Does active application of universal adhesives to enamel in self-etch mode improve their performance?

Bonding performance of universal adhesive systems to enamel - Effects of the acidic composition

OBJECTIVES

To evaluate the self-etch bonding potential of universal adhesive systems with varying acidic compositions by analyzing the wettability properties, topographical change, and microshear bond strength (µSBS) to enamel.

METHODS

Eight universal adhesives were tested: All-Bond Universal (Bisco), Ambar Universal (FGM), Gluma Bond Universal (Kulzer), OptiBond Universal (Kerr), Peak Universal Bond (Ultradent), Prime&Bond Universal (Dentsply), Singlebond Universal (3 M ESPE), and Tetric N-Bond Universal (Ivoclar). Bovine incisors were prepared and treated with each adhesive according to the manufacturer's instructions. The following tests were carried out: contact angle to measure the adhesives' wetting ability; optical profilometry to evaluate the topographical changes obtained with adhesives' application; energy dispersive X-ray spectroscopy (EDX) to quantify the removal of inorganic elements from enamel; and µSBS to verify the bonding potential of adhesives to enamel. Statistical analyzes included ANOVA, Kruskal-Wallis, Weibull analysis, Pearson correlation, and chi square test (α=0.05).

RESULTS

Significant differences were found in contact angles immediately after adhesive application and after 30 s, with Gluma Bond Universal and Tetric N-Bond Universal showing the lowest (the best wetting ability) and the highest values (the lowest wetting ability), respectively. EDX revealed varying degrees of Ca and P reduction, with Gluma Bond Universal resulting in the greatest Ca and P reduction from enamel (∼65 % and ∼62 % reduction, respectively. Topographical analysis indicated significant changes in roughness, mainly for Gluma Bond Universal. The µSBS mean values ranged from 14.7 MPa (Ambar Universal) to 26.8 MPa (Tetric N-Bond Universal). OptiBond Universal and Tetric N-Bond Universal exhibited the highest resin-enamel bonds. Weibull analysis was performed to better understand the bonding reliability of the tested adhesives, with OptiBond Universal demonstrating increased modulus and characteristic strength, performing as one of the most interesting compositions for enamel bonding. Adhesives based on carboxylic acids were more acidic than adhesives containing phosphate-based monomers (p = 0.033), and the removal of Ca and P elements from enamel was more intense with the use of adhesives based on carboxylic acids (p = 0.029). There was a strong relationship between the Sz values of adhesively treated enamel and the baseline contact angle (wettability) of adhesives (R² = -0.771; p = 0.025).

SIGNIFICANCE

The study highlights significant variability among universal adhesives in terms of their interaction with enamel. Adhesives based on GPDM (OptiBond Universal) and 10-MDP (Tetric N-Bond Universal) demonstrated the best bonding performance, suggesting they may be preferable in clinical settings where strong and reliable enamel bonds are critical. The presence of 10-MDP was not significantly associated with improved dental bonds. The present findings provide valuable information for dentists in selecting adhesives that optimize clinical outcomes in enamel substrate using the self-etching adhesive approach.

Six-year clinical evaluation of a copper-containing universal adhesive in non-carious cervical lesions: A split-mouth double-blind randomized clinical trial

OBJECTIVES

To evaluate the clinical performance of a universal adhesive system containing 0.1 % copper nanoparticles (CuNp) in non-carious cervical lesions (NCCLs) after 6 years.

MATERIAL AND METHODS

Two hundred and sixteen restorations (n = 54) were randomly placed in 36 participants with at least four NCCLs. Groups included: ER-Cu (adhesive in etch-and-rinse strategy with CuNp), ER-Ct (etch-and-rinse without CuNp), SE-Cu (self-etch with CuNp), and SE-Ct (self-etch without CuNp). Restorations were evaluated at baseline and after 1, 3, 4, and 6 years using the FDI and USPHS criteria.

PRIMARY OUTCOME

fracture of material and retention. Examiners and patients were blinded to group assignment.

RESULTS

After 6 years, 104 restorations were analyzed (ER-Cu 24, ER-Ct 29, SE-Cu 27, SE-Ct 24). Fourteen restorations loss retention (ER-Cu 6, ER-Ct 1, SE-Cu 2, SE-Ct 7). Retention rates (95 % confidence interval) were 79.3 % (61.6 - 90.1) for ER-Cu; 97.0 % (83.3 - 99.4) for ER-Ct; 93.1 % (78.1 - 98.1) for SE-Cu; and 76.7 % (59.1 - 88.2) for SE-Ct, with statistical differences between SE-Cu vs. ER-Ct, and SE-Ct vs. ER-Ct (p < 0.05). Thirty-one restorations (ER-Cu 6, ER-Ct 5, SE-Cu 9, SE-Ct 11) showed minor marginal staining, and forty-one restorations (ER-Cu 8, ER-Ct 10, SE-Cu 11, SE-Ct 12) presented minimal marginal adaptation defects (p > 0.05). No significant differences were found for other secondary parameters (p > 0.05).

CONCLUSION

This is the first 6-year clinical trial showing the long-term behavior of a universal adhesive system in NCCLs. The addition of CuNp does not affect the clinical performance of the universal adhesive.

HEMA-free versus HEMA-containing adhesive systems: a systematic review

BACKGROUND

Hydrophilic monomer 2-hydroxyethyl methacrylate (HEMA)-free adhesive systems are gaining increasing popularity nowadays. Although the addition of HEMA to dental adhesives improves dentin wettability and resin diffusion into demineralized collagen fibrils, HEMA's high hydrophilicity can lead to hydrolytic degradation of the adhesive interface. Thus, HEMA-free adhesive systems have been developed. Unfortunately, the lack of HEMA in the adhesive composition may lead to a separation phase between hydrophobic and hydrophilic components. The aim of this systematic review was to evaluate the clinical performance of HEMA-free adhesive systems and compare them with HEMA-containing ones.

METHODS

An electronic search of The National Library of Medicine (MEDLINE/PubMed) was conducted. Eligibility criteria were reporting empirical data from clinical studies published between 2013 and 2023 about the clinical performance of HEMA-free adhesive systems for direct resin composite restorations. Studies with at least 2-year clinical follow-up done in permanent dentition in any form of cavities were selected. The included studies were assessed for risk of bias using the modified Cochrane Collaboration tool criteria.

RESULTS

The database search returned 147 studies; a total of 7 studies were included in this review; the majority of studies reported no significant difference between the two types of adhesives for the parameter of retention.

CONCLUSIONS

HEMA-free adhesive systems exhibited good clinical performance with regard to retention. There was some concern about their influence on marginal adaptation and marginal discoloration due to the conflicted results reported by the included trials. Thus, the results need to be confirmed with long-term evaluations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023448952.

Effect of Application Mode and Aging on Microtensile Bond Strength of Universal Adhesives to Enamel of Primary Teeth

BACKGROUND

Limited reports are available regarding bonding of universal adhesives to primary teeth' enamel.

AIM

To evaluate the effect of application mode and aging on microtensile bond strength (μTBS) of universal adhesives to primary enamel.

DESIGN

Ninety-six human primary molars were randomly assigned to three groups: SU: Scotchbond Universal (3M); CU: Clearfil Universal Bond Quick (Kuraray Noritake); iBU: iBond Universal (Heraeus Kulzer), then subdivided according to phosphoric acid etching time into three subgroups (SG): SG1: 0s; SG2: 15s; SG3: 30s. Samples were incubated for 24 h, while separate samples for SG1 & SG2 were aged for 6 months. After μTBS testing, light microscope was used for evaluating failure patterns and SEM for the adhesive interface. Data were analyzed using linear mixed model and post hoc tests (p < 0.05).

RESULTS

Selective etching increased μTBS of universal adhesives to enamel (p < 0.001) without significance between 15 and 30 s etching (p > 0.05). Six-month aging significantly reduced the μTBS of SU in SG2 (p < 0.014) when compared to 24 h aging.

CONCLUSIONS

Selective etching with phosphoric acid remains the gold standard for bonding universal adhesives to primary teeth enamel. While etching time showed no significant effect on immediate μTBS, aging may affect the μTBS of SU applied on 15 s etched enamel.

Prospective, randomized clinical trial evaluating the clinical performance of a new universal adhesive in Class I and Class II restorations at 1 year

OBJECTIVE

This randomized controlled trial compared the 1-year clinical efficacy of Scotchbond Universal Adhesive Plus (SBU+) with that of its predecessor Scotchbond Universal Adhesive (SBU) to restore Class I and Class II preparations using the self-etch strategy in adult patients.

