Biomodification to dentin by a natural crosslinker improved the resin-dentin bonds

Particle abrasion as a pre-bonding dentin surface treatment: A scoping review

OBJECTIVE

This scoping review aims to assess the influence of air abrasion with aluminum oxide and bioactive glass on dentin bond strength.

MATERIALS AND METHODS

An electronic search was conducted in three databases (PubMed, Cochrane Library, and Embase), on March 3rd, 2023, with previously identified MeSH Terms. A total of 1023 records were screened. Exclusion criteria include primary teeth, air abrasion of a substrate other than sound dentin, use of particles apart from aluminum oxide or bioactive glass, and studies in which bond strength was not assessed.

RESULTS

Out of the 1023 records, title and abstract screening resulted in the exclusion of 895 and 67 studies, respectively, while full-text analysis excluded another 25 articles. In addition, 5 records were not included, as full texts could not be obtained after requesting the authors. Two cross-references were added. Thus, 33 studies were included in this review. It is important to emphasize the absence of standardization of air abrasion parameters. According to 63.6% of the studies, air abrasion does not influence dentin bond strength. Moreover, 30.3% suggest improving bonding performance, and 6.1% advocate a decrease.

CONCLUSIONS

Air abrasion with aluminum oxide does not enhance or impair dentin bond strength. The available data on bioactive glass are limited, which hinders conclusive insights.

CLINICAL SIGNIFICANCE

Dentin air abrasion is a widely applied technique nowadays, with numerous clinical applications. Despite the widespread adoption of this procedure, its potential impact on bonding performance requires a thorough analysis of the existing literature.

Pomegranate extract on eroded dentin: antioxidant action, bond strength and morphology of the adhesive interface after aging

Objectives

This study aimed to evaluate the effect of pomegranate solution (Punica granatum) on eroded dentin through antioxidant action, shear bond strength (SBS) and interface morphology.

Materials and Methods

The 10% pomegranate peel extract was prepared by the lyophilization method. Punicalagin polyphenol was confirmed by high-performance liquid chromatography. Antioxidant activity was evaluated by capturing the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical. For the SBS, 48 dentin fragments were divided into sound or eroded, and subdivided according to the pretreatment (n = 12): water or P. granatum. The surfaces were restored with self-etch adhesive and a bulk-fill resin (Ecosite; DMG). The SBS was done immediately (24 hours) and after thermal cycling + water storage (12 months). For scanning electron microscopy, 48 dentin fragments (24 sound and 24 eroded) received the same treatments as for SBS (n = 6), and they were analyzed after 24 hours and 12 months.

Results

The P. granatum had antioxidant action similar (p = 0.246) to the phenolic standard antioxidants. After 24 hours, eroded dentin had lower SBS than sound dentin (p < 0.001), regardless of the pretreatment. After 12 months, P. granatum maintained the SBS of sound dentin (13.46 ± 3.42 MPa) and eroded dentin (10.96 ± 1.90 MPa) statistically similar. The lowest values were found on eroded dentin treated with water (5.75 ± 1.65 MPa) (p < 0.001). P. granatum on eroded dentin caused peritubular demineralization and hybrid layer with resin tags.

Conclusions

The pomegranate extract had antioxidant action and preserved the adhesive interface of the eroded dentin.

Clinical Assessment of Moringa oleifera as a Natural Crosslinker for Enhanced Dentin Bond Durability: A Randomized Controlled Trial

BACKGROUND

Dentin biomodification is a biomimetic approach that strengthens the collagen network, making it less susceptible to enzymatic degradation and improving the durability of bonded restorative materials, using collagen crosslinkers.

OBJECTIVE

This study aimed to assess the effectiveness of Moringa oleifera as a natural crosslinker in improving the clinical success of resin-dentin restorations.

METHOD

A double-blind, controlled, randomized clinical trial was conducted in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines, with 50 adult participants with initial carious lesions (ICDAS 4 and 5) enrolled. Participants were randomly assigned to either the experimental group (which received Moringa oleifera as a pretreatment liner) or the control group (standard restorative procedures without a liner). Functional and biological outcomes were assessed at baseline, six months, and 12 months using the FDI criteria. Statistical analysis included Fisher's exact test, Wilcoxon sign rank test, and Mann-Whitney U test.

RESULTS

Both groups exhibited excellent functional properties and marginal adaptation at baseline and six months. At the 12-month mark, the test group displayed clinically better functional properties (97.9%, n=47) compared to the control group (95.8%, n=46), but there was no significant difference (p-value>0.05). Marginal gaps were observed in both groups at six and 12 months (8.3%, n=4), with no significant inter-group variation (p-value>0.05). Radiographic examination showed a harmonious restoration-to-tooth transition. Patient satisfaction remained high, with the test group 4.2% (n=2) and control 2.1% (n=1) reporting minor issues at 12 months, though not statistically significant (p-value>0.05). Postoperative sensitivity was minimal, and tooth integrity was well-preserved.

CONCLUSION

Moringa oleifera, as a pretreatment liner, showed promise in enhancing the clinical success of resin-dentin restorations. Despite minor reported issues, the groups had no statistically significant differences regarding functional and biological outcomes.

Role of Natural Cross Linkers in Resin-Dentin Bond Durability: A Systematic Review and Meta-Analysis

BACKGROUND

The role of endogenous Matrix Metallo Proteinases in resin dentin bond deterioration over time has been well documented. The present study aimed to systematically review the literature; in vitro and ex vivo studies that assessed the outcomes of natural cross-linkers for immediate and long-term tensile bond strength were included.

METHODS

The manuscript search was carried out in six electronic databases-PubMed/MEDLINE, LILACS, SciELO, Cochrane, Web of Science and DOAJ, without publication year limits. Only manuscripts in English (including the translated articles) were selected, and the last search was performed in December 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed.

RESULTS

From the 128 potentially eligible studies, 48 full-text articles were assessed for eligibility. After eligibility assessment and exclusions, 14 studies were considered for systematic review and seven studies for meta-analysis. Amongst the selected studies for meta-analysis, three had a medium and four had a low risk of bias.

CONCLUSIONS

It was evidenced by the available data that Proanthocyanidin is the most efficient natural cross-linker to date, in preserving the bond strength even after ageing.

Dentin Biomodification with Flavonoids and Calcium Phosphate Ion Clusters to Improve Dentin Bonding Stability

The purpose of this study was to evaluate the effects of flavonoids and calcium phosphate ion clusters (CPIC) on dentin bonding stability. Seven experimental solutions were synthesized using icaritin (ICT), fisetin (FIS), silibinin (SIB), CPIC, and combinations of one of three flavonoids and CPIC (ICT + C, FIS + C, SIB + C). The experimental solutions were applied to demineralized dentin prior to the application of a universal adhesive. A group without any experimental solution served as a control. Dentin specimens pretreated with the experimental solutions were assayed using Fourier transform infrared (FTIR) spectroscopy. The microtensile bond strength (µTBS) and nanoleakage were evaluated at 24 h and after 10,000 thermocycles. FIS and ICT + C showed significantly higher µTBS than the control group at 24 h. CPIC, ICT + C, FIS + C, and SIB + C showed significantly higher µTBS than the control group after thermocycling. After thermocycling, silver infiltration into the hybrid layer and interfacial gaps was more noticeable in the control group than in the other groups. The FTIR spectra revealed the formation of apatitic minerals in the demineralized dentin in the flavonoid and CPIC combination groups. The pretreatment of demineralized dentin with flavonoids and CPIC improved dentin bonding stability. The flavonoid and CPIC combinations preserved dentin bond strength.

