subjected to tensile, microtensile, shear, microshear or interfacial toughness tests. All specimens were inspected for failure modes. The microtensile test showed the highest bond value (18.29 N/mm²). The microshear tests showed the highest coefficient of variation (0.59) and highest number of pre-test failures. The interfacial energy to fracture test showed that as the shear stress increased its interaction in the adhesive interface, the coefficient of variation also increased. The bond strength of Y-TZP showed different results according to the methodology, as well as its interfacial energy to fracture varied according to the angulation/type of stress specimen was submitted. The lower the shear stress at the adhesive interface of the mixed tests (interfacial energy to fracture), the lower was the variability of the test.

The Influence of Blade Type and Feeding Force during Resin Bonded Dentin Specimen Preparation on the Microtensile Bond Strength Test

This paper presents the effect of blade type and feeding force during resin-bonded dentin specimen preparation on the microtensile bond strength (μTBS) test. Forty resin-bonded flat middle dentin specimens were divided into four groups. The specimens of each group were sectioned according to type of blade and feeding force as follows: fine grit/20 N, fine grit/40 N, medium grit/20 N, and medium grit/40 N to obtain resin-dentin sticks with a cross-sectional area of 1.0 mm². Four sticks from the center of each tooth were subjected to the μTBS test. Five remaining sticks of each group were selected for surface topography observation under a scanning electron microscope (SEM). As a result, the bond strength of the medium-grit group was higher than that of the fine-grit group (p < 0.001), whereas the feeding force had no influence on bond strength values (p = 0.648). From the SEM, sticks prepared with the fine-grit blade showed a smoother surface integrity and fewer defects on the specimen edges in comparison with the sticks prepared with the medium-grit blade. The grit type of the blade is one of the considerable factors that may affect the bond strength and the surface integrity of resin-dentin specimens for microtensile testing.

Effect of Cathodic Arc Plasma Deposition on Shear Bond Strength between Palladium Cobalt Chromium Coated with Titanium Nitride and Titanium Aluminium Nitride with Ceramic

Background:

The success of esthetic ceramo-metal restoration is strongly influenced by its bond strength. The success of ceramo-metal restoration is subjective to its bond strength.

Aim and Objectives:

The aim of this study is to evaluate the shear bond strength between palladium-based cobalt chromium (Co-Cr) alloy coated with titanium nitride (TiNi) and titanium aluminum nitride with feldspathic ceramics.

Materials and Methods:

According to the International Organization for standardization 9693; technical report 1,140,640 samples were prepared using Palladium-based Co-Cr alloy with ×4 vertical projection resting on 5 mm diameter base. The samples were divided into Group: A (control), Group: B (Sandblasted), Group: C (TiNi coated), and Group: D (titanium aluminum nitride coated by cathodic arc plasma deposition, following which feldspathic ceramic application was performed. Shear bond test was performed using universal testing machine and surface analysis was performed using scanning electron microscope.

Results:

The mean shear bond strength for Group A was 172.994 ± 3.739 N, Group B 209.485 ± 5.913 N, Group C 176.536 ± 4.780 N, and Group D 260.576 ± 16.351 N. Comparison within the groups was made using one-way ANOVA, and multiple group comparisons were made using Tukey's honestly significant difference Post hoc test where the P < 0.001was considered statistically significant.

Conclusion:

Palladium based Co-Cr alloy coated with titanium aluminum nitride by cathodic plasma arc deposition showed maximum shear bond strength with feldspathic ceramic compared to noncoated, sandblasted, and TiNi coated alloy.

Effect of Different Application Techniques of Universal Bonding System on Microtensile Bond Strength of Bulk-Fill Composites to Primary and Permanent Dentin

Objectives

This study aimed to determine the microtensile bond strength (μTBS) of a bulk-fill composite to permanent and primary coronal dentin using a universal adhesive in self-etch and total-etch modes.

Materials and Methods

This in-vitro study was performed on 52 occlusal dentinal surfaces of human primary and permanent teeth. The crowns were cut to the gingival level. The 48 prepared dentin sections were randomly assigned to the following groups (n=13): A: Primary/Total-etch, B: Primary/Self-etch, C: Permanent/Total-etch, and D: Permanent/Self-etch. In groups A and C, after etching for 15 seconds, two layers of a universal bonding (Futurabond U) were applied and cured for 10 seconds. All samples were filled with a bulk-fill composite (x-trafil; VOCO) and cured for 40 seconds. The samples were cut to a bar-shaped dentin block with the dimensions of 1×1×1 mm³, and after 10,000 thermocycles, the μTBS test was accomplished at a crosshead speed of 1 mm/minute. The mean and standard deviation (SD) of μTBS were calculated, and the data were analyzed using two-way analysis of variance (ANOVA) and Fisher's exact test.

Results

The mean μTBS was as follows: A: 15.03±2.0279, B: 11.11±2.4423, C: 23.50±4.8165, and D: 16.26±6.3200 MPa. Futurabond U showed a higher μTBS in the total-etch mode (P<0.001). The permanent teeth had greater μTBS than the primary teeth (P<0.001). Similar percentages of failure modes were observed in the total-etch groups but in the self-etch groups, most failures were in the form of adhesive and mixed.

Conclusion

Greater μTBS was observed in the permanent teeth with the total-etch technique.

Physicochemical properties, bond strength and dual-species biofilm inhibition effect of dental resin composites with branched silicone methacrylate

Dental resin composites (DRCs) with 15 wt% (EC-15%) and 20 wt% (EC-20%) synthesized branched silicone methacrylate (BSM) in resin matrix have showed anti-adhesion effect against Streptococcus mutans. With the aim to evaluate the BSM containing DRCs further, water sorption (WS), solubility (SL), mechanical properties before and after water immersion, anti-adhesion effect against dual-species, bonding strength to adhesive treated dentin, and cytotoxicity of BSM containing DRCs were investigated. DRC without BSM was used as control. The WS and SL were obtained until the mass variation of composite in distilled water kept stable. Three-point bending test was used to evaluate flexural strength (FS) and modulus (FM) of composite before and after water immersion. Mixture of Streptococcus mutans and Lactobacillus acidophilus was used to study the anti-adhesion effect against dual-species. Bonding strength of composite to adhesive treated dentin was measured through macro-shear test. Extract of composite was used to evaluate its cytotoxicity effect on L-929 mouse fibroblasts, and cell viability was obtained by MTT assay. The results showed that EC-15% and EC-20% had similar WS and SL as control (p < 0.05); After water immersion, FS and FM of all composites decreased (p < 0.05), but there was no significant difference in value of FS and FM between different groups (p > 0.05); More bacteria were recovered from the surface of control than those from the surface of EC-15% and EC-20% (p < 0.05); Extract of EC-15% was less cytotoxic (higher cell viability) than those EC-20% and control (p < 0.05). All of results revealed that incorporation of 15 wt% or 20 wt% BSM in resin matrix could endow DRC with inhibition effect on dual-species biofilm formation without impairing physiochemical properties, bonding strength to adhesive treated dentin, and cytotoxicity of DRC.