MATERIALS AND METHODS

Fifty-one subjects participated in this study. Two posterior teeth in each subject were randomized to a restoration with SBU+ or to a restoration with SBU (control) using the self-etch strategy. Teeth were restored with Filtek Universal Restorative. Restorations were evaluated at baseline, 6 months and 1 year using the FDI criteria. The Wilcoxon signed-rank test was used to compare outcomes.

RESULTS

No restorations were graded as "Insufficient/Unsatisfactory" or "Poor" for any of the FDI criteria at the baseline, 6-month, or 1-year visits. At 1 year the retention rate was 100% for both SBU+ and SBU. For fracture of the restorative material 42/44 SBU+ restorations (95%) and 44/44 SBU restorations (100%) were graded "Excellent/Very Good" (p > 0.05). All restorations were clinically acceptable for marginal adaptation at 1 year with no statistical differences between the two adhesive materials. There were no recurrent caries lesions at the 1-year visit.

CONCLUSIONS

The clinical efficacy of the SBU+ at 1-year was not different to that of its predecessor SBU in Class I and Class II restorations of adult patients using the self-etch strategy.

CLINICAL RELEVANCE

The two dental adhesives used in this clinical trial showed excellent results in posterior restorations at 1 year without using a separate phosphoric etching step.

Effect of an Additional Hydrophobic Adhesive Layer Application on the Clinical Performance of Class V Resin Composite Restorations: An 18-month Randomized Clinical Trial

OBJECTIVES

This study aimed to evaluate the 18-month clinical performance of two different one-step adhesives that were applied alone or with an additional hydrophobic adhesive layer to noncarious cervical lesions.

METHODS AND MATERIALS

One hundred sixty teeth in 31 patients were included in the study. Each patient received at least four restorations. A 2-hydroxyethylmethacrylate (HEMA)-containing one-step self-etch adhesive (Clearfil S3 Bond Plus, Kuraray Noritake, Noritake, Japan) and a HEMA-free universal adhesive (G-Premio Bond) were applied to noncarious cervical lesions with or without additional hydrophobic adhesive (Heliobond) randomly. Teeth were restored with a nanohybrid composite. Restorations were evaluated according to FDI criteria at baseline, 6-, 12-, and 18-month recalls. Data were analyzed with the Kruskal-Wallis and the Friedman analysis of variance (ANOVA) tests (α=0.05).

RESULTS

At 18 months, recall rates were 100%, and there was no significant difference between four different adhesive applications in terms of any criteria (p>0.05). The cumulative retention rates were 92.5%, 92.5%, 97.5%, and 100% for the restorations with one-step self-etch, one-step self-etch plus hydrophobic adhesive layer, a universal adhesive, and a universal adhesive plus hydrophobic adhesive layer, respectively.

CONCLUSION

An additional hydrophobic adhesive layer was found to have no significant effect on the 18-month clinical performance of two different one-step adhesive systems with and without HEMA.

Dentin Bonding Durability of Four Different Recently Introduced Self-Etch Adhesives

The objectives of this study were to evaluate the bonding durability of four different self-etch adhesives to dentin after 24 h and thermal cycling (TC) and to measure the degree of polymerization conversion (DC) in situ. Two-step self-etch adhesives, Clearfil SE Bond 2 (SE2, Kuraray Noritake Dental) and G2-Bond Universal (G2B, GC), and one-step self-etch adhesives, Scotchbond™ Universal Plus Adhesive (SBU, 3M ESPE) and Clearfil Universal Bond Quick (UBQ, Kuraray Noritake Dental), were used. The labial surfaces of bovine teeth were ground to create flat dentin surfaces. The adhesives were applied according to the manufacturers' instructions. After resin composite buildup and 24 h water storage, the specimens were sectioned into beams and all groups were subjected to thermal stress for 0, 10,000 (10k), or 20,000 (20k) cycles followed by micro-tensile bond strength (µTBS) testing. In situ DC was investigated with a laser Raman microscope. The µTBS data were statistically analyzed and subjected to a Weibull analysis. The different groups were compared at the characteristic strength (63.2% probability of failure) (α = 0.05). Two-Way ANOVA was used to show the effect of different adhesives and thermal cycling on the mean DC% followed by Tukey's multiple comparison post hoc test. G2B/TC10k resulted in a significant increase in the µTBS compared to TC0. SBU/TC20k showed significantly higher µTBS compared to TC0. For comparison between different tested adhesives, SBU showed a significantly lower µTBS compared to G2B after TC10k. G2B and SBU showed a greater number of adhesive failures after TC. Mean DC% was different for each adhesive. The newly developed MDP- and HEMA-free 2-SEA showed similar bonding performance with the gold-standard 2-SEA. However, there is still room for further improvement in terms of SEAs.

Influence of residues from bioceramic sealer on the bond interface with universal adhesive in different application modes

This study evaluated the effect on adhesive layer thickness, bond strength, and adhesive failure pattern of the application of universal adhesive (Scotchbond Universal) using either manual or rotary brush in dentin previously impregnated with bioceramic sealer (Sealer Plus BC) using a manual brush, at 24 h and 1 year. Eighty-eight bovine crowns were divided into four groups (n = 22) according to the intervention: (i) use of bioceramic sealer and adhesive application using manual brush, (ii) use of bioceramic sealer and adhesive application using rotary brush, (iii) use of resin sealer and adhesive application using manual brush, and (iv) use of resin sealer and adhesive application using rotary brush. Subsequently, specimens were restored with a composite resin (Filtek Z-250). Adhesive layer thickness was evaluated using confocal microscopy. Bond strength was assessed using the microtensile bond strength test, and adhesive failure pattern was evaluated under a stereomicroscope. Data were analyzed using two-way ANOVA/Tukey tests. Specimens where a rotary brush had been used exhibited lower adhesive layer thickness. Specimens treated with resin sealer and using a manual brush showed lower bond strength values and a higher occurrence of adhesive failures at 24 h and 1 year than specimens treated with bioceramic sealer and using rotary brush for adhesive application.

Clinical performance of posterior restorations using a universal adhesive over moist and dry dentin: A 36-month double-blind split-mouth randomized clinical trial

OBJECTIVES

To evaluate the influence of dentin moisture on the clinical behavior of a universal adhesive on posterior teeth after 36 months of follow-up.

METHODS

Forty-five patients participated in this study. Following a split-mouth design, three operators placed 90 Class I/Class II restorations over moist dentin (MD) or dry (DD) (n = 45) with resin composite (Filtek Bulk Fill) and a universal adhesive used in the etch-and-rinse mode (Single Bond Universal). Each restoration was evaluated according to the FDI and USPHS criteria (postoperative sensitivity, fracture and retention, marginal staining, marginal adaptation, and recurrence of caries) at baseline and after 6-, 12-, and 36 months. For statistical analysis, Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used.

RESULTS

No significant difference between groups was observed in each FDI criterion after 36 months of clinical evaluation (p > 0.05). The retention rates (confidence interval 95 %) were 97.37 % (86.5 - 99.5) for both MD and DD without significant difference between them (p > 0.05). Eight restorations (MD = 4; DD = 4) showed minimal marginal staining defects (p > 0.05). Two restorations were lost (MD = 1; DD = 1). Fifteen restorations (MD = 8; DD = 7) presented minor marginal discrepancies according to the FDI criteria (p > 0.05).

CONCLUSION

The clinical performance of the universal adhesive when applied in etch-and-rinse mode was not influenced by dentin moisture in posterior bulk-fill composite restorations.

CLINICAL SIGNIFICANCE

The level of dentin moisture appears not to influence the clinical efficacy of a universal adhesive when applied using the etch-and-rinse technique in posterior composite resin restorations.

Influence of bioceramic sealer residues on the adhesion interface with a universal adhesive in the etch-and-rinse strategy, based on the application protocol and evaluation time

The aim of this study was to evaluate the effects of the application of universal adhesive in the etch-and-rinse (ER) strategy with a manual brush (MB) or rotary brush (RB) in adhesion to dentin impregnated (WB) or not (NB) with bioceramic sealer, at 24 h and 1 year. Eighty-eight crowns of bovine incisors were divided into four groups (n=22): WB-MB, WB-RB, NB-MB, NB-RB. After the restorative protocol, dentin penetrability was evaluated by confocal microscopy. Bond strength was evaluated by microtensile test. Data were analyzed using one-way ANOVA/Tukey tests (α=0.05). NB-RB and WB-RB exhibited greater extensions of resin tags in dentin. At 24 h, WB-RB and NB-MB showed the highest and lowest values of bond strength, respectively. At 1 year, WB-MB and WB-RB demonstrated the highest bond strength values. The RB increases the formation of resin tags and residues of bioceramic sealer provides higher bond strength in the ER strategy.