Physicochemical Properties of Dentine Subjected to Microabrasive Blasting and Its Influence on Bonding to Self-Adhesive Prosthetic Cement in Shear Bond Strength Test: An In Vitro Study

The aim of this in vitro study was to assess the influence of microabrasive blasting on the physicochemical properties of dentine and shear bond strength (SBS) of self-adhesive resin cement (Maxcem Elite, Kerr, Orange, CA, USA) bonded to the dentine surface. Ninety cylindrical specimens with exposed dentine of human teeth were prepared and divided into three randomized, parallel sample sets A, B, and C. Groups B and C were subjected to abrasive blasting using a micro-sandblasting device (Microetcher IIa, Danville Materials, Carlsbad, CA, USA) with two gradations of Al₂O₃ abrasives (Group B, abrasion with a gradation of 50 μm; group C, abrasion with a gradation of 27 μm). SEM imaging, profilometry, chemical composition analysis, contact angle measurements, surface free energy, and SBS tests were performed. The resulting data were statistically analyzed using the Statistica software (ver. 13.3, Tibco Software Inc., Palo Alto, CA, USA). Microabrasive blasting caused changes in surface topography, structural features, and the connection strength between the dentin surface and self-adhesive prosthetic cement. Air microabrasion through the multifactorial positive reorganization of the treated surface of dentine is recommended as a pretreatment method in fixed prosthodontics adhesive cementation protocols.

Proanthocyanidin-functionalized hydroxyapatite nanoparticles as dentin biomodifier

OBJECTIVE

This study evaluated the potential combined effects of nanohydroxyapatite and proanthocyanidin on the remineralization and collagen stabilization of demineralized dentin.

METHODS

Seventy-five coronal dentin beams (6 × 1 × 1 mm³) were randomly allocated into five experimental groups (n = 15): Sound (no treatment), Control (pH-cycling), nHAp (nanohydroxyapatite), nHAp_PA (Proanthocyanidin-functionalized nanohydroxyapatite), and PA (proanthocyanidin) treatments. The sound group (negative control) were immersed in distilled water over the experimental period. The remaining groups were submitted to a pH-cycling process for 14 days. Following the de-re mineralization process, specimens corresponding to the control group (positive control) were immersed in distilled water whereas the test groups were immersed in 1 mL of respective solution treatment (nHAp, nHAp_PA, or PA) for 1 min. The dentin samples were analyzed to determine their chemical composition (ATR-FTIR and Thermogravimetric) and mineralogical (XRD) characteristics as well as their mechanical response, obtained by three-point bending test.

RESULTS

Higher phosphate content (v₄ PO₄: ATR-FTIR) and amount of mineral (XRD) was observed in the nHAp_PA group. Furthermore, a larger induction of collagen cross-links (ATR-FTIR) and %Organic Matter (TGA) would indicate the PA incorporation and the achievement of dentin matrix stability. These effects on dentin properties were related to increasing flexural strength (MPa), demonstrating that 15% w/v nHAp_PA treatment improved the mechanical properties of the samples.

SIGNIFICANCE

nHAp_PA shows significant potential for promoting remineralization while improving collagen stability into demineralized dentin in a clinically feasible period of 1 min.

The effect of universal adhesives on dentine collagen

OBJECTIVES

The purpose of the study was to evaluate the integrity of dentine type I collagen after self-etching (SE) treatments with strong and mild universal adhesives.

METHODS

Coronal dentine specimens (n=10/product) were imaged by optical microscopy and analyzed by ATR-FTIR spectroscopy before and after treatment with 32% phosphoric acid gel (PA-negative control), 17% neutral EDTA (ED-positive control) conditioners and Adhese Universal (AD), Clearfil Universal Bond Quick (CQ), G-Premio Bond (GP), Prelude One (PR) and Scotchbond Universal (SB) adhesives. From the spectroscopic analysis the following parameters were determined: a) Extent of dentine demineralization (DM%) and b) percentage area of the Amide I curve-fitted components of β-turns, 3₁₀-helix/β-turns, α-helix, random coils, β-sheets and collagen maturation (R) index. Statistical analysis was performed by one-way ANOVA (DM%), paired t-test/Wilcoxon test (Amide I components) and Spearman correlation coefficient (DM% vs Amide I components) at an a=0.05 level.

RESULTS

PA, ED and GP removed the smear-layer and opened tubule orifices, whereas all other treatments removed only the intratubular smear-layer fraction. The ranking of the statistically significant differences in DM% was PA>GP>ED>AD, SB, CQ, PR, with AD being significantly different from PR. Regarding the Amide I components, PA demonstrated a significant reduction in β-turns, α-helices and an increase in β-sheets, GP a reduction in β-turns, AD an increase in β-turns and random coils, and CQ an increase in β-turns. PR, SB and ED showed insignificant differences in all the Amide I components. Significant correlations were found between DM%-random coils and DM%-R.

SIGNIFICANCE

The universal adhesives used in the SE mode induced none to minimal changes in dentine collagen structure, without evidence of the destabilization pattern observed after conventional phosphoric acid treatments.

Effect of Root Dentin Pretreatment on Micro-Push-Out Bond Strength of Fiber Posts to Root Canal Dentin: Cold Atmospheric Argon Plasma (CAAP) and Ethylenediaminetetraacetic Acid (EDTA)

Purpose

Debonding from the root canal dentin is the most common failure mode of fiber posts. This study aimed to assess the effects of cold atmospheric argon plasma (CAAP) and ethylenediaminetetraacetic acid (EDTA) on micro-push-out bond strength of fiber posts to root canal dentin.

Materials and Methods

Forty maxillary canine teeth were decoronated, underwent endodontic treatment, and were stored in an incubator for 7 days. After post space preparation, the teeth were randomly divided into four groups for different surface treatments: (I) saline, (II) 17% EDTA, (III) CAAP, and (IV) 17% EDTA + CAAP. Fiber posts (Whitepost no. 2, FGM) were cemented into the root canals using Panavia F2.0 resin cement, and 1 mm-thick sections were made at the coronal, middle, and apical thirds of the roots. The samples underwent micro-push-out bond strength test. The mode of failure was also determined under a stereomicroscope. Data were analyzed using three-way ANOVA and Tukey's post hoc test (α = 0.05). The mode of failure data were analyzed using the chi-square test.

Results

The mean micro-push-out bond strength of fiber posts was not significantly different in the four groups (P > 0.05). However, the bond strength values in the coronal third were significantly higher than the corresponding values in the apical third (P=0.01). There was no significant difference in the modes of failure between the groups (P > 0.05).

