To etch or not to etch, Part I: On the fatigue strength and dentin bonding performance of universal adhesives

To etch or not to etch, Part III: On the hydrophobic-rich content and fatigue strength of universal adhesives after long-term ageing

OBJECTIVES

To examine whether dentin-etching extension and/or the hydrophobic-rich content of hybrid layers would affect fatigue strengths of a mild universal adhesive after long-term aging.

METHODS

Twin-bonded resin-dentin interfaces were produced by etching sound midcoronal dentin beams with 32 % ortho-phosphoric acid for 15 s (OPA15s), 3 s (OPA3s) or 10 % meta-phosphoric acid for 15 s (MPA15s). Samples were bonded with a mild universal adhesive with or without additional coating using a solvent-free bisGMA-based bonding resin. Self-etch application served as control. Composite buildups were made with a nanofilled composite. Bar-shaped twin-bonded interfaces (0.9 × 0.9 × 12 mm) were aged for two years in artificial saliva at 37 ℃ and tested under 4-point flexure at quasi-static (n = 16) and cyclic loads (n = 35) until failure. The stress-life fatigue behavior was evaluated using the staircase method at 4 Hz. Crack initiation and fracture patterns were evaluated by SEM. Cyclic-loaded data was analyzed by Kruskal-Wallis on Ranks (α = 0.05).

RESULTS

Significantly higher fatigue life distributions and higher endurance limits were observed for less aggressive etch-and-rinse protocols (OPA3s and MPA15s) after long-term ageing. Hydrophobic-rich coating produced 20-32 % higher endurance limits, prevented micrometer-sized porosities at bonded interfaces, reduced etching-associated variability and lowered crack formation. Significance Long-term hydrolysis produces detrimental effects on the fatigue strength of resin-dentin interfaces. The bond-promotion effect of less aggressive etch-and-rinse protocols and the creation of hybrid layers with higher hydrophobic-rich content are critical to extend the durability of mild universal adhesives. Therefore, current oversimplification trends in adhesive dentistry may limit resin-dentin bonding performance.

Effect of etchant containing an Urushiol monomer from lacquer sap on dentin biostability and bonding performance

Objectives: This study aimed to evaluate the effectiveness of urushiol as an additive to surface acid etchant on dentin structure, by assessing the biostability of dentin, and determine the bonding strengths of dentin and enamel to the composite in the complicated oral microecology. Methods: Etchants with different concentrations of urushiol (0.5, 1, or 3 wt%) were formulated and tested for their bonding performance. Demineralized dentin beams that were etched with experimental etchants were incubated in simulated body fluid solutions by evaluating the weight decrement after 1 month. The effects of urushiol on dentin and matrix metalloproteinases were confirmed by scanning electron microscopy (SEM). Moreover, the antibiotic actions of urushiol on the common cariogenic bacteria Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii as well as the biofilm were evaluated, and its effect on bacterial morphology was observed by scanning electron microscopy. Finally, enamel and dentin specimens were prepared from human molars to determine the depth of demineralization by the etchants and the relationship with the resin bond strengths to enamel and dentin (μTBS) and the morphology of the bonding interface. Results: Urushiol could interact with dentine and inhibit collagenase activity, resulting in biostable dentine. The application of the etchants containing 0.5, 1, or 3 wt% urushiol significantly improved the durability of the dentin bonding interface with its instinctive antibacterial property (p < 0.05). Conclusion: Urushiol not only improves dentin stability by interacting with collagen and inactivating MMP activity but also plays a role in the antibacterial effects in the complicated oral microecology. The effectiveness of urushiol etchant prolongs the longevity of bonded dental restorations without compromising clinical operation time.

Effect of matrix metalloproteinase inhibitors on bonding durability of universal adhesives

This study aimed to evaluate the effect of different matrix metalloproteinase inhibitors (MMPIs) on the microtensile bond strength (μTBS) and nanoleakage of universal adhesives. One hundred twenty non-carious human molars were prepared and randomly assigned to two groups: Scotchbond Bond Universal (SBU) and Gluma Bond Universal (GBU). The samples in each group were assigned to five subgroups (n=12) based on one control (water) and four MMPIs (Benzalkonium-chloride (BAC), Batimastat (BB94), Chlorhexidine (CHX), and Epigallocatechin-gallate (EGCG)). Each adhesive was applied in self-etch (SE) mode or etch-and-rinse (ER) mode. Dentin/composite sticks were fabricated and subjected to the μTBS test after 24 h or 6 months. At 6 months, MMPIs did not affect the μTBS of the adhesives, regardless of etching mode. Nanoleakage was more pronounced in ER mode than in SE mode for all subgroups. All MMPIs, with the exception of CHX, decreased the nanoleakage of GBU in ER mode.

Effect of Thermocycling on the Bond Strength of Self-Adhesive Resin Cements Used for Luting CAD/CAM Ceramics to Human Dentin

The aim of the study was to evaluate the influence of thermocycling on the shear bond strength of self-adhesive, self-etching resin cements luted to human dentin and computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics. Three modern self-adhesive dental cements (Maxcem Elite, RelyX U200, Panavia SA) were used to lute three CAD/CAM ceramics (IPS Empress CAD, IPS e.max CAD, IPS e.max ZirCAD) onto the dentin. One conventional cement (Panavia V5) served as a control. After preparation, the samples were subjected to thermocycling as a method of artificial aging of dental materials applied to simulate long-term use in oral conditions. Shear bond strength was evaluated according to PN-EN ISO 29022:2013-10 and failure modes were observed under a light microscope. Statistical analysis was performed. The study demonstrated that a combination of ceramics and cements directly impacts the bond strength. The highest bond strength was observed in Panavia V5, lower in Panavia SA and Maxcem Elite and the lowest–in RelyX U200. Adhesive failure between human dentin and cements was the most common failure mode. Moreover, thermocycling highly decreased bond strength of self-adhesive, self-etching cements.

Composite repair: On the fatigue strength of universal adhesives

OBJECTIVES

To determine whether the composition of universal adhesives and the use of silane coupling agents could affect the fatigue strength of composite repair.

METHODS

Composite samples were aged in water at 37 °C for 90 days and bonded to fresh composite to produce twin-bonded bar-shaped composite specimens (2 × 2 × 12 mm). Five universal adhesives, a multistep composite repair system and a hydrophobic solvent-free resin associated to a separate silane coupling agent application were used for bonding. Composite samples were tested under 4-pointflexure initially at quasi-static loading (n = 12) followed by cyclic loading (n = 25). The stress-life fatigue behavior was evaluated following the staircase method at 4 Hz. The unfractured side of cyclic loaded beams were evaluated under SEM to determine crack initiation sites. Fatigue data was analyzed by ANOVA and Tukey test and Wilcoxon Rank Sum Test (α = 0.05).

RESULTS

Bonding protocols were unable to restore the cohesive strength of the nanofilled composite (p < 0.05). Fatigue testing was more discriminative to reveal discrepancies in composite repair than conventional quasi-static loading. While the composition of universal adhesives affected composite repair potential, the highest endurance limits occurred for the separate silane coupling agent application. Crack propagation sites were mostly located on the aged composite surface.

SIGNIFICANCE

Although a trend for simplification invariably overruns current adhesive dentistry, composite repair using solely universal adhesives may result in inferior repair potential. The additonal use of silane coupling agents remains as an important procedure in composite repairs.