Can a Novel Device with Pure Dry Air Increase the Shear Bond Strength of Dental Composites to Dentin? An Experimental Study

Modern conservative dentistry is taking the lead in daily clinical practice and is relying on adhesion. Whether it is a simple composite, ceramic inlays, onlays, veneers or crowns, the common factor for a successful outcome is a good bonding of these elements to dental structures. Thus, the purpose of this study was to evaluate the bond strength of resin composite to dentin when using a new device, the DENTIPURE KM™ (KM, Beirut, Lebanon), which provides a pure air flow, free of any contaminants and without humidity, when compared to other dental equipment. One hundred and eighty extracted human molars were equally divided into three groups according to the device used, the DENTIPURE KM™ (KM, Beirut, Lebanon), the KAVO™ (ESTETICA E30/E70/E80 Vision, KAVO, Biberach, Germany), or the ADEC™ (A-dec Performer 200, Newberg, OR, USA). The shear bond strength (SBS) was evaluated after 24 h of storage in distilled water on a universal testing machine. Statistical analysis was set with a level of significance at p ≤ 0.05. The results revealed that significantly different bond strength was imparted by the DENTIPURE KM™ device and the ADEC™ dental unit (p = 0.042). In conclusion, while the DENTIPURE KM™ device shows promise in providing contaminant-free air during bonding, its impact on dentin bond strength compared to devices like the KAVO™ appears minimal. Further research is needed to fully assess its potential in enhancing dentinal adhesion procedures.

Clinical evaluation of posterior restorations over wet and dry dentin using an etch-and-rinse adhesive: A 36-month randomized clinical trial

OBJECTIVES

To evaluate the clinical performance of posterior restorations over wet and dry dentin with an etch-and-rinse adhesive after 36 months of clinical service.

METHODS

Forty-five participants were recruited, each one had at least two posterior teeth that needed restoration. Ninety restorations were placed on Class I or Class II cavities. For the restoration protocol, a simplified etch-and-rinse adhesive (Adper Single Bond 2) was applied over wet (WD) or dry dentin (DD) and later restored with a bulk-fill composite (Filtek Bulk Fill) under rubber dam isolation. Each restoration was evaluated using the World Dental Federation (FDI) criteria after 6, 12, and 36 months of clinical service, regarding the following principal restoration characteristics: postoperative sensitivity, marginal discoloration, marginal adaptation, fracture of material and retention, and recurrence of caries. Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used for statistical analysis.

RESULTS

After 36 months of clinical evaluation, no significant difference between groups was observed in each FDI criterion (p > 0.05). Twenty restorations (WD=10, DD=10) showed minor marginal staining, and twenty-two restorations (WD=11, DD=11) presented small marginal adaptation defects (p > 0.05). Four restorations were lost (WD = 2, DD = 2) and the fracture rates (95% confidence interval) were 94.9% for each one, without significant difference between wet and dry dentin (p > 0.05).

SIGNIFICANCE

The degree of dentin moisture does not seem to affect the clinical performance of a simplified etch-and-rinse adhesive in posterior restorations when the adhesive is applied vigorously over the dentine surface.

Prolonged polymerization of a universal adhesive in non-carious cervical lesions: 36-month double-blind randomized clinical trial

OBJECTIVE

To evaluate the effect of prolonged (P) polymerization time of a universal adhesive system applied in etch-and-rinse (ER) or self-etch (SE) strategies on the clinical performance of restorations in non-carious cervical lesions (NCCLs), after 36 months of clinical service.

METHODS

A total of 140 restorations were randomly placed in 35 subjects according to the polymerization time groups: ER (10 s); ER-P (40 s); SE (10 s); and SE-P (40 s) at 1,200 mW/cm2. Composite resin was placed incrementally. The restorations were evaluated immediately and after 6, 12, 18, and 36 months using the FDI criteria. Data were analyzed using the Kaplan-Meier survival test for retention loss, and the Kruskal-Wallis' test for secondary outcomes (α = 0.05).

RESULTS

After 36 months, 19 restorations were lost: ER 6, ER-P 2, SE 9, SE-P 2. The retention rates were 82.3% for ER; 94.1 % for ER-P; 73.5 % for SE; and 94.1 % for SE-P, with a significant difference between ER vs. ER-P and SE vs. SE-P, as well as ER vs. SE-P and ER-P vs. SE (p < 0.0001). Minor defects were observed in 18 restorations for the marginal staining criteria: ER 5, ER-P 2, SE 8, SE-P 3; and in 33 restorations for the marginal adaptation criteria: ER 11, ER-P 4, SE 12, and SE-P 6 (p > 0.05). No restorations showed recurrence of caries or postoperative sensitivity.

CONCLUSIONS

A prolonged polymerization time of 40 s improves the clinical performance of the universal adhesive for both adhesive strategies evaluated, even after 36 months.

CLINICAL SIGNIFICANCE

Prolonging the polymerization time of a universal adhesive from 10 to 40 s has been shown to improve its clinical performance when used in NCCLs.

Influence of Application Modes on Increasing Bond Strength Longevity of Self-etching and Universal Adhesive Systems to Enamel

The present study aimed to evaluate the influence of application mode on the short-term microshear bond strength longevity of self-etching and universal adhesive systems to enamel, the failure mode, and the resulting enamel surface micromorphology. Ninety enamel surfaces were obtained from sound third molars, planed, and randomly assigned to nine groups, according to the application mode and the adhesive system (n=10). There were three primer application modes: according to the manufacturer's recommended application time (control), using double the application time recommended for the primer and selective enamel etching. The adhesive systems used were: Clearfil SE Bond (Kuraray), FL-Bond II (SHOFU), and Futurabond U (Voco). At least two resin-bonded composite cylinders (Grandioso Light Flow, Voco) were placed on each enamel surface, and then evaluated for microshear bond strength at 24 hours and 180 days of storage in solution body fluid (SBF) at pH 7.4. Failure modes were evaluated with a stereoscopic microscope at 20× magnification. A micromorphological analysis of the enamel surface was performed under a scanning electron microscope at 5000× magnification before and after the treatments. Mixed models for repeated measures over time showed significant interaction among application modes, adhesive systems, and time periods (p=0.0331). The bond strength of FL-Bond II adhesive to enamel observed after performing selective enamel etching was significantly higher than that observed after applying the control treatment (p=0.0010) at both 24 hours and 180 days. However, no significant difference was observed between the application of this same adhesive at double the time recommended by the manufacturer and the other two application modes (p>0.05). There was also no significant difference in the microshear bond strength for the enamel treatments applied using Clearfil SE Bond and Futurabond U (p>0.05). A significant reduction in bond strength to enamel was observed at the 180-day storage time for all the adhesive systems when selective enamel etching was performed (p<0.0001). No significant association was observed between the adhesive system failure mode and the enamel treatments (p=0.1402 and p=0.7590 for 24 hours and 180 days, respectively). The most prevalent failure was the adhesive type.

Prolonged application time effects on universal adhesives in non-carious cervical lesions: An 18-month split mouth randomized clinical trial

OBJECTIVE

This double-blind, split mouth randomized clinical trial aimed to assess the clinical performance of Clearfil Universal Bond Quick (CBUq) universal adhesive under different application times (no waiting and waiting) compared to Clearfil SE Bond adhesive in non-carious cervical lesions (NCCLs) over 18 months.

METHODS

One hundred and eighty-three restorations were distributed randomly into three groups based on the adhesive system and waiting time: CUBq without waiting time (CUBq-NW), CUBq with a 20 s waiting time (CUBq-W), and CSE with a 20 s waiting time. After placement, restorations were evaluated after 18 months using the International Dental Federation (FDI) and United States Public Health Service (USPHS) criteria. Statistical analyses involved Friedman repeated measures analysis of variance and Wilcoxon tests, with a significance level set at 5 %.

RESULTS

Over the 18-month period, no restorations were lost across the tested groups. Marginal adaptation evaluation indicated minor discrepancies in 21 restorations (8 CUBq-NW, 6 CUBq-W, and 7 CSE). There were no significant differences observed among the three groups following the 18-month clinical assessment (p > 0.05). Only two restorations showed marginal discoloration after 18 months (1 CUBq-NW and 1 CSE).

CONCLUSIONS

The application of Clearfil Universal Bond Quick using either the "waiting" or "no-waiting" technique exhibited excellent clinical results in NCCLs during the 18-month follow-up period, demonstrating comparable performance to Clearfil SE Bond in all assessed outcomes.