Conclusion

Application of CAAP alone or in combination with 17% EDTA could not successfully increase the bond strength of fiber posts to root canal dentin.

Methacrylate-functionalized proanthocyanidins as novel polymerizable collagen cross-linkers - Part 2: Effects on polymerization, microhardness and leaching of adhesives

OBJECTIVE

The aim of the study was to investigate the effects of a novel polymerizable collagen cross-linker methacrylate-functionalized proanthocyanidins (MAPA) on the polymerization, microhardness and leaching of a HEMA-based experimental dental adhesive system.

METHODS

Three MAPAs were synthesized using different methacrylate (MA) to proanthocyanidins (PA) feeding ratios of 1:2, 1:1, and 2:1 to obtain MAPA-1, MAPA-2, and MAPA-3, respectively. The resulting three MAPAs and PA were added to an experimental adhesive formulated with HEMA and a tri-component photoinitiator system (0.5 wt% CQ/EDMAB/DPIHP) at 1%, 5% and 10% MAPA or PA concentrations (wt%). The adhesive polymerization kinetics was measured continuously in real-time for 10 min using a Fourier-transform infrared spectroscopy (FTIR) with an attenuated total reflectance (ATR) accessory. Degree of conversion (DC) and Vickers microhardness (MH) of cured adhesives were measured at 72 h post-cure. The leaching of cured adhesives in DI water was monitored using UV-vis spectrophotometer. Statistical analysis was performed using one-way and two-way ANOVA, Tukey's (p < 0.05).

RESULTS

The adhesive formulations with 1%, 5% and 10% MAPAs-1, -2, -3 all generated higher rate of polymerization and 10-min DC than the formulations with PA at the same concentrations. At 72 h post-cure, the adhesive formulation with 5% MAPA-2 exhibited significantly higher DC (99.40%) and more than doubled MH (18.93) values than the formulation with 5% PA (DC = 89.47%, MH = 8.41) and the control (DC = 95.46%, MH = 9.33). Moreover, the cured adhesive with 5% MAPA-2 demonstrated significantly reduced PA leaching in comparison with cured adhesive with 5% PA.

SIGNIFICANCE

Synthesized MAPA is a novel class of polymerizable collagen cross-linker that not only stabilizes dentin collagen via its PA component, but also improves polymerization, mechanical properties and stability of HEMA-based adhesives via its MA component. By inheriting the benefit while overcoming the drawback of PA, MAPA offers a revolutionary solution for improved bond-strength and longevity of dental restorations.

Effects of Dentine Pretreatment Solutions Containing Flavonoids on the Resin Polymer-Dentine Interface Created Using a Modern Universal Adhesive

The aim of the present study was to evaluate the influence of several experimental pretreatment crosslinker solutions on the resin polymer–dentine interface created using a representative universal adhesive system, by means of microtensile bond strength testing (μTBS), nanomechanical properties and ultramorphology confocal laser scanning microscopy (CLSM). Five experimental solutions containing different flavonoids were applied as dentine pretreatment after acid etching. A control pretreatment group containing no flavonoid was also employed. A representative modern universal adhesive was then applied, followed by a 3 mm thick composite built up. Specimens were sectioned into sticks and submitted to a μTBS test or nanoindentation analysis along the interface (24 h or 25,000 thermocycles). The ultramorphology of the polymer–resin interface was also evaluated using CLSM. The results were analyzed using two-way ANOVA and Bonferroni’s post hoc test (α = 0.05). All flavonoids improved short- and long-term μTBS values (p < 0.01), while only some specific such solutions improved the nanomechanical properties (p < 0.05) and preserved the structural morphology of the interface after aging. Pretreatment of acid-etched dentine using specific flavonoid-containing solutions may be a promising approach to improve both the nanomechanical properties and the durability of modern universal adhesive systems.

Polyphenol-enriched extract of Arrabidaea chica used as a dentin pretreatment or incorporated into a total-etching adhesive system: Effects on bonding stability and physical characterization

The aim of this paper was to evaluate the physical properties and the long-term bond strength of a 2.5% polyphenol-enriched extract of Arrabidaea chica (AC) incorporated into both the phosphoric acid and the primer of a three-step total-etch adhesive, or into an aqueous solution as a dentin pretreatment. Fifty dentin surfaces received the treatments (n = 10): CON (control) - application of the three-step adhesive system (Adper Scotchbond Multipurpose, 3M ESPE); WAT - distilled water used as a pretreatment after dentin etching and before application of the adhesive system; ACPA - AC incorporated into the phosphoric acid; ACW - dentin pre-treatment with AC incorporated into an aqueous solution after etching; ACP - AC incorporated into the primer. Microtensile bond strength tests were performed after 24 h, 6 and 12 months of storage. Slices from the resin-dentin interface were obtained for scanning electron microscopy analysis of the hybrid layer. Degree of conversion of AC incorporated into the primer was evaluated. The particle size, polydispersity index and zeta potential of all the solutions prepared by incorporating AC (phosphoric acid, primer and distilled water) were measured by dynamic light scattering, which brought about changes after incorporation. Degree of conversion of the primer was not affected after incorporating AC. ACP showed lower microtensile bond strength values than the other groups. Bond strength decreased after 6 months of storage, stabilizing at the 12-month evaluation. Therefore, use of AC incorporated into the primer led to lower bond strength values, since AC modified the physical properties (particle size, polydispersity index and zeta potential) of the primer, but did not change the degree of conversion. Application of AC as a dentin pretreatment did not affect bond strength or the micromorphological characteristics of the hybrid layer.

Influence of Dentine Pre-Treatment by Sandblasting with Aluminum Oxide in Adhesive Restorations. An In Vitro Study

Dentine pretreatment through sandblasting procedures has been widely studied but no curve test results are currently available. Thus, the aim herein was to in vitro compare the adhesive strength in sandblasted or not samples using a universal testing machine. Thirty -two bovine teeth were divided into two groups, namely test (n = 16 bars), sandblasting with aluminum oxide particles (50 µm) was performed before the adhesion procedures), and control (n = 16 bars), where no sandblasting procedure was performed. A bi-material curve test was used to evaluate the characteristics of the dentine pretreatment in terms of tensile stress and fracture strength. A scanning electron microscope (SEM) was used to analyze the fracture topography in the composite, bonding, dentin, and at the relative interfaces. The results demonstrated a statistically significant difference between the two groups in terms of tensile stress at maximum load showing values of 84.300 ± 51.342 MPa and 35.071 ± 16.609 MPa, respectively for test and control groups (p = 0.033). Moreover, a fracture strength test showed values of 18.543 ± 8.145 MPa for test and 8.186 ± 2.833 MPa for control group (p = 0.008). In conclusion, the sandblasting treatment of the dentine significantly influenced the mechanical resistance of the adhesion in this in vitro study.

Influence of flavonoids on long-term bonding stability on caries-affected dentin

OBJECTIVES

To evaluate the effect of experimental dentin pre-treatment solutions formulated with different flavonoids on microtensile bond strength (μTBS), nanohardness (NH) and ultra-morphological characteristics of artificial caries-affected dentin (CAD) bonded using a universal bonding system.

