Acid etching of human enamel in clinical applications: a systematic review

Effect of phosphoric acid etching and blasting with aluminum oxide on the enamel topography and adhesion of resin composite to intact or abraded enamel

OBJECTIVES

To evaluate the effects of the phosphoric acid (PA) etching, self-etching technique (SE) and blasting with Al2O3 particles (BL) on the bonding of a dental adhesive to intact (INT) or abraded (ABR) enamel.

METHODS

Enamel surfaces were treated as follows: 1- ABR-PA: INT was abraded with SiC paper and etched with PA (20 s) before Clearfil Universal Bond Quick adhesive application; 2- ABR-SE: ABR was SiC and adhesive applied in SE mode; 3- INT-PA: INT was etched with PA and adhesive applied; 4- INT-SE: the adhesive (SE mode) was applied to INT; 5- INT-BL: INT was BL and the adhesive was applied (SE mode), and 6- INT-BA: INT was BL, etched with PA and adhesive applied (SE mode). The enamel surface treated was examined with scanning electron microscopy (SEM) (n = 3) and Al2O3 particles were characterized using SEM and EDX. The enamel bond strength was measured by microtensile test (24 h and 1 year) (n = 8) and the morphology of enamel-adhesive interfaces were analyzed by SEM (n = 3). Bond strength data were analyzed by two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

Al2O3 particles had an irregular shape, their length varied (50-20 µm) and the perimeter mean was 38.8 µm. The enamel morphology significantly influenced the enamel bond strength. ABR-PA, INT-BL, and INT-BA provided greater and stable enamel-dentin interaction and bond strength.

SIGNIFICANCE

The enamel morphology significantly influenced the enamel bond strength. Using the adhesive in etch-and-rinse mode, enamel must be abraded before etching and must be Al2O3-blasted when used in SE mode.

Adhesive Performance of Pit and Fissure Sealants on Deproteinized Enamel with Different Proteolytic Agents: In Vitro Study

The objective of this work was to assess the efficacy of different proteolytic agents on the bond strength of pit and fissure sealants to bovine enamel. Eighty-four bovine enamel specimens were randomly assigned in groups according to the pit and fissure sealant applied (HelioSeal F or Dyad Flow). Then, the specimens were subdivided according to the proteolytic agent used (n = 7): Group 1, distilled water (control); Group 2, 10 wt.% Tergazyme®; Group 3, 10 wt.% ZYME®; Group 4, 10% papain gel; Group 5, 10% bromelain gel; and Group 6, 5.25 wt.% sodium hypochlorite. The cell viability of the proteolytic solutions was assessed through the MTT assay. The proteolytic agents were applied on the enamel surface prior to the acid-etching procedure; then, the pit and fissure sealants were placed. The micro-shear bond strength was evaluated after 24 h or 6 months of water storing at 37 °C. Representative SEM images were taken for each experimental group. The bond strength data were statistically analyzed by a three-way ANOVA test using a significance level of α = 0.05. Bromelain and papain proteolytic solutions did not exert any cytotoxic effect on the human dental pulp cells. After 24 h and 6 months of aging, for both pit and fissure sealants, sodium hypochlorite, papain, bromelain, and Tergazyme® achieved statistically significant higher bond strength values (p < 0.05). Irrespective of the deproteinizing agent used, Dyad Flow resulted in a better bond strength after 6 months of aging. The type 1 etching pattern was identified for sodium hypochlorite, papain, and bromelain. Tergazyme®, papain, and bromelain demonstrated efficacy in deproteinizing enamel surfaces prior to acid etching, leading to the improved bond strength of pit and fissure sealants. Clinically, this suggests that these proteolytic agents can be considered viable alternatives to traditional methods for enhancing sealant retention and longevity. Utilizing these agents in dental practice could potentially reduce sealant failures.

Shear bond strength of universal adhesives to human enamel and dentin

OBJECTIVE

The composition of universal adhesives is highly diverse. The purpose of this in vitro study was to compare the shear bond strength of a composite with five different universal adhesives to human enamel and dentin.