CLINICAL SIGNIFICANCE

The findings suggest that the new universal adhesive applied using the no-waiting technique demonstrates promising clinical performance when compared to conventional application methods.

TRIAL REGISTRATION

ClinicalTrials.gov identifer RBR-69p7mpr.

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.

Effect of the Absence of HEMA on the Bonding Properties of Universal Adhesive Systems Containing 10-MDP: An In Vitro Study

OBJECTIVES

To evaluate the absence of 2-hydroxyethyl methacrylate (HEMA) on the adhesive properties with enamel and dentin of universal adhesive systems containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP).

METHODS AND MATERIALS

One hundred and twelve caries-free third molars were used to test adhesion to dentin (n=64) and enamel (n=48). For each substrate, teeth were divided into eight experimental groups: four different adhesives each using two adhesive strategies. The adhesives used were: (1) Scotchbond Universal (SBU, 3M Oral Care, St Paul, MN, USA) as a HEMA-containing universal adhesive; (2) Gluma Bond Universal (GBU, Kulzer, Hanau, Germany); (3) Solare Universal Bond (SUB, GC, Tokyo, Japan); and (4) Zipbond Universal (ZIP, SDI, Victoria, Australia) as HEMA-free universal adhesives. The adhesive strategies used were etch-and-rinse (ER) and self-etch (SE). For dentin tests, the occlusal third of the crown of all teeth was removed and an adhesive protocol was applied. After completing the restoration, specimens were sectioned into bonded sticks (0.8 mm 2) and tested for microtensile bond strength (μTBS), in situ degree of conversion (DC), and nanoleakage (NL) by scanning electron microscopy. For enamel tests, teeth were sectioned into four parts (buccal, lingual, and proximal), and an adhesive protocol was applied. After completing the restoration, the specimens were tested for their microshear bond strength (μSBS). For in situ degree of conversion (DC) and nanoleakage (NL) evaluation of enamel, the specimens were sectioned in slices to be evaluated. The data for each substrate were subjected to two-way ANOVA and Tukey's test (α=0.05) for each property evaluated.

RESULTS

The SBU and ZIP adhesives showed the highest μSBS, and DC (dentin and enamel) and lower NL (dentin) values compared to GBU and SUB (p=0.001). However, SBU showed better results in terms of μTBS and μSBS (SE strategy), and DC (dentin and enamel) than ZIP. Strategy ER presented higher values of μTBS and μSBS when compared to strategy SE (p=0.001), except for SBU.

CONCLUSION

The effect of the absence of HEMA in commercial universal adhesive systems on enamel and dentin adhesive properties appears to be material-dependent.

Adhesion to enamel and dentine: an update

With the continuous development of adhesive technology leading to a wide variety of bonding systems in the market, clinicians are often faced with a vast number of systems to choose from. Although research and manufacture of bonding systems is constantly progressing, the focus has generally been on simplifying the bonding process by reducing the number of clinical steps, with little emphasis on evidence-based performance. This article draws attention to the current strategies of common commercially available products to guide clinicians during bonding system selection and application.

48-month clinical evaluation of a copper-containing universal adhesive in non-carious cervical lesions: A double-blind randomised clinical trial

OBJECTIVES

This study aimed to evaluate the effect of copper nanoparticles (CuNp) on the clinical performance of a universal adhesive system used as an etch-and-rinse or self-etch strategy.

METHODS

A total of 216 class V (non-carious lesions) restorations were randomly placed in 36 subjects according to the following groups: ERcu, adhesive in etch-and-rinse with 0.1% CuNp; ERct, adhesive in etch-and-rinse without CuNp; SEcu, adhesive in self-etch with 0.1% CuNp; and Sect, adhesive in self-etch without CuNp. Restorations were evaluated at baseline and at 6, 12, 18, 36, and 48 months, using the FDI and USPHS criteria. Appropriate statistical analyses were performed (α = 0.05).

RESULTS

After 48 months, 14 restorations were lost (two for ERcu, five for SEcu, and seven for SEct) and the retention rates (95% confidence interval [CI]) were 74.1% for ERcu (95% CI 61.1-83.8); 81.5% for ERct (95% CI 69.2-89.6); 64.8% (95% CI 51.5-76.2) for SEcu; and 64.8% (95% CI 51.5-76.2) for SEct, with statistical differences between SEct vs. ERct and SEcu vs. ERct (p < 0.05). No significant differences between the groups were observed when the secondary parameters were evaluated (p > 0.05). Nineteen restorations (two for ERcu, two for ERct, six for SEcu, and nine for SEct) showed minor marginal staining, and 44 restorations (7 for ERcu, 8 for ERct, 14 for SEcu, and 15 for SEct) presented minimal marginal adaptation defects.

SIGNIFICANCE

This is the first long-term clinical trial to show that the addition of CuNp to a universal adhesive system does not affect clinical performance.

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.

Eighteen-month clinical evaluation of a new universal adhesive applied in the "no-waiting" technique: a randomized clinical trial

OBJECTIVE

The aim of this double-blind, randomized clinical trial was to evaluate the 6- and 18-month clinical performances of a new universal adhesive applied in the "no-waiting" (NW) technique to non-carious cervical lesions (NCCLs) using two evaluation criteria.

MATERIALS AND METHODS

One hundred and seventy-six restorations were assigned to four groups according to the adhesive system, adhesive strategy, and application mode: Prime&Bond Active (PB) applied using the etch-and-rinse (ER) and self-etch (SE) strategies with 20 s applications and Clearfil Universal Bond Quick (CQ) applied using the ER and SE strategies with the NW technique. The composite resin restorations were evaluated at baseline and after 6 and 18 months using the World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. The Friedman repeated measures analysis of variance and Wilcoxon test were used for statistical analyses (α = 0.05).

RESULTS

No significant differences were observed among any of the groups or criteria after 6 months (p > 0.05). After 18 months, 10 restorations were lost (p > 0.05) (2 with PB-ER [95.5%; 95%CI: 92-100%], 4 with PB-SE [90.9%; 95%CI: 82-98%], 0 with CQ-ER [100%; 95%CI: 92-100%], and 4 with CQ-SE [90.9%; 82-98%]). The restorations performed with the SE strategy showed more marginal discrepancies than those performed with the ER strategy, mainly when the FDI criteria were used (p < 0.05). Those that used the PB-SE showed fewer marginal discrepancies than those that used the CQ-SE (FDI; p < 0.05). A few restorations showed marginal discrepancies after the USPHS analysis (p > 0.05).

CONCLUSIONS

The results when using the CQ-SE and -ER strategies with the NW technique were similar to those when using the PB-SE and -ER strategies in standard applications to non-carious cervical lesions after 6 and 18 months of clinical evaluation.

CLINICAL RELEVANCE

After 6 and 18 months, the application of Clearfil Universal Bond Quick with the "no-waiting" technique showed similar clinical performance compared to the standard application of Prime & Bond Active applied using the standard application time (20 s).

TRIAL REGISTRATION

ClinicalTrials.gov identifier RBR-5f9gps.

Role of the smear layer in adhesive dentistry and the clinical applications to improve bonding performance

Currently, dental adhesives can be divided into two systems; a smear layer-removal approach with etch-and-rinse adhesives or a smear layer-modified approach with self-etching adhesives. After phosphoric acid etching, the smear layer is completely removed. More attention is, however, required when using self-etching adhesives. The smear layer is partially demineralized by the weak acidic monomer and subsequently incorporated into the hybrid layer. Therefore, the characteristics of the smear layer play an important role on the bonding performance of self-etching adhesives. Such characteristics, for instance, smear layer thickness and smear layer density, are influenced by many factors, e.g., instruments used for dentin surface preparation, cutting speed, and the abrasive particle size of the cutting instruments. This review discusses the contributing factors that affect the smear layer characteristics, and the influence of the smear layer on the bonding performance of dental adhesives. Also, the application techniques regarding how to improve the bonding performance of self-etching adhesives - the smear layer removal by using chemical agents, or the modification of the adhesive application procedures - are provided.