METHODS

A microbiological method was used to create an artificial CAD in 91 human molars. Five experimental pre-treatment solutions were created using the following flavonoids: quercetin (QUE); hesperidin (HES); rutin (RUT); naringin (NAR), or proanthocyanidin (PRO). A placebo solution (PLA) with no flavonoids added was also evaluated. The flavonoids or placebo solutions were applied to the CAD prior to the application and photoactivation of a universal adhesive (Scotchbond Universal, 3M Oral Care). A control group (CON), in which only the bonding agent was applied without any flavonoid solution, was also evaluated. A 3-mm-thick block of resin composite (Opallis, FGM) was built up on the flat bonded CAD surfaces and was light-cured following the manufacturer's instructions. Specimens were sectioned to obtain resin-dentin slices and sticks (cross-sectional area of 0.8 mm²). The μTBS, NH, and confocal ultramorphology analysis of resin-dentin interface was evaluated at 24 h and after thermo-cycling aging (25,000 cycles). The results were analyzed using 2-way ANOVA followed by Bonferroni's post hoc test (pre-set α = 0.05).

RESULTS

The specimens from groups QUE, NAR, and RUT presented greater μTBS values than those from CON group (p<0.05). Specimens from some of these experimental groups presented greater nanomechanical properties (p<0.05), and no morphological degradation at the resin-dentin interface after aging.

SIGNIFICANCE

The use of exogenous cross-linkers as dentin pre-treatment before bonding procedures may represent a suitable strategy to improve the longevity of universal adhesive systems applied to caries-affected dentin.

Research Advances in the Use of Bioactive Compounds from Vitis vinifera By-Products in Oral Care

Oral health is considered an important factor of general health and it contributes to the quality of life. Despite the raising awareness of preventive measures, the prevalence of oral health conditions continues to increase. In this context, a growing interest in investigating natural resources like Vitis vinifera (V. vinifera) phenolic compounds (PhCs) as oral health promoters has emerged. This paper aims to review the evidence about the bioactivities of V. vinifera by-products in oral health. Up to date, a high number of studies have thoroughly reported the antimicrobial and antiplaque activity of V. vinifera extracts against S. mutans or in multi-species biofilms. Moreover, the bioactive compounds from V. vinifera by-products have been shown to modulate the periodontal inflammatory response and the underlying oxidative stress imbalance induced by the pathogenic bacteria. Considering these beneficial effects, the utility of V. vinifera by-products in the maintaining of oral health and the necessary steps towards the development of oral care products were emphasized. In conclusion, the high potential of V. vinifera by-products could be valorized in the development of oral hygiene products with multi-target actions in the prevention and progression of several oral conditions.

The interaction of sodium trimetaphosphate with collagen I induces conformational change and mineralization that prevents collagenase proteolytic attack

OBJECTIVES

This study evaluated the cell viability and expression of different major genes involved in mineralization in odontoblast-like cells exposed to sodium trimetaphosphate (STMP). It was also investigated the influence of STMP on the rate of calcium phosphate crystal growth, its anti-proteolytic action against the enzymatic degradation of type I collagen, the binding mechanism of STMP to collagen fibrils, and the potential mechanism to induce collagen stabilization.

METHODS

Immortalized rat odontoblast MDPC-23 cells were cultured. Cell viability was assessed by trypan blue staining, and the changes in gene expression balance induced by STMP were assessed by quantitative reverse transcription (qRT) PCR assays. Crystalline particle formation was monitored by light-scattering detectors to estimate pH variation and the radial size of the crystalline particles as a function of reaction time (pH 7.4, 25°C) in the presence of STMP in supersaturated calcium phosphate solution (Ca/P=1.67). Images were obtained under atomic force microscopy (AFM) to measure the particle size in the presence of STMP. A three-point bending test was used to obtain the elastic modulus of fully demineralized dentin beams after immersion in STMP solution. The binding mechanism of STMP to collagen fibrils and potential stabilization mechanism was assessed with circular dichroism spectrometry (CD). The data were analyzed statistically (α=0.05).

RESULTS

STMP had no significant influence on the cell viability and gene expression of the MDPC-23 cells. STMP greatly increased the rate of crystal growth, significantly increasing the average radial crystal size. AFM corroborated the significant increase of STPM-treated crystal size. Mineralized collagen I fibrils exhibited less collagenase degradation with lower STMP concentration. CD analysis demonstrated changes in the conformational stability after STMP binding to type I collagen.

SIGNIFICANCE

The increased resistance of collagen against the proteolytic activity of collagenases appears to be related to the conformational change induced by STMP binding in collagen I and the STMP capacity for promoting biomimetic mineralization in type I collagen fibrils.

Sealing effects of different Chinese herbal medicines on dentinal tubules: a scanning electron microscopic observation

BACKGROUND AND OBJECTIVES

To evaluate the sealing effects of different Chinese herbal medicines on dentinal tubules, and to provide a reference for the clinical treatment of dentin hypersensitivity.

METHODS

Forty dentin slices prepared by freshly extracted bovine mandibular central incisors were randomly assigned to procyanidins, tannic acid, gallic acid, naringin, epigallocatechin gallate (EGCG), glycyrrhizic acid, paeonol, and blank groups. Dentin slices in each Chinese herbal medicine group were treated three times a day, each for 5 min, and then immersed in a remineralization solution for the rest of the time. Dentin slices in the blank group were directly immersed in the remineralization solution for 7 days. The dentinal tubule sealing effect was observed under the scanning electron microscope (SEM).

RESULTS

SEM results showed that the dentinal tubules were almost completely open in the blank group, which was mostly open in the gallic acid, EGCG, glycyrrhizic acid, and paeonol groups, and were sealed in procyanidins, tannic acid, and naringin groups. Significant differences were detected in mean area, mean diameter of dentinal tubules, and mean plugging rate of dentinal tubules between the remaining Chinese herbal medicine groups and blank group (P < .05). Among them, the dentinal tubule sealing effect of procyanidins, tannic acid, and naringin was obvious.

CONCLUSION

The findings suggested that procyanidins, tannic acid, and naringin can effectively seal dentinal tubules, which provided a basis for clinical treatment of dentin hypersensitivity.

Effect of proanthocyanidin mediated immediate and delayed dentin sealing on the strength of premolars restored with composite resin inlay

Background

Immediate dentin sealing (IDS) with proanthocyanidin (PA) could be used before cementation with a self-adhesive (SA) cement. The aim of this study was to assess the effect of PA treatment on acid-etched dentin before adhesive application, in IDS and delayed dentin sealing (DDS), on the strengthening property of SA-cemented composite resin inlay in premolars.