MATERIALS AND METHODS

The shear bond strength of a composite (G-aenial Universal Injectable) to human enamel and dentin was tested in selective enamel etching mode before and after thermocyclic aging (10,000 cycles) using five different universal adhesive systems (Adhese Universal VivaPen, Clearfil Universal Bond Quick, G-Premio Bond, Prime&Bond active, and Scotchbond Universal Plus). Two-bottle systems (OptiBond FL and G2-Bond Universal) were used as control. Scanning electron microscopy was conducted of the bonding interface.

RESULTS

Significant differences in shear bond strength values were found among the five evaluated universal adhesives. Lowest shear bond strength values were observed for 2-hydroxyethylmethacrylate (HEMA)-free systems. Thermocyclic aging did not significantly reduce shear bond strength values indicating that the initial bond remains stable.

CONCLUSIONS

The clinical use of universal adhesives Adhese Universal VivaPen, Clearfil Universal Bond Quick, and Scotchbond Universal Plus can be encouraged as they provided comparable or even better shear bond strength values than the two-bottle controls.

CLINICAL SIGNIFICANCE

Universal adhesives that were developed for the same indication and approved for clinical use demonstrated variety in shear bond strength values. When applied in the selective enamel etching mode, a stable bond can be expected from adhesives containing HEMA and monomers with phosphate groups.

The Classification and Selection of Adhesive Agents; an Overview for the General Dentist

Adhesive agents are essential to most restorative procedures used in everyday practice. Depending on the clinical situation, the dentist will choose among a rapidly evolving variety of adhesive agents (bonding agents). Due to the availability of many adhesive agents, appropriate selection can take time and effort. Typically, a practitioner relies more on marketing and experience than in-depth material knowledge. The classification of adhesive agents may need to be clarified and easier to remember due to its lack of relevance to clinical procedures. This paper reviews the published literature retrieved from PubMed, Google Scholar, and Scopus by using specific keywords "adhesive agents", "classification", "dentin", "enamel", "universal", "self-etch", "etch-and-rinse", and "bonding". The titles and abstracts were screened, and the relevant literature was retrieved. The list of references from each identified article was examined to find other potentially relevant articles. Adhesive agents can be classified as etch-and-rinse, self-etch, or "multi-mode" according to their approach to interacting with the smear layer, and each approach can be further classified according to the number of clinical steps required during application. This article reviews the classification of current adhesive agents and discusses the properties that make a specific adhesive agent the optimal choice for a particular clinical indication. The review will assist the general dentist in understanding the various types of available adhesive agents and how they function. Overall, the review will facilitate decision-making and allow the selection of appropriate materials.

Micromechanical interlocking structure at the filler/resin interface for dental composites: a review

Dental resin composites (DRCs) are popular materials for repairing caries or dental defect, requiring excellent properties to cope with the complex oral environment. Filler/resin interface interaction has a significant impact on the physicochemical/biological properties and service life of DRCs. Various chemical and physical modification methods on filler/resin interface have been introduced and studied, and the physical micromechanical interlocking caused by the modification of fillers morphology and structure is a promising method. This paper firstly introduces the composition and development of DRCs, then reviews the chemical and physical modification methods of the filler/resin interface, mainly discusses the interface micromechanical interlocking structures and their enhancement mechanism for DRCs, finally give a summary on the existing problems and development potential.

Effect of Extra Hydrophobic Resin Layer on Bonding of Universal Adhesive Systems to Enamel

OBJECTIVE

The objective of this study was to compare the effect of solvent in universal adhesives (UA) and the application of an extra layer of hydrophobic bonding resin on enamel shear bond strengths (SBS).