Effectiveness of sodium hypochlorite treatment on the bonding of four adhesive systems to fluorotic enamel

The study evaluated the effect of sodium hypochlorite (NaOCl) treatment on fluorotic enamel bonding of four adhesive systems. They were Single Bond 2 (SB2), Prime&Bond NT (PBN), Clearfil SE Bond (CSB), and Single Bond Universal (SBU). One hundred eighteen extracted moderate fluorotic molars were divided into eight groups according to NaOCl pretreatment and four adhesive systems. The microshear bond strength (μSBS), etching pattern, and penetration depth (PD) were observed. The statistical method was two-way ANOVA and least significant difference (LSD) test (α=0.05). The application of NaOCl significantly increased the μSBS of PBN and SBU (p<0.05). The enamel-etching pattern of CSB and SBU was deeper under SEM. A noticeable increase of PD was in SB2 and SBU after the application of NaOCl (p<0.05). Pretreatment of 5.25% NaOCl for the 60 s can increase μSBS of PBN and SBU, PD of SB2 and SBU, and improve enamel-etching pattern of CSB and SBU to fluorotic enamel.

Effect of Self-cured Universal Adhesive System on Shear Bond Strengths of Conventional and Bulk-fill Composites

ABSTRACT Effect of Self-cured Universal Adhesive System on Shear Bond Strengths of Conventional and Bulk-fill Composites Ihsan HUBBEZOGLU1, Serra KUTLU2, Ayşegül KARAARSLAN3 1 Sivas Cumhuriyet University, Faculty of Dentistry, Department of Restorative Dentistry, Sivas, Turkey 2 Niğde Oral and Dental Center, Niğde, Turkey 3 Sivas Oral and Dental Center, Sivas, Turkey Aim: The aim of this study was to investigate the effect of self-cured universal adhesive system on shear bond strengths of two conventional and two bulk-fill composites to dentin. Material-method: In this study, four groups were formed: two conventional condensable composites[G-aenial posterior(GC), Palfique Estelite Paste(Tokuyama)], and two bulk-fill composites[Estelite Bulk Fill Flow(Tokuyama), Beautifil Bulk Restorative(Shofu)]. Each group was divided into two subgroups; G-premio bond (control group) ve self-cured Universal Bond (Tokuyama). 32 human third molar human teeth were prepared to expose dentin surfaces. After the preparation, the teeth were randomly divided into 4 main groups and 2 subgroups (n = 8), composites were applied to the surfaces with the help of cylindrical silicone transparent mold with a diameter of 4 mm and a height of 4 mm. Results: In this study, when both adhesive systems are evaluated; the highest shear bond strength value was Palfique Estelite Paste, while the lowest shear bond strength value was Beautifil Bulk Restorative. While the difference between Palfique Estelite Paste and Estelite bulk-fill flow, Beautifil Bulk Restorative was found to be statistically significant (p&lt;0.05), the difference with G-aenial posterior was not significant (p&gt;0.05). The difference between G-aenial posterior and Beautifil Bulk Restorative was found to be statistically significant (p&lt;0.05). When adhesive systems are compared; G-premio bond was found to be higher in all composite groups compared to self-cured Universal Bond, but the difference between them was statistically insignificant (p&gt;0.05). Conclusion: While conventional composites exhibited high shear bond strengths, bulk-fill composites showed values close to these values. The self-cured adhesive system we used showed near values of shear bond strength to the light-polymerized adhesive system. In terms of bond strength self-cured adhesive systems can be recommended for use in areas where light can be difficult to reach in clinical applications. It is advisable to use self-cured adhesive systems for use in areas where light can be difficult to access in clinical applications. Keywords: shear bond strength, bulk-fill composites, self-cured adhesive systems ÖZET Geleneksel ve Bulk-fill Kompozitlerin Makaslama Bağlanma Dayanımlarına Işıksız Adeziv Sistemin Etkisi Amaç: Çalışmamızın amacı, iki geleneksel ve iki bulk-fill kompozitlerin dentine makaslama bağlanma dayanımlarına ışıksız adeziv sistemin etkisinin incelenmesidir. Materyal-metod: Çalışmamızda iki geleneksel kondanse edilebilen kompozit [G-aenial posterior(GC), Palfique Estelite Paste(Tokuyama)], kütlesel yerleştirilebilen iki bulk-fill kompozit [Estelite Bulk Fill Flow(Tokuyama), Beautifil Bulk Restorative(Shofu)] olarak 4 grup oluşturuldu. Her grup iki alt gruba ayrıldı; G-premio bond (Kontrol grubu) ve ışıksız Universal Bond (Tokuyama). 32 adet insan üçüncü molar insan dişi dentin yüzeyleri açığa çıkacak şekilde prepare edildi. Preparasyonun ardından dişler rastgele 4 ana, 2 alt gruba ayrıldı(n=8), yüzeylere 4 mm çapında ve 4 mm yüksekliğindeki silindirik silikon şeffaf kalıp yardımıyla kompozitler uygulandı. Tüm grupların makaslama bağlanma değerleri universal test cihazında ölçüldü, kuvvet birimi ise “newton” (=N) olarak kalibre edildi. Bulgular: Çalışmamızda her iki adeziv sistem kullanıldığında da, en yüksek makaslama bağlanma dayanım değerini Estelite Paste gösterirken, en düşük makaslama bağlanma dayanım değerini Beautifil Bulk Restorative göstermiştir. Estelite pasteile; Bulk-fill flow ve Beautifil Bulk Restorative arasındaki fark istatistiksel olarak anlamlı bulunurken (P&lt;0,05), G-aenial posterior ile arasındaki fark anlamsız bulunmuştur(P&gt;0,05). G-aenial posterior ile Beautifil Bulk Restorative arasındaki fark istatistiksel olarak önemli bulunmuştur(P&lt;0,05). Adeziv sistemler kıyaslandığında; tüm kompozit gruplarında G-premio bond, Işıksız Universal Bonda göre daha yüksek bağlanma sağlarken, aralarındaki fark istatistiksel olarak anlamsız bulunmuştur (P&gt;0,05). Sonuçlar: Geleneksel kompozitler, yüksek makaslama bağlanma dayanımları sergilerken, bulkfill kompozitler bu değerlere yakın değerler göstermiştir. Kullandığımız ışıksız adeziv sistem, ışıkla polimerize edilen adeziv sisteme yakın bağlanma değerleri sergilemiştir. Işıksız adeziv sistemler, klinik kullanımlarda ışığın zor olabileceği bölgelerde bağlanma dayanımı açısından kullanılması önerilebilir. Anahtar kelimeler: makaslama bağlanma dayanımı, bulkfill kompozitler, ışıksız adezivler

Sixty-month follow up of three different universal adhesives used with a highly-filled flowable resin composite in the restoration of non-carious cervical lesion

OBJECTIVE

The purpose of this clinical trial was to evaluate and compare the performances of three different universal adhesives used with a highly filled flowable universal resin composite in the restoration of non-carious cervical lesions (NCCLs) over a 60-month period.

MATERIAL AND METHODS

Ninety-nine NCCLs were restored at 18 participants. NCCLs were divided into three different universal adhesive groups: Clearfil Universal Bond (CU) (n = 31), iBOND Universal (IU) (n = 33), and G-Premio Bond (GP) (n = 35). Prior to the adhesive procedures, selective enamel etching was performed with 37% phosphoric acid in all experimental groups. Adhesive systems were applied following the manufacturers' instructions, and the lesions were restored with a highly filled flowable resin composite (G-ænial Universal Flo). Restorations were finished and polished immediately after placement. All restorations were scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, surface texture, and color match using modified United States Public Health Service (USPHS) criteria after 1 week (baseline) and 6, 12, 18, 24, 36, and 60 months. Statistical analyses were performed using chi-square and McNemar's and Kaplan Meier tests. The level of significance was set at p < 0.05.

RESULTS

After 60 months, the recall rate was 72.2%. Survival rates of CU, IU, and GP restorations were 87%, 85.2%, and 96.5%, respectively. Five CU (25%), 8 IU (34.8%), and 12 GP (42.9%) restorations exhibit bravo scores for marginal adaptation. However, no differences were seen among them. CU showed lower bravo score than IU and GP for marginal discoloration (CU, 0%; IU, 26.1%; GP, 32.1%). Two CU, 7 IU, and 6 GP restorations showed bravo scores for surface texture, and 2 (9.1%) CU and 1 (3.3%) GP restorations were scored as bravo score for color match (p > 0.05).

CONCLUSION

The tested universal adhesives showed similar success rates during the 60-month follow-up. However, CU showed better clinical performance than IU and GP in terms of marginal adaptation and discoloration.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03415412 CLINICAL RELEVANCE: The long-term clinical performances of the three universal adhesives in the restoration of NCCLs using selective enamel etching mode were successful after 60 months.

Effects of rotary brush active application on enamel etching patterns of self-etch adhesive systems

Abstract.