Material and Methods

Eighty-four maxillary premolars were divided into 7 groups (n=12): 1) (Intact) Sound teeth served as controls; groups 2-7) After cavity preparation and fabrication of composite resin inlay, temporary inlays were made and cemented. After one week, the inlays were removed and composite inlays were luted with a self-adhesive resin cement as follows: 2) (SA) Without dentin- pretreatment; 3) (DDS) Etch-and-rinse adhesive before the cementation; 4) (DDS/PA) PA treatment of acid-etched dentin before the adhesive, followed by the cementation; 5) (Etch/PA) PA treatment of acid-etched dentin before the cementation; 6 and 7) (IDS and IDS/PA) Application of IDS without or with PA treatment, respectively, one week before the cementation. After thermo-mechanical aging, fracture resistance (FR) was tested. Data were analyzed using one-way ANOVA and Tamhane tests (α=0.05).

Results

There was a significant difference between the study groups (P<0.001). The IDS and IDS/PA groups yielded significantly higher FR compared to the SA group (P ≤ 0.003), but the DDS, DDS/PA and Etch/PA groups did not differ from the SA group (P>0.05). The effect of PA on FR in the IDS and DDS techniques was not significant.

Conclusions

IDS with or without PA treatment considerably improved the strength of premolars with self-adhesive-cemented inlay, while the value of only IDS with PA treatment reached the level of the sound teeth.

Key words:Delayed dentin sealing, fracture resistance, immediate dentin sealing, proanthocyanidin.

Modifying Adhesive Materials to Improve the Longevity of Resinous Restorations

Dental caries is a common disease on a global scale. Resin composites are the most popular materials to restore caries by bonding to tooth tissues via adhesives. However, multiple factors, such as microleakage and recurrent caries, impair the durability of resinous restorations. Various innovative methods have been applied to develop adhesives with particular functions to tackle these problems, such as incorporating matrix metalloproteinase inhibitors, antibacterial or remineralizing agents into bonding systems, as well as improving the mechanical/chemical properties of adhesives, even combining these methods. This review will sum up the latest achievements in this field.

Two-year clinical evaluation of proanthocyanidins added to a two-step etch-and-rinse adhesive

OBJECTIVE

To compare the clinical behavior of Proanthocyanidins (PA)-free and PA-containing two-step etch-and-rinse adhesive used underneath resin composite restorations in non-carious cervical lesions (NCCLs) over a 6- (6 M) and 24-month (24 M) period.

METHODS

135 restorations were randomly placed in 45 subjects. The NCCLs were conditioned (37% phosphoric acid for 15 s) and distributed into 3 groups: Control (EX0) - ExciTE F (Ivoclar Vivadent) adhesive applied following the manufacturer's recommendations; EX2 and EX5 - 2 wt% and 5 wt% of PA were added to ExciTE F, respectively, and applied as in EX0. Resin composite was placed incrementally and light-cured. The restorations were evaluated at baseline, 6 M and 24 M, using FDI and USPHS criteria. Statistical analyses were performed using Friedman and Wilcoxon tests (α = 0.05).

RESULTS

The retention rates were 98% (95% confidence interval 88-99%) for EX0, 92% (80-97%) for EX2; and 85% (72-93%) for EX5 at 6 M. A significant difference was found only for EX5 at 6 M when compared with the respective baseline findings (p = 0.03) and when compared with EX0 and EX2 (p = 0.001) at 6 M. After 24 M, the retention rates were 98% (88-99%) for EX0, 73% (59-84%) for EX2, and 71% (56-82%) for EX5. Only EX0 did not result in significant difference in retention rate at 24 M when compared with baseline but showed a significant higher retention rate when compared with those of EX2 and EX5 (p = 0.001).

CONCLUSION

Adding proanthocyanidins to the adhesive solution jeopardized the retention of composite resins restorations in non-carious cervical lesions after 24 months.

CLINICAL RELEVANCE

In spite of being user-friendlier than when used separately, the incorporation of proanthocyanidins into the adhesive solution impairs the longevity of composite restorations.

Natural products in endodontics

Herbal remedies are used throughout the world, either in earlier or in recent times. The number of studies on this alternative therapeutic system increased in the last decades. In this paper, the relevant literature on the use of natural products in root canal therapy is revised from a MEDLINE database search. The uses of medicinal plants in endodontics include cleaning and disinfection of root canals, intracanal medicaments between appointments, sealer cements, and for removal of obturation material. Other studies showed the effect of natural products in pulpal and dentin repair. Their use is anecdotal, and their effectiveness showed to be variable and is always compared to the chemical standards currently being used. Alkaloids, coumarins, saponins, and flavonoids are aromatic substances that are produced by plants and evaluated for their therapeutic potential. Further investigation into benefits of natural products is warranted.

Polyphenol uses in biomaterials engineering

Polyphenols are micronutrients obtained from diet that have been suggested to play an important role in health. The health benefits of polyphenols and their protective effects in food systems as antioxidant compounds are well known and have been extensively investigated. However, their functional roles as a "processing cofactor" in tissue engineering applications are less widely known. This review focuses on the functionality of polyphenols and their application in biomaterials. Polyphenols have been used to stabilize collagen and to improve its resistance to degradation in biological systems. Therefore, they have been proposed to improve the performance of biomedical devices used in cardiovascular systems by improving the mechanical properties of grafted heart valves, enhancing microcirculation through the relaxation of the arterial walls and improving the capillary blood flow and pressure resistance. Polyphenols have been found to stimulate bone formation, mineralization, as well as the proliferation, differentiation, and the survival of osteoblasts. These effects are brought about by the stimulatory effect of polyphenols on osteoblast cells and their protective effect against oxidative stress and inflammatory cytokines. In addition, polyphenols inhibit the differentiation of the osteoclast cells. Collectively, these actions lead to promote bone formation and to reduce bone resorption, respectively. Moreover, polyphenols can increase the cross-linking of dentine and hence its mechanical stability. Overall, polyphenols provide interesting properties that will stimulate further research in the bioengineering field.

Dual function of proanthocyanidins as both MMP inhibitor and crosslinker in dentin biomodification: A literature review

Proanthocyanidin, a natural phytochemical bioactive agent, simultaneously can silence the activity of dentinal proteases and crosslink the collagen matrix; both of these phenomena would be the fundamentals for bio-stability of resin-dentin interface which is essential for a promising adhesive dentistry. This review provides an overview of the data developed by different groups of researchers and highlighted topics are proanthocyanidin chemistry, natural resources and the unique interactions between proanthocyanidincollagen and proanthocyanidin-MMPs in dentin. Besides, clinical applications of proanthocyanidin in the form of proanthocyanidin-containing adhesives, preconditioners and etchants have been reviewed. One hundred and twelve studies have been published in peer-reviewed journals from 1981 to 2017, all were comprised in this review, some of them have been actually proven to be promising from clinical point of view and others need further assessment before their adoption as clinically practicable protocols.

Effect of Baicalein on Matrix Metalloproteinases and Durability of Resin-Dentin Bonding

OBJECTIVE

In an attempt to increase resin-dentin bonding quality, this study used baicalein as a preconditioner in an etch-and-rinse adhesive to evaluate its effect on matrix metalloproteinases (MMPs) and adhesive durability.