METHODS AND MATERIALS

Crowns of 224 bovine mandibular incisors were embedded in acrylic resin, wet-polished up to 600-grit silicon carbide paper and assigned to 3 UAs with different solvents (n=32): ethanol-based UA (ADU, AdheSE Universal, Ivoclar Vivadent); isopropanol-based UA (PBU, Prime&Bond Universal, Dentsply Sirona); and acetone-based UA (OPT, OptiBond Universal, Kerr Co). The same UAs were also applied with an extra layer of a hydrophobic bonding resin (HLB, Heliobond, Ivoclar Vivadent): ADU + HLB; PBU + HLB; and OPT + HLB. HLB alone was used as control. Enamel was etched with 37.5% H3PO4 (Kerr Gel Etchant, Kerr Co) for 15 seconds, rinsed with water, and air dried. UAs were applied according to the respective manufacturer's instructions. After adhesive application, composite cylinders (Filtek Z250, 3M Oral Care) were built up and light-cured (40 seconds/increment, 40 J/cm2) keeping the light tip in contact with the mold. Specimens were stored in water for 24 hours (24H) or for 6 months (6M). A knife-edged metallic rod (Ø=2.8-mm semicircular notch) loaded the composite cylinders until fracture. Mode of failure was analyzed with optical microscopy (40×). Statistics included twoway analysis of variance (ANOVA; adhesive strategy and water storage) and Tukey honestly significant difference (HSD) post hoc test (α=95%).

RESULTS

Mean enamel SBS ranged from 3.6 (±2.2) MPa (HLB/6M) to 24.7 (±7.1) MPa (ADU + HLB/6M). ANOVA revealed significant differences for adhesive strategy (p≤0.001) but no significant differences for water storage (p>0.05). All UAs resulted in similar mean enamel SBS with or without an extra layer of HLB at 24H. After 6M, only ADU resulted in higher enamel SBS when an extra layer of HLB was applied. All UAs resulted in higher mean enamel SBS than HLB (control). Most failures were adhesive exception for PBU/HLB/6M, which had mostly mixed failures.

CONCLUSIONS

UAs resulted in statistically higher enamel SBS than the nonsolvated hydrophobic bonding resin (control), regardless of the solvent in their composition. Application of an extra layer of hydrophobic bonding resin over UAs did not improve mean enamel SBS for isopropanol- and acetone-based UAs but did improve mean enamel SBS for the ethanol-based UA after 6M. Resin composite bonding to enamel using a hydrophobic bonding resin alone is not recommended.

Effect of Different Etching Times on Pit-and-Fissure Sealant Micro-Shear Bond Strength to the Enamel of Primary Teeth

Successful clinical use of pit-and-fissure sealants relies on the sufficient etching of the enamel, field isolation and sealant retention. The etching time changes the physical and mechanical surface properties of the etched tooth tissues; therefore, it impacts both etching depth and the bond strength of sealants to the enamel. We examined if reducing the recommended 15 s etching time of primary teeth enamel affects the micro-shear bond strength (µSBS) of pit-and-fissure sealants. The cusps of forty non-carious, extracted human primary molars were separately etched for 8, 15 or 30 s. Then, a pit-and-fissure sealant was placed and light-cured. The µSBS values were evaluated and compared among the three groups. The mean µSBS values ± standard deviations were 34.68 ± 16.93, 34.19 ± 17.35 and 36.56 ± 16.57 MPa in the cusps etched for 8, 15 and 30 s, respectively. No statistically significant differences in µSBS were observed among the three test groups. In this study, we showed for the first time that the recommended etching time of primary teeth enamel may be reduced from 15 to 8 s without compromising the µSBS of the sealant. Further evaluations in a clinical setting are warranted.