Dental adhesion with resin composites: a review and clinical tips for best practice

Modern restorative dentistry would not be possible without the ability to bond to tooth structure. The development of dental adhesives has a lengthy gestation, from the beginnings around 1950, to the latest generation: modern universal adhesives, which were introduced during the 2010s. The foundation for these developments was a deeper understanding of the mechanisms of adhesion to the tooth structure, and to restoration materials. Typically, the performance of an adhesive does not depend on the use of a single ingredient, but on an overall balanced and optimised formulation that contains various components with different roles, such as functional adhesive monomers.While a wealth of literature exists on adhesives that have a long and successful clinical history ('gold standards'), some universal adhesives have also accumulated a lot of scientific evidence while offering benefits like ease of use, low technique sensitivity and versatility.To achieve reliable results with a modern adhesive, several tips should be kept in mind regardless of the product, which result in a homogeneous adhesive layer, proper cure and ultimately high bond strength. Although high performance is already achieved with the adhesives currently available, this is still an exciting area of ongoing research.

Sonic application of one-step self-etch adhesive in composite restorations of non-carious cervical lesions: A double-blind randomized clinical trial

OBJECTIVES

To evaluate the influence of the sonic device on the clinical performance of one-step self-etch adhesive systems in non-carious cervical lesions (NCCLs) after 18 months.

MATERIALS AND METHODS

Forty patients participated in this study. Eighty restorations were assigned to two groups (n = 40): Sonic application and Manual application. After the adhesive application (iBond Self-Etch, Kulzer, Hanau, Germany), NCCLs were restored using composite resin (Charisma, Kulzer, Hanau, Germany). The restorations were evaluated at baseline and after 18 months both according to the Word Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon test for significance in each pair were applied (α = 0.05).

RESULTS

After 18 months, 38 patients were evaluated. Twenty-three restorations were lost (19 for manual vs. 4 for sonic application). The retention rates (95% confidence interval) were 50% (CI 34.8%-65.1%) for manual application and 84.2% (CI 69.6%-92.6%) for sonic application (p < 0.05). Twelve restorations showed marginal staining (nine for manual vs. three for sonic application; FDI, p < 0.05) and nine some marginal discrepancy (seven for manual vs. two for sonic application; FDI, p < 0.05). No restorations showed postoperative sensitivity and caries recurrence at the time.

CONCLUSION

The sonic application increases the retention rate of iBond Self-Etch after 18 months of clinical evaluation in NCCLs.

CLINICAL RELEVANCE

The application of a simplified self-etch adhesive (iBond Self-Etch) associated to a sonic device seems to be an alternative to improve the clinical behavior in NCCLs.

An 18-month clinical evaluation of prolonged polymerization of a universal adhesive in non-carious cervical lesions: A double-blind randomized clinical trial

OBJECTIVE

This study aimed to evaluate the effect of prolonging polymerization time on the 18 months clinical performance of a universal adhesive system used as etch-and-rinse (ER) and self-etch (SE).

METHODS

140 restorations were randomly placed in 35 subjects according to the following groups: ER10 (light-curing for 10 s); ER40 (light-curing for 40 s); SE10 (light-curing for 10 s) and; SE40 (light-curing for 40 s/1200 mW/cm²). A resin composite was placed incrementally. The restorations were evaluated at baseline and after 18 months by using the FDI criteria. The following outcomes were evaluated: marginal staining, marginal adaptation, spontaneous post-operative sensitivity and recurrence of caries. The differences among the groups were calculated using Friedman repeated measures analysis of variance rank (α = 0.05).

RESULTS

After 18 months the retention/fracture rates were 88.9% (95%CI 74.1-95.6%) for ER10, 94.3% (95%CI 91.4-98.5%) for ER40, 77.2% (95%CI 60.1-87.9) for SE10 and 97.2% (95%CI 85.5-99.9%) for SE40. A significant difference was detected in the retention rate when SE10 was compared to the SE40 (p = 0.01). Also, ER40 showed a significant improvement of the marginal adaptation when compared to ER10 (p = 0.01).

SIGNIFICANCE

This is the first study that demonstrates an improvement in the clinical performance of universal adhesive systems in non-carious cervical lesions when prolonged light-cured was applied.

Effect of Time and Temperature of Air Jet on the Mechanical and Biological Behavior of a Universal Adhesive System

OBJECTIVES

To evaluate the influence of heat application on the degree of conversion (DC) of the 3M Single Bond Universal Adhesive System, as well as its transdentinal cytotoxicity and microtensile bond strength to dentin.

METHODS

Experimental groups were established according to the time and temperature of the air jet: G1: 5 seconds-25°C; G2: 10 seconds-25°C; G3: 20 seconds-25°C; G4: 5 seconds-50°C; G5: 10 seconds-50°C; G6: 20 seconds-50°C. In control group (G7), no treatment was performed. The DC was assessed using the Fourier transform infrared spectroscopy-attenuated total reflectance (FTIR-ATR) technique. For the transdentinal cytotoxicity test, dentin discs fitted in artificial pulp chambers (APC) received the application of the adhesive system and the air jets. For the microtensile bond strength, healthy molars were restored and submitted to the microtensile test after 24 hours and 6 months, respectively.

RESULTS

Significant reduction in viability of Mouse Dental Papilla Cell-23 (MDPC-23), which exhibited morphological changes, was observed in all experimental groups compared to control (p<0.05). Although all tested protocols resulted in transdentinal diffusion of 2-hydroxyethyl methacrylate (HEMA), the group G6 presented the highest degree of monomeric conversion and the lowest cytotoxic effect, with higher dentin bond strength values in comparison to group G1 (p<0.05).

CONCLUSIONS

Applying an air blast at 50°C for 20 seconds increases the DC and microtensile bond strength of the 3M Single Bond Universal Adhesive System to dentin, as well as reduces the transdentinal cytotoxicity of the material to pulp cells.

Marginal quality of a full-body bulk-fill composite placed with an universal adhesive system in etch-and-rinse and self-etch mode: An in vitrostudy

Background

Marginal seal of a nanohybrid bulk-fill composite compared to a nanohybrid conventional composite, using a universal adhesive (UA) applied in etch-and-rinse (ER) and self-etch (SE) mode was investigated.

Material and Methods

Thirty-six intact molars were selected and two standardized cavities in each tooth were prepared and allocated into four groups according to restorative material and etching strategy. All samples were placed in a 1% methylene blue solution for 24 h, then cut in the middle of the restorations obtaining two parts (n=144) and used for microscopic evaluation (50x) for dye penetration measurements.

Results

The data were analysed by ANOVA and Tukey post-hoc test (p<0.05). Marginal seal was influenced by adhesive strategy (p<0.05) but not from the composite used (p>0.05).

Conclusions

Simplified restorations with nanohybrid bulk-fill composite showed comparable marginal leakage to incrementally placed nanohybrid composite. The UA used with a ER technique resulted in better marginal seal irrespective of the restorative material used.

Key words:Bulk-fill composite, universal adhesive, self-etching, etch-and-rinse, marginal seal.

Two-year randomized clinical trial of different restorative techniques in non-carious cervical lesions and MMP activity in gingival crevicular fluid

OBJECTIVES

To evaluate different restorative techniques for non-carious cervical lesions (NCCLs) and the activity of matrix metalloproteinases (MMPs) in gingival crevicular fluid.

MATERIALS AND METHODS

Two hundred restorations were performed in 50 patients using resin composite restorative system without (I) and with selective enamel conditioning (II) and resin-modified glass-ionomer cement without (III) and with EDTA pretreatment (IV). Gingival crevicular fluid samples were collected in 15 patients. Restorations were evaluated using USPHS criteria at baseline and after 2 years. Percentages of MMP activity were assessed by zymography as a surrogate outcome. Equality tests of two proportions, logistic regression analysis, survival analysis, ANOVA repeated measures, and Fisher tests were used.

RESULTS

No differences in clinical performance were found among groups. Group I had lower retention at 2 years than at baseline. Decreased alpha scores for marginal integrity and marginal discoloration were observed for all groups after 2 years. MMP-2 decreased after 1 year, and its activity increased back to the initial level after 2 years, mainly for groups I, II, and III. MMP-9 increased after 1 year, and it was reduced to the initial level after 2 years, mainly for group I.

CONCLUSIONS

All restorative techniques performed similarly in NCCLs after 2 years with initial marginal defect alterations. MMP-2 reestablished its initial levels after 2 years, and MMP-9 had few alterations over time in crevicular fluid. Clinical relevance The different restorative techniques are equally successful in NCCLs after 2 years of clinical functioning and have similar effects on MMPs present in crevicular fluid.