METHODS

As a MMP inhibitor and potential collagen cross-linking agent, baicalein was used as a preconditioner in an etch-and-rinse adhesive system. The degree of conversion was evaluated by Fourier-transform infrared spectroscopy. EnzChek gelatinase/collagenase assay kits were then used to detect the MMP inhibitory effect of different concentrations of baicalein (0.1, 0.5, 2.5, and 5.0 μg/mL) on dentin powders. During in vitro bonding procedures, flat dentin surfaces on sound third molars were preconditioned with 2.5 μg/mL baicalein after being acid-etched; this step was followed by continuation of adhesive processes and build-up of resin composite. After resin-dentin stick preparation, bonding strength, failure mode, and interface nanoleakage were respectively evaluated via microtensile testing, stereomicroscopy, and field emission scanning electron microscopy either immediately or after storage in artificial saliva for three or six months. Data were analyzed by two-way analysis of variance and Tukey test (α=0.05).

RESULTS

Baicalein at a concentration of 0-5.0 μg/mL did not influence the conversion of adhesives. However, it inhibited the activities of dentin-bond gelatinase and collagenase, especially at a concentration of 2.5 μg/mL, while effectively increasing microtensile bonding strength and decreasing nanoleakage in vitro, both immediately and after aging.

CONCLUSIONS

Baicalein used as preconditioner in an etch-and-rinse adhesive system has an anti-MMP function and effectively improves resin-dentin bonding durability in vitro, which has potential value in clinical bonding procedures.

Effects of Collagen Crosslinkers on Dentine: A Literature Review

This aim of this review is to explore the current research related to crosslinking agents used on dentine. A systematic search of publications in PubMed and Web of Science databases was performed. Further retrieval was conducted using the search terms of specific names of crosslinkers. Reviews, conference abstracts, dissertation and theses, non-English articles, studies of intrinsic crosslinking of dentine, studies of adhesives without specific crosslinker components, studies of crosslinker applications in other collagenous tissues or tooth-like structures and irrelevant studies were excluded. Manual screening was conducted on the bibliographies of remaining papers to identify other relevant articles. One hundred and one articles were included in this systematic review and full texts were retrieved. Both synthetic and naturally derived crosslinkers have been found to exhibit significant effects in biomodification of dentine via their multiple interactions with the dentine matrix. A stable matrix network or a durable hybrid layer in dentine bonding could be achieved, where the dentine collagen fibrils show improved biochemical and biomechanical properties and enzymatic biodegradation is reduced. Although no crosslinkers have been tested in clinical trials, extensive research has been conducted in laboratory studies to investigate their potential applicability for inhibition of demineralisation and/or promotion of remineralisation, caries prevention as well as improvement of bonding performance of adhesive systems. Further studies are needed to develop the feasibility for clinical use, reduce side effects as well as explore mechanisms of action and long-term effectiveness.

Mechanical properties, water sorption characteristics, and compound release of grape seed extract-incorporated resins

Objective

This study evaluated the effect of grape seed extract (GSE) incorporation on the mechanical properties, water sorption, solubility, and GSE release from the experimental adhesive resins.

Material and Methods

An experimental comonomer mixture, consisting of 40% Bis-GMA, 30% Bis MP, 28% HEMA, 0.26% camphorquinone and 1% EDMAB, was used to prepare four GSE-incorporated adhesive resins at concentrations of 0.5, 1, 1.5, and 2 wt%. The neat resin without GSE was used as the control. Six resin beams (25 mm x 2 mm x 2 mm) per group were prepared for flexural strength and modulus of elasticity evaluations using a universal testing machine at a crosshead speed of 1 mm/min. Five disks (6 mm in diameter and 2 mm in thickness) per group were used for microhardness measurements using a Leitz micro-hardness tester with Leica Qgo software. Five disks (7 mm in diameter and 2 mm in thickness) per group were prepared and stored in deionized water for 28 days. Water sorption, solubility, and GSE release in deionized water were calculated for each GSE-incorporated adhesive at the end of 28th day. Data was evaluated using one-way ANOVA and Tukey multiple comparisons.

Results

Flexural strength, modulus of elasticity and microhardness of GSE-incorporated adhesive decreased significantly with incorporation of 1.5% of GSE (p<0.05). Addition of GSE had no effect on the water sorption of the adhesive resins (p=0.33). The solubility of the resin also increased significantly with incorporation of 1.5% of GSE (p<0.05). Quantities of GSE release increased with increased concentration of GSE in the adhesive resin.

Conclusion

Up to 1% of GSE can be incorporated into a dental adhesive resin without interfering with the mechanical properties or solubility of the resins.

Recent Advances in Adhesive Bonding - The Role of Biomolecules, Nanocompounds, and Bonding Strategies in Enhancing Resin Bonding to Dental Substrates

PURPOSE OF REVIEW

To present an overview on the main agents (i.e., biomolecules and nanocompounds) and/or strategies currently available to amplify or stabilize resin-dentin bonding.

RECENT FINDINGS

According to studies retrieved for full text reading (2014-2017), there are currently six major strategies available to overcome resin-dentin bond degradation: (i) use of collagen crosslinking agents, which may form stable covalent bonds with collagen fibrils, thus strengthening the hybrid layer; (ii) use of antioxidants, which may allow further polymerization reactions over time; (iii) use of protease inhibitors, which may inhibit or inactivate metalloproteinases; (iv) modification of the bonding procedure, which may be performed by using the ethanol wet-bonding technique or by applying an additional adhesive (hydrophobic) coating, thereby strengthening the hybrid layer; (v) laser treatment of the substrate prior to bonding, which may cause specific topographic changes in the surface of dental substrates, increasing bonding efficacy; and (vi) reinforcement of the resin matrix with inorganic fillers and/or remineralizing agents, which may positively enhance physico-mechanical properties of the hybrid layer.

SUMMARY

With the present review, we contributed to the better understanding of adhesion concepts and mechanisms of resin-dentin bond degradation, showing the current prospects available to solve that problematic. Also, adhesively-bonded restorations may be benefited by the use of some biomolecules, nanocompounds or alternative bonding strategies in order to minimize bond strength degradation.

Influence of EDC on Dentin-Resin Shear Bond Strength and Demineralized Dentin Thermal Properties

This study aimed to evaluate the bonding strength and thermal properties of demineralized dentin with and without EDC treatment. Sound human molars were randomly divided into seven treatment groups (n = 20): control, 80% ethanol, and five EDC ethanol solutions (0.01–1.0 M). In each group, 16 samples were used for bond strength assessment and 4 samples were used for scanning electron microscopy (SEM) analysis. A further 70 intact molars were used to obtain a fine demineralized dentin powder, treated with the same solutions and were evaluated the crosslink degree by ninhydrin test and denaturation temperature (T_d) by differential scanning calorimetry. EDC-treated specimens (<1.0 M) had a higher bond strength, especially 0.3 and 0.5 M group, than the control counterpart. There was a significant drop in bond strength of 1.0 M EDC group. SEM revealed a homogeneous and regular interface under all treatments. EDC treatment significantly increased the demineralized dentin cross-link degree and T_d compared with the control and ethanol treatments. The 0.3 and 0.5 M treatments showed the highest cross-link degree and T_d. In terms of mechnical and theramal properties consideration, 0.3 and 0.5 M EDC solutions may be favorable for when applied with etch-and-rinse adhesives, but it is still needed further long-term study.