Shear bond strength of different bonding agents to orthodontic metal bracket and zirconia

This study aimed to evaluate the shear bond strength (SBS) of four bonding agents used to bond metal brackets to zirconia under different storage conditions. Four bonding agents were used [FLC: (Fuji ORTHO LC), XT: (Transbond^TM XT), RUC-SBU: (Rely X^TM Ultimate Clicker Adhesive Resin Cement+Single Bond Universal), and RUC-GBU: (Rely X^TM Ultimate Clicker Adhesive Resin Cement+Gluma Bond Universal)] to bond two types of metal brackets (PT/3M) to zirconia surfaces, and they were stored in water at 37ºC for 24 h or thermocycling for 3,000 cycles. The SBS data of RUC-SBU and RUC-GBU using PT brackets were significantly higher than those of 3M brackets before and after thermocycling. It could be concluded that RUC-SBU and RUC-GBU could offer sufficient bond strength between metal brackets and zirconia for the short term compared with FLC and XT. The design of brackets can significantly affect the bond strength to zirconia.

Bond Durability of Two-Step HEMA-Free Universal Adhesive

The purpose of this study is to compare bond durability, in terms of fatigue bond strength, of a two-step HEMA-free universal adhesive and representative adhesives in each systematic category. The adhesives used in this study were OptiBond FL, Prime&Bond NT, Clearfil SE Bond 2, G2-Bond Universal, and Scotchbond Universal Plus Adhesive. Fatigue bond strength testing and scanning electron microscopy analysis of adhesively bonded enamel and dentin interfaces were performed. For the adhesives in etch-and-rinse mode, the enamel fatigue bond strength of the G2-Bond Universal adhesive was significantly higher than those of other adhesives, and the dentin fatigue bond strength of Prime&Bond NT was significantly lower than the others. For adhesives in self-etch mode, the enamel fatigue bond strengths of Clearfil SE Bond 2 and G2-Bond Universal were significantly higher than that of the Scotchbond Universal Plus Adhesive, and the dentin fatigue bond strength of G2-Bond Universal was significantly higher than Clearfil SE Bond 2 and the Scotchbond Universal Plus Adhesive. The two-step HEMA-free universal adhesive showed higher enamel and higher or equal dentin fatigue bond strength than other selected representative adhesive systems in etch-and-rinse mode and higher or equal enamel and higher dentin fatigue bond strength than adhesive systems in self-etch mode.

Renewal MI Dental Composite Etch and Seal Properties

This study's aim was to assess whether the Renewal MI composite can self-etch enamel, seal sound cavities, and stabilize demineralized dentine. Etching was assessed using scanning electron microscopy (SEM). Cavity sealing was quantified using the ISO-11405 dye microleakage test. Demineralized dentine stabilization was evaluated by visualizing resin tag formation, enzyme activity and mineral precipitation at the adhesion interface. Renewal MI provided a mild etching of sound enamel in comparison with 37% phosphoric acid. It provided a comparable seal of sound cavities to Z250/Scotchbond Universal adhesive and a superior seal to Activa, Fuji IX and Fuji II LC. With demineralized dentine, Renewal MI formed 300-400 µm resin tags covering 63% of the adhesion interface compared with 55 and 39% for Z250/Scotchbond and Activa. Fuji IX and Fuji II LC formed no resin tags. A higher tag percentage correlated with lower surface enzyme activity. Unlike Activa and Fuji II LC, Renewal MI promoted mineral precipitation from simulated body fluid, occluding adjacent dentinal tubules within 6 months. These novel etching and sealing properties may facilitate Renewal MI's application in minimally invasive dentistry.

Ultrastructural characterisation of young and aged dental enamel by atomic force microscopy