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.

Update on Enamel Bonding Strategies

Optimal strategies for the application of an adhesive differ between enamel and dentin because of the differences in their composition. The development of adhesive systems has mainly focused on the bonding of dentin, rather than on the enamel, by etching with phosphoric acid (PA). Dental adhesive technologies continue to rapidly advance, and various adhesive systems have been developed since the study of Buonocore in 1955. He introduced the enamel acid-etch technique. Then, the etch-and-rinse (ER) system was developed, and subsequently, the self-etch (SE) system. Universal adhesives are a new generation of one-bottle SE adhesives that can be applied with either ER mode or SE mode, or a combined system involving selective enamel etching mode. Since the combination of PA etching and the SE system differs from conventional ER systems, the enamel bonding strategy should be carefully considered. This concise review of the literature on reliable enamel bonding strategies should prove helpful to clinicians to choose an appropriate adhesive system to achieve optimal clinical outcomes.

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.

[Effects of three self-etch adhesives and mild salivary contamination on the bonding durability of deciduous teeth]

OBJECTIVE

To compare the bonding durability of three different self-etch adhesives to primary enamel and dentin, and to investigate the effect of mild salivary contamination followed by air drying on the bonding durability.

METHODS

Two hundred and forty enamel specimens were divided randomly into 16 groups (n=15/group)according to the adhesive system [self-etch adhesives: Clearfil SE Bond(SE), AdperTM Easy One (EO), Scotchbond Universal (SBU); total-etch adhesive: AdperTM Single Bond Plus(SL)], contamination status (non-contaminated vs. salivary-contaminated) and storage condition (stored in distilled water for 24 h vs. aging mode 5 000 thermal cycles in 5 ℃ and 55 ℃). Two hundred and forty dentin specimens were assigned in the same way. Shear bond strength for 12 specimens in each group were measured. The adhesive interface for the residual specimens in each group was observed by scanning electron microscopy(SEM). Data were analyzed by three-way analysis of variance and Tukey test(P < 0.05).

RESULTS

For primary enamel, total-etch adhesive showed higher initial shear bond strength values (28.92±1.83) MPa and shear bond strength values (27.27±3.03) MPa after thermal cycles compared with the other groups, and the difference between the groups was statistically significant (P < 0.01). Shear bond strength values of EO decreased significantly in salivary-treated groups, regardless of storage conditions, and the difference was statistically significant (P < 0.01). For primary dentin, shear bond strength values of EO decreased significantly in salivary-treated groups after 24 h (P < 0.01). After 5 000 thermal cycles, total-etch adhesive showed significantly lower shear bond strength values (14.31±1.97) MPa compared with the other groups, and the difference between the groups was statistically significant (P < 0.01), and shear bond strength values of EO were significantly lower than those in SE and SBU groups (P < 0.01), regardless of contamination status.

CONCLUSION

Total-etch adhesive SL has better bonding durability to primary enamel. SE and SBU have better bonding durability to primary dentin and have a certain resistance to salivary contamination, while the bonding performance of EO is compromised greatly by mild salivary contamination followed by air drying.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Effect of ultrasonic activation of the adhesive system on dentin tubule penetration and the pushout bond strength of fiber posts

STATEMENT OF PROBLEM

Whether ultrasonic activation of the adhesive system improves dentin tubule penetration and the bond strength of fiber posts to root dentin is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of ultrasonic activation of 2 adhesive systems (etch-and-rinse and self-etch) and 1 glass ionomer cement on the dentin tubule penetration and pushout bond strength of fiber posts to root dentin.

MATERIAL AND METHODS

Sixty maxillary central incisors were endodontically treated and divided into 6 groups (n=10) as per the post cementation strategy: etch-and-rinse, etch-and-rinse and ultrasonic, self-etch, self-etch and ultrasonic, glass ionomer cement, and glass ionomer cement and ultrasonic. The primers, the adhesives, and the glass ionomer cement were activated for 20 seconds each, and the fiber posts were cemented with a resin cement. Dentin tubule penetration was evaluated by confocal laser scanning microscopy and the pushout bond strength measured at 3 post locations: cervical, middle, and apical. The failure patterns were also described after pushout testing.

RESULTS

Self-etch and ultrasonic showed higher dentin tubule penetration than the other cementation strategies (P<.05) and improved the bond strength values (P<.05), which were higher than etch-and-rinse and ultrasonic and glass ionomer cement and ultrasonic (P<.05). Adhesive failures at the cement and dentin interface were predominant in the etch-and-rinse, self-etch, and self-etch and ultrasonic groups.

CONCLUSIONS

Ultrasonic activation improved the dentin tubule penetration of a self-etch adhesive system. The bond strength of fiber posts cemented with a self-etch adhesive system and a resin cement was improved after ultrasonic activation.

Glycerol Phosphate Dimethacrylate: An Alternative Functional Phosphate Ester Monomer to 10-Methacryloyloxydecyl Dihydrogen Phosphate for Enamel Bonding

The bonding performance of a glycerol phosphate dimethacrylate (GPDM)-based, two-step, self-etch (SE) adhesive was experimentally compared to that of 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-based universal adhesives in different application modes for enamel bonding. Microtensile bond strength (μTBS) for adhesives bonded to enamel was measured initially (24 h water storage) and after 10 000 thermocycles plus water storage for 30 days. A GPDM-based, two-bottle, two-step, self-etch adhesive (Optibond Versa, OV) and three one-bottle MDP-based universal adhesives, one self-etching (Tetric N Bond Universal, TNBU) and two with etch-and-rinse (E&R) processing (Single Bond Universal (SBU); Clearfil Universal Bond Quick (CUBQ)), were tested. Scanning electron microscopy (SEM) evaluated nanoleakage at the bonding interfaces. A profilometer determined roughnesses of enamel surfaces after phosphoric acid etching, OV priming, or TNBU conditioning. SEM observed the corresponding surface morphology. NMR and X-ray photoelectron spectroscopy (XPS) characterized chemical bonding in hydroxyapatites (HAps) conditioned with the adhesives. Etch-and-rinse samples had significantly stronger bonding than self-etch samples (p < 0.05) irrespective of aging. The μTBS values for initial and aged OV were significantly higher than those of TNBU (p < 0.05). Aging did not significantly decrease μTBS for any sample except TNBU (p < 0.05), but it significantly aggravated nanoleakage. Etch-and-rinse processing resulted in less nanoleakage than self-etching; the OV samples leaked less than TNBU, both before and after aging. Phosphoric acid etching achieved the highest enamel surface roughness, followed by OV primer. Ca-O-P bonds in hydroxyapatite conditioned with TNBU, SBU, and CUBQ were confirmed by NMR, which showed similar results to XPS observations of conditioned hydroxyapatite powders except OV primer. The GPDM-based, two-step, self-etch adhesive can provide higher micromechanical retention potential, bond strength, and durability than the MDP-based universal adhesive in self-etch mode but lower performance than the MDP-based universal adhesive in etch-and-rinse mode. None of the tested adhesives could avoid nanoleakage after aging.

Effect of surface treatments on the adhesive properties of metallic brackets on fluorotic enamel

OBJECTIVE

To compare the effectiveness of the pretreatment with sandblasting and deproteinization with NaOCl on bond strength (SBS), in situ conversion degree (CD) of brackets in fluorotic enamel, and enamel etching pattern.

METHODS

A total of 90 non-carious maxillary premolars were used. The teeth were then assigned to six experimental groups according to: enamel surface (sound and fluorotic enamel); surface treatment (Regular etch with 37% phosphoric acid [RE]; 5.2% sodium hypochlorite + phosphoric acid [NaOCl + RE]; sandblasting + phosphoric acid [sandblasting + RE]). After storage in distilled water (37°C/24h), the specimens were tested at 1 mm/min until failure (SBS). Enamel-resin cement interfaces were evaluated for CD using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a scanning electron microscope. Data from SBS and in situ CD values were analyzed using ANOVA two-away and Tukey test (α=0.05). The enamel etching pattern was evaluated only qualitatively.

RESULTS

For sound enamel, RE showed the highest SBS values, when compared to NaOCl + RE and Sandblasting + RE groups (p< 0.01). Regarding CD, only NaOCl + RE significantly compromised the mean DC, in comparison with other groups (p= 0.002). For fluorotic enamel, the Sandblasting + RE group significantly increased the mean SBS values, in comparison with RE group (p= 0.01) and no significant change was observed for CD (p> 0.52).

CONCLUSIONS

The application of NaOCl or sandblasting associated to phosphoric acid improved the SBS of the brackets in fluorotic enamel without compromising the CD of the resin cement, with improving of enamel interprismatic conditioning.

Current perspectives on dental adhesion: (1) Dentin adhesion - not there yet

The essential goal of any adhesive restoration is to achieve a tight and long-lasting adaptation of the restorative material to enamel and dentin. The key challenge for new dental adhesives is to be simultaneously effective on two dental substrates of conflicting nature. Some barriers must be overcome to accomplish this objective. While bonding to enamel by micromechanical interlocking of resin tags within the array of microporosities in acid-etched enamel can be reliably achieved and can effectively seal the restoration margins against leakage, bonding effectively and durably to organic and humid dentin is the most puzzling task in adhesive dentistry.

Much of the research and development of dental adhesives has focused on making the clinical procedure more user-friendly by reducing the number of bottles and/or steps. Although clinicians certainly prefer less complicated and more versatile adhesive materials, there is a trade-off between simplification of dental adhesives and clinical outcomes. Likewise, new materials are launched with claims of being novel and having special properties without much supporting evidence.

This review article discusses dental adhesion acknowledging pioneer work in the field, highlights the substrate as a major challenge to obtain durable adhesive restorations, as well as analyzes the three adhesion strategies and their shortcomings. It also reviews the potential of chemical/ionic dental adhesion, discusses the issue of extensively published laboratory research that does not translate to clinical relevance, and leaves a few thoughts in regard to recent research that may have implications for future adhesive materials.

Five-year clinical evaluation of a universal adhesive: A randomized double-blind trial

OBJECTIVE

To evaluate the five-year clinical performance of Scotchbond Universal Adhesive (SU; 3M Oral Care, St. Paul, MN, USA) in non-carious cervical lesions (NCCLs) using two evaluation criteria.

METHODS

Thirty-nine patients participated in this study. Two hundred restorations were assigned to four groups: SU-ERm: etch-and-rinse + moist dentin; SU-ERd: etch-and-rinse + dry dentin; SU-Set: selective enamel etching; and SU-SE: self-etch. A nanofilled composite resin was placed incrementally. The restorations were evaluated at baseline and after 5 years using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. The survival rates (retention/fractures) were calculated with the Kaplan-Meier and the log-rank test. For the secondary outcomes, Friedman repeated measures analysis of variance by rank was applied (α = 0.05).

RESULTS

After 5 years the recall rate was 86%. The retention/fracture rates were 93% for Erm and ERd, 88.4% for SEet and 81.4% for SE. A significant difference was observed for SE vs. ERd and SE vs. ERm (p = 0.01). Also, marginal discoloration and adaptation showed significant differences with ERm and ERd resulting in fewer marginal discrepancies than SE (p < 0.05).

SIGNIFICANCE

After 5 years, the clinical behavior of the universal adhesive in the etch-and-rinse strategy was better when compared to the self-etch strategy. The use of selective enamel etching is highly recommended for the self-etch strategy. The FDI and USPHS evaluation criteria showed similar results after 5 years.

A New Dual-cure Universal Simplified Adhesive: 18-month Randomized Multicenter Clinical Trial

CLINICAL RELEVANCE

Non-carious cervical lesion restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse mode showed satisfactory clinical performance after 18 months.

SUMMARY

Objectives: The objective of this multicenter, double-blind, split-mouth randomized clinical trial was to evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco GmBH) when applied using different strategies over a period of 18 months.Methods and Materials: Fifty patients participated in this study. Two hundred non-carious cervical lesions were restored using the adhesive Futurabond U according to four adhesive strategies (n=50 per group): only self-etch (SEE), selective enamel etching + self-etch (SET), etch-and-rinse with dry dentin (ERDry), and etch-and-rinse with wet dentin (ERWet). After the adhesive application, cavities were restored using Admira Fusion composite resin. These restorations were evaluated according to FDI World Dental Federation criteria for the following characteristics: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity, and caries recurrence.Results: After 18 months, only four patients (12 months: one patient, n=4 restorations; and 18 months: three patients, n=12 restorations) were not evaluated. Fourteen restorations were lost after 18 months of clinical evaluation (four for SEE, three for SET, three for ERDry, and four for ERWet). The retention rates for 18 months (95% confidence interval) were 92% (81%-97%) for SEE, 94% (83%-97%) for SET, 94% (83%-97%) for ERDry, and 92% (81%-97%) for ERWet (p>0.05). Thirty-eight restorations were considered to have minor discrepancies in marginal adaptation at the 18-month recall (13 for SEE, 13 for SET, six for ERDry, and six for ERWet; p>0.05). Fourteen restorations were detected as a minor marginal discoloration at the 18-month recall (six for SEE, six for SET, one for ERDry, and one for ERWet; p>0.05). However, all were considered clinically acceptable. No restorations showed postoperative sensitivity or caries recurrence at the time.Conclusion: The clinical performance of the Futurabond U did not depend on the bonding strategy used, and it was considered reliable after 18 months of clinical evaluation, although more marginal discrepancy was observed in the self-etch group.

Influence of different phosphoric acids before application of universal adhesive on the dental enamel

BACKGROUND

There are different etching gels available, which have different composition, different pH, and different viscosity, and there is little information in the literature comparing all these products.

OBJECTIVE

To evaluate the mean microshear bond strength and morphological characteristics of tooth enamel by evaluating different phosphoric acids combined with a universal adhesive system.

MATERIALS AND METHODS

Eighty-four enamel samples were used, which were divided according to the acid conditioning: G1: Scotchbond Etchant (3M Oral Care), G2: Ultra-Etch (Ultradent), G3: Eco-Etch (IvoclarVivadent), G4: ETCH-37 with BAC (Bisco), G5: Etching gel (Densell), G6: Condac 37 (FGM), and G7: Scotchbond Universal Adhesive (3M Oral Care) in self-etch mode. For the adhesive procedure, Scotchbond Universal Adhesive was the one used as indicated the manufacturer's instructions, 0.9-mm-diameter resin cylinders were placed. The microshear bond strength test was performed after being stored for 24 hours in water. The morphological characteristics of tooth enamel were analyzed using the Raman confocal microscope alpha300RA. The analysis of variance (ANOVA) test and Tukey post-test were used to analyze the differences between the groups.

RESULTS

The mean microshear bond strength values obtained for groups 1, 4, 5 were significantly greater than groups 2, 3, 6 and 7 (p < .05). All groups presented demineralization after the application of the etching acid, and few signs of demineralization were evident in group 7.

CONCLUSIONS

Acid-etching with ETCH-37 with BAC, Etching gel, and Scotchbond Etchant improved the adhesive strength in the enamel using an universal adhesive, and acid-etching with Condac 37, Ultra-Etch, and Eco-Etch provides similar adhesive strength values to self-etch mode of universal adhesive.

CLINICAL SIGNIFICANCE

All acid etchants should be considered as different. The test confirms that enamel etching prior to the application of a universal adhesive system depends on the selected acid etchand product.

Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial

OBJECTIVE

This randomized clinical trial evaluated the survival of direct restorations on first permanent molars (FPMs) with molar incisor hypomineralization (MIH) and its impact on self-reported dental pain and dental anxiety.

MATERIAL AND METHOD

FPMs with MIH of 35 patients aged 7 to 16 years were included. The FPMs were randomized into the following two groups: total-etch (TE-37% phosphoric acid etching) and self-etch (SE-no prior etching). The FPMs were restored with universal adhesive and bulk-fill resin composites. The restoration survival was evaluated according to USPHS criteria modified by a blinded examiner. Dental anxiety (Venham picture test) and dental pain (Faces pain scale-revised) were evaluated before treatment and at 1, 6, and 12 months post-treatment. Survival rates were analyzed by the Kaplan-Meier method and the log-rank test. Nonparametric tests compared pain and anxiety in the follow-up periods.

RESULTS

A total of 64 FPMs were restored (TE = 33; SE = 31). Survival rates were 96.9% (TE) and 96.7% (SE) after 1 month, 90.5% (TE) and 80.6% (SE) after 6 months, and 80.8% (TE) and 62.3% (SE) after 12 months (p > 0.05). Self-reported dental pain and anxiety level decreased after treatment in both groups (p < 0.05). Self-reported pain decreased after 1 month in SE, but it occurred at 6 months in TE.

CONCLUSION

Both restorative protocols presented similar longevity, decreasing self-reported pain and anxiety levels.

CLINICAL RELEVANCE

A universal adhesive could be appropriate for restoration of MIH-affected teeth, and the survival of restorations could be higher in the total-etch technique, reducing dental pain and anxiety.