Caries-resistant bonding layer in dentin

The present study examined the mechanism for caries resistance and the pulp responses in vital teeth following the use of the augmented-pressure adhesive displacement technique. Dentin adhesives were applied to the surface of sound dentin disks in 4 experimental groups: non-antibacterial adhesive and gentle adhesive displacement (N-G), non-antibacterial adhesive and augmented-pressure adhesive displacement (N-H), antibacterial adhesive and gentle adhesive displacement (A-G), antibacterial adhesive and augmented-pressure adhesive displacement (A-H). The depth of demineralization induced by biological or chemical demineralization models was measured using confocal laser scanning microscopy and analyzed with two-way ANOVA. Pulp responses of vital dog's teeth to the augmented-pressure adhesive displacement technique were evaluated using light microscopy. Depth of demineralization was significantly affected by "adhesive type" and "intensity of adhesive displacement" for biological demineralization. For chemical demineralization, only "intensity of adhesive displacement" showed significant influence on lesion depth. Pulp response of 0.1, 0.2 and 0.3 MPa groups showed only moderate disorganization of the odontoblast layer at 24 hours that completely re-organized after 3 weeks. Augmented-pressure adhesive displacement improves the caries resistance property of bonded dentin and does not cause irreversible pulpal damage to vital teeth when the air pressure employed is equal or smaller than 0.3 MPa.

Experimental primers containing synthetic and natural compounds reduce enzymatic activity at the dentin-adhesive interface under cyclic loading

OBJECTIVE

To evaluate the effect of experimental primers (chlorhexidine, enriched mixture of proanthocyanidins, and doxycycline) on the adhesive properties and gelatinolytic activity at dentin-resin interfaces of occlusal Class I restorations.

METHODS

The inactivation of enzymes by the experimental primers was assessed by fluorescence assay and gelatin zymography. To assess the adhesive properties, occlusal Class I cavities were prepared in sound human molars, etched with phosphoric acid and restored with one of the primers and an etch-and-rinse adhesive system (Adper Single Bond Plus-3M ESPE). After the restorative procedures, specimens were divided into two subgroups (n=6) consisting of storage in incubation buffer or axial cyclic loading at 50N and 1,000,000 cycles. Then, the specimens were sectioned and slices were assigned to in situ zymography assay and microtensile bond strength (TBS) test.

RESULTS

Fluorescence assay and gelatin zymography revealed that the experimental primers inactivated rMMPs. In situ zymography (2-way ANOVA, Tukey, p<0.05) showed that cyclic loading increased the gelatinolytic activity at the resin-dentin interface and the experimental primers decreased the gelatinolytic activity at the adhesive interface. The experimental primers had no significant effects on dentin-adhesive bond strengths with or without cyclic loading (2-way ANOVA, p>0.05).

SIGNIFICANCE

The use of experimental primers impaired the enzymatic activity at the dentin-adhesive interface after cyclic loading and the activity of rMMPs. Cyclic loading did not have a significant effect on the bond strength.

Novel Cavity Disinfectants Containing Quaternary Ammonium Monomer Dimethylaminododecyl Methacrylate

This study was set to assess the possible benefits of novel cavity disinfectants with 5% dimethylaminododecyl methacrylate (DMADDM); and compare the effectiveness of saliva microbial-aging method with water-aging in measuring the changing of resin-dentin bond strength. Three cavity disinfectants were tested: 0.2% Chlorhexidine (CHX); 5% DMADDM; and 5% DMADDM + 0.2% CHX. Microtensile bond strength (μTBS) test was performed after microbial-aging with saliva microbial or water aging for one month. Hydroxyproline (HYP), the production of collagen degradation, was measured spectrophotometrically. Additionally, the antibacterial effects of each reagent were evaluated. The 5% DMADDM exerted the least percentage of resin-dentin bond strength loss after one month microbial-aging (p < 0.05). There were no statistically significant differences of bond strength decrease after one month water aging among the tested groups (p > 0.05). Microbial-aging method yield more drop of bond strength than water aging in all groups except 5% DMADDM (p < 0.05). Meanwhile, 5% DMADDM had the same matrix metalloproteinases (MMPs) inhibitory effects as the other two agents (p > 0.05), but much stronger antibacterial capability than 0.2% CHX (p < 0.05). This indicated that a cavity disinfectant with 5% DMADDM is promising for improving the stability of resin-dentin bonds in appearance of saliva biofilm; and the saliva microbial-aging method is more promising for studying the durability of resin-dentin bonds than water aging.

In vitro analysis of riboflavin-modified, experimental, two-step etch-and-rinse dentin adhesive: Fourier transform infrared spectroscopy and micro-Raman studies

To modify two-step experimental etch-and-rinse dentin adhesive with different concentrations of riboflavin and to study its effect on the bond strength, degree of conversion, along with resin infiltration within the demineralized dentin substrate, an experimental adhesive-system was modified with different concentrations of riboflavin (m/m, 0, 1%, 3%, 5% and 10%). Dentin surfaces were etched with 37% phosphoric acid, bonded with respective adhesives, restored with restorative composite–resin, and sectioned into resin–dentin slabs and beams to be stored for 24 h or 9 months in artificial saliva. Micro-tensile bond testing was performed with scanning electron microscopy to analyse the failure of debonded beams. The degree of conversion was evaluated with Fourier transform infrared spectroscopy (FTIR) at different time points along with micro-Raman spectroscopy analysis. Data was analyzed with one-way and two-way analysis of variance followed by Tukey's for pair-wise comparison. Modification with 1% and 3% riboflavin increased the micro-tensile bond strength compared to the control at 24 h and 9-month storage with no significant differences in degree of conversion (P<0.05). The most predominant failure mode was the mixed fracture among all specimens except 10% riboflavin-modified adhesive specimens where cohesive failure was predominant. Raman analysis revealed that 1% and 3% riboflavin adhesives specimens showed relatively higher resin infiltration. The incorporation of riboflavin in the experimental two-step etch-and-rinse adhesive at 3% (m/m) improved the immediate bond strengths and bond durability after 9-month storage in artificial saliva without adversely affecting the degree of conversion of the adhesive monomers and resin infiltration.

Dentine bond strength and antimicrobial activity evaluation of adhesive systems

OBJECTIVES

This study evaluated the dentine bond strength (BS) and the antibacterial activity (AA) of six adhesives against strict anaerobic and facultative bacteria.

METHODS

Three adhesives containing antibacterial components (Gluma 2Bond (glutaraldehyde)/G2B, Clearfil SE Protect (MDPB)/CSP and Peak Universal Bond (PUB)/chlorhexidine) and the same adhesive versions without antibacterial agents (Gluma Comfort Bond/GCB, Clearfil SE Bond/CSB and Peak LC Bond/PLB) were tested. The AA of adhesives and control groups was evaluated by direct contact method against four strict anaerobic and four facultative bacteria. After incubation, according to the appropriate periods of time for each microorganism, the time to kill microorganisms was measured. For BS, the adhesives were applied according to manufacturers' recommendations and teeth restored with composite. Teeth (n=10) were sectioned to obtain bonded beams specimens, which were tested after artificial saliva storage for one week and one year. BS data were analyzed using two-way ANOVA and Tukey test.