Recent advances in atomic force microscopy (AFM) have allowed the characterisation of dental-associated biomaterials and biological surfaces with high-resolution. In this context, the topography of dental enamel - the hardest mineralised tissue in the body - has been explored with AFM-based approaches at the micro-scale. With age, teeth are known to suffer changes that can impact their structural stability and function; however, changes in enamel structure because of ageing have not yet been explored with nanoscale resolution. Therefore, the aim of this exploratory work was to optimise an approach to characterise the ultrastructure of dental enamel and determine potential differences in topography, hydroxyapatite (HA) crystal size, and surface roughness at the nanoscale associated to ageing. For this, a total of six teeth were collected from human donors from which enamel specimens were prepared. By employing intermittent contact (AC mode) imaging, HA crystals were characterised in both transversal and longitudinal orientation (respect to surface plane) with high-resolution in environmental conditions. The external enamel surface displayed the presence of a pellicle-like coating on its surface, that was not observable on cleaned specimens. Acid-etching exposed crystals that were imaged and morphologically characterised in high-resolution at the nanoscale in both the external and internal regions of enamel in older and younger specimens. Our results demonstrated important individual variations in HA crystal width and roughness parameters across the analysed specimens; however, an increase in surface roughness and decrease in HA width was observed for the pooled older external enamel group compared to younger specimens. Overall, high-resolution AFM was an effective approach for the qualitative and quantitative characterisation of human dental enamel ultrastructure. Future work should focus on exploring the ageing of dental enamel with increased sample sizes to compensate for individual differences as well as other potential confounding factors such as behavioural habits and mechanical forces. Lay abstract: Currently, advanced microscopy techniques such as atomic force microscopy (AFM) can be used to characterise surfaces relevant to dentistry with great detail. Among these surfaces of interest, dental enamel - the hardest mineralised tissue in the body- is important as it protects the deeper areas of the tooth from harmful stimuli such as sudden temperature changes, bacterial penetration, and chemical attack. Also, dental enamel is an important surface for the adhesion of some types of dental restorations; thus, its structure and organisation is highly relevant for both dental scientists and clinicians. With age, teeth are known to suffer changes that can impact their structural stability and function; however, changes in enamel structure as a result of ageing have not yet been explored with nanoscale resolution. It is necessary to develop and optimise AFM-based techniques in order to process specimens from dental samples across different age groups for ageing-associated nanoscale studies in the future. Therefore, the aim of this investigation was to optimise an approach to characterise the ultrastructure of dental enamel and determine potential differences in enamel topography, hydroxyapatite (HA) crystal size, and surface roughness at the nanoscale associated to ageing. For this, human enamel specimens obtained from a total of six teeth were collected and analysed with AFM, and HA crystals were characterised in both transversal and longitudinal orientation with high-resolution in environmental conditions. Upon AFM observation, sound superficial enamel displayed the presence of a pellicle-like coating on its surface, that was not observable after specimens were cleaned. Furthermore, acid-etching exposed HA crystals that were imaged and morphologically characterised in high-resolution at the nanoscale across different regions of enamel in older and younger specimens. We observed important individual variations in HA crystal width and roughness parameters across the analysed specimens and groups, suggesting individual as well as age-associated differences. Overall, high-resolution AFM was an effective approach for the qualitative and quantitative characterisation of human dental enamel ultrastructure at the nanometer range with minimal sample preparation. This proof-of-concept work can pave the way for future studies employing increased sample sizes to compensate for individual differences and population level factors. This article is protected by copyright. All rights reserved.

Evaluation of Infiltrant Application in the Course of Root Cementum Caries with Different Methods of Surface Preparation—An In Vitro Study

The aim of this study is to evaluate the depth of penetration of an experimental preparation with the characteristics of a dental infiltrant into the decalcified root cementum tissue and observation of the root cementum tissue subjected to a single and repeated twice hydrochloric acid etching process. The study material consisted of 20 human teeth (the study group—12 demineralised teeth, the control group—8 teeth). A commercially available Icon preparation and an experimental preparation were used for the study with addition 2% of YF3 (yttrium trifluoride) added as an indicator to facilitate microscopic observation. Each tooth was divided into two zones, blue (Icon) and red (experimental preparation). The teeth were divided into two subgroups—in the first subgroup, the etching preparation was applied once, in the second subgroup twice, and at the end the teeth were infiltrated with the experimental preparation and the Icon preparation. The study of tooth longitudinal section morphology and chemical composition was performed with the use of a Hitachi S-3400N scanning electron microscope. Microscopic observations show that the applied YF3 tracer in most cases agglomerates and remains in the form of conglomerates on the surface of the root cementum. Single particles of YF3 are visible, penetrating through the cementum tissues into the root dentine structure. The degree of tissue infiltration with the resin (depth of penetration into decalcified tissues) is visible at a depth of approx. 80–120 μm. In the test group subjected to a single etching process, good penetration of both resins was noticeable, however, excessive erosion of the root surface was evident in several of the specimens—indicating that damage occurred as a result of the etching process. In the test group subjected to two etching processes, excessive erosion of the cementum is visible in each deposit.

Effect of diode laser-assisted bleaching on the bond strength of different adhesive systems to enamel: Interfacial SEM analysis

The aim of this study was to investigate the effectiveness of diode laser-assisted bleaching on the shear bond strength (SBS) of different adhesive systems to enamel and examine the adhesive enamel interface under scanning electron microscope (SEM). 180 incisor teeth were randomly divided into three bleaching groups: (1) Unbleached control group, (2) Opalescence Boost (OB) 40%, and (3) Diode laser-assisted LaserWhite20 (LW20) 45%. After bleaching, each group was divided into two subgroups according to waiting time: immediately or 7 days' delay. The six groups were then divided into three subgroups based on the adhesive procedure: Single Bond 2 (SB2), Clearfil SE Bond (CSB), and Clearfil Universal Bond (CUB). After adhesive procedures, composite resin cylinders were bonded to the enamel surfaces. All specimens were subjected to a SBS test after 24 hr of storage in water. Data were analysed using three-way variance analysis (p < .05). Specimens were examined under a stereomicroscope and SEM. There was a significant difference between the groups bonded immediately and 7 days after bleaching (p < .05). SB2 after 7 days showed the highest SBS values (19.24 ± 2.18), whereas CUB showed the lowest values in both bleaching treatments and control groups (10.84 ± 1.66). SEM analysis of the unbleached specimens revealed long tags and uniform hybrid layer compared OB and LW20 bleaching groups. LW20 and OB bleaching adversely affected SBS to enamel when bonded immediately. Diode laser-assisted bleaching might be an alternative option due to the short working time but delaying bonding for 7 days after bleaching may not be enough for ideal adhesion. RESEARCH HIGHLIGHTS: Bleaching agents containing high concentration hydrogen peroxide reduces the enamel bond strength of adhesive systems. Postponing composite restorations for 7 days after bleaching may not be sufficient to achieve ideal adhesion. Diode laser-assisted bleaching may be preferred as an alternative bleaching method today due to its ability to shorten the operation time and cause minimal morphological changes on the enamel surface.

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.

Restoration's thickness and bonding tooth substrate are determining factors in minimally invasive adhesive dentistry

Purpose To explore fracture strength and failure behaviour of minimally invasive CAD-CAM composite resin overlay restorations.Methods Eighty bi- and tri-layer cylindrical overlay model including the restoration bonded over bovine tooth dentin (Groups D) and enamel-dentin (Groups E) were assembled (diameter 9 mm). Restorations were milled from CAD-CAM composite resin blocks (Brilliant Crios, Coltène/Whaledent AG) in different thicknesses (0.5mm, 1mm, 1.5mm, 2mm) and equally distributed in four Groups D and four Groups E (n=10). All specimens were submitted to an Hertzian load-to-failure contact test with spherical indenter. Critical loads were recorded in Newton and data were analysed using Kruskal-Wallis test for multiple and Mann-Whitney test for 2-samples comparisons (p < 0.05). Fragments were examined using SEM. The stress distribution for specimens with restorations of 0.5 mm and 2 mm was also investigated with FEA.Results For all specimens, the mean static loads in Newton increased with an increase in restoration thickness. On contrary, restorations with the same thickness displayed higher resistance values when bonded over enamel than dentin, except for the 2-mm thick restorations. A damage competition was detected between cone/median cracks originating at the loading contact area of the restorations and radial cracks beginning at their inner surface, with the former prevailing in restorations bonded on enamel and the latter being dominant for restorations bonded on dentin.Conclusions For bonded ultra-thin resin composite restorations (0.5 mm to 1.5 mm) enamel as