RESULTS

Saliva storage for one year reduces the BS only for GCB. In general G2B and GCB required at least 24h for killing microorganisms. PUB and PLB killed only strict anaerobic microorganisms after 24h. For CSP the average time to eliminate the Streptococcus mutans and strict anaerobic oral pathogens was 30 min. CSB showed no AA against facultative bacteria, but had AA against some strict anaerobic microorganisms.

CONCLUSIONS

Storage time had no effect on the BS for most of the adhesives. The time required to kill bacteria depended on the type of adhesive and never was less than 10 min.

CLINICAL SIGNIFICANCE

Most of the adhesives showed stable bond strength after one year and the Clearfil SE Protect may be a good alternative in restorative procedures performed on dentine, considering its adequate bond strength and better antibacterial activity.

Dentin bonding: can we make it last?

In dentin bonding, contemporary dental adhesive systems rely on formation of the hybrid layer, a biocomposite containing dentin collagen and polymerized resin adhesive. They are usually able to create at least reasonable integrity of the hybrid layer with high immediate bond strength. However, loss of dentin-bonded interface integrity and bond strength is commonly seen after aging both in vitro and in vivo. This is due to endogenous collagenolytic enzymes, matrix metalloproteinases, and cysteine cathepsins, responsible for the time-dependent loss of hybrid layer collagen. In addition, the hydrophilic nature of adhesive systems creates problems that lead to suboptimal hybrid layers. These problems include, for example, insufficient resin impregnation of dentin, phase separation, and a low rate of polymerization, all of which may reduce the longevity of the bonded interface. Preservation of the collagen matrix integrity by inhibition of endogenous dentin proteases is key to improving dentin bonding durability. Several approaches to retain the integrity of the hybrid layer and to improve the long-term dentin bond strength have been tested. These include the use of enzyme inhibitors, either separately or as incorporated into the adhesive resins; increase of collagen resistance to enzymatic degradation; and elimination of water from the interface to slow down or eliminate hydrolytic loss of the hybrid layer components. This review looks at the principles, current status, and future of the different techniques designed to prevent the loss of hybrid layer and bond strength.

Non-thermal atmospheric plasmas in dental restoration: improved resin adhesive penetration

OBJECTIVE

To investigate the influence of non-thermal plasma treatment on the penetration of a model dental adhesive into the demineralized dentine.

METHODS

Prepared dentine surfaces were conditioned with Scotchbond Universal etchant for 15s and sectioned equally perpendicular to the etched surfaces. The separated halves were randomly selected for treatment with an argon plasma brush (input current 6mA, treatment time 30s) or gentle argon air blowing (treatment time 30s, as control). The plasma-treated specimens and control specimens were applied with a model adhesive containing 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]-propane (BisGMA) and 2-hydroxyethyl methacrylate (HEMA) (mass ratio of 30/70), gently air-dried for 5s, and light-cured for 20s. Cross-sectional specimens were characterized using micro-Raman spectral mapping across the dentine, adhesive/dentine interface, and adhesive layer at 1-μm spatial resolution. SEM was also employed to examine the adhesive/dentine interfacial morphology.

RESULTS

The micro-Raman result disclosed that plasma treatment significantly improved the penetration of the adhesive, evidenced by the apparently higher content of the adhesive at the adhesive/dentine interface as compared to the control. Specifically, the improvement of the adhesive penetration using plasma technique was achieved by dramatically enhancing the penetration of hydrophilic monomer (HEMA), while maintaining the penetration of hydrophobic monomer (BisGMA). Morphological observation at the adhesive/dentine interface using SEM also confirmed the improved adhesive penetration. The results further suggested that plasma treatment could benefit polymerization of the adhesive, especially in the interface region.

CONCLUSION

The significant role of the non-thermal plasma brush in improving the adhesive penetration into demineralized dentine has been demonstrated. The results obtained may offer a better prospect of using plasma in dental restoration to optimize adhesion between tooth substrate and restorative materials.

Anti-proteolytic capacity and bonding durability of proanthocyanidin-biomodified demineralized dentin matrix

Our previous studies showed that biomodification of demineralized dentin collagen with proanthocyanidin (PA) for a clinically practical duration improves the mechanical properties of the dentin matrix and the immediate resin-dentin bond strength. The present study sought to evaluate the ability of PA biomodification to reduce collagenase-induced biodegradation of demineralized dentin matrix and dentin/adhesive interfaces in a clinically relevant manner. The effects of collagenolytic and gelatinolytic activity on PA-biomodified demineralized dentin matrix were analysed by hydroxyproline assay and gelatin zymography. Then, resin-/dentin-bonded specimens were prepared and challenged with bacterial collagenases. Dentin treated with 2% chlorhexidine and untreated dentin were used as a positive and negative control, respectively. Collagen biodegradation, the microtensile bond strengths of bonded specimens and the micromorphologies of the fractured interfaces were assessed. The results revealed that both collagenolytic and gelatinolytic activity on demineralized dentin were notably inhibited in the PA-biomodified groups, irrespective of PA concentration and biomodification duration. When challenged with exogenous collagenases, PA-biomodified bonded specimens exhibited significantly less biodegradation and maintained higher bond strengths than the untreated control. These results suggest that PA biomodification was effective at inhibiting proteolytic activity on demineralized dentin matrix and at stabilizing the adhesive/dentin interface against enzymatic degradation, is a new concept that has the potential to improve bonding durability.

Dentin biomodification: strategies, renewable resources and clinical applications

OBJECTIVES

The biomodification of dentin is a biomimetic approach, mediated by bioactive agents, to enhance and reinforce the dentin by locally altering the biochemistry and biomechanical properties. This review provides an overview of key dentin matrix components, targeting effects of biomodification strategies, the chemistry of renewable natural sources, and current research on their potential clinical applications.

METHODS

The PubMed database and collected literature were used as a resource for peer-reviewed articles to highlight the topics of dentin hierarchical structure, biomodification agents, and laboratorial investigations of their clinical applications. In addition, new data is presented on laboratorial methods for the standardization of proanthocyanidin-rich preparations as a renewable source of plant-derived biomodification agents.

RESULTS

Biomodification agents can be categorized as physical methods and chemical agents. Synthetic and naturally occurring chemical strategies present distinctive mechanism of interaction with the tissue. Initially thought to be driven only by inter- or intra-molecular collagen induced non-enzymatic cross-linking, multiple interactions with other dentin components are fundamental for the long-term biomechanics and biostability of the tissue. Oligomeric proanthocyanidins show promising bioactivity, and their chemical complexity requires systematic evaluation of the active compounds to produce a fully standardized intervention material from renewable resource, prior to their detailed clinical evaluation.

SIGNIFICANCE

Understanding the hierarchical structure of dentin and the targeting effect of the bioactive compounds will establish their use in both dentin-biomaterials interface and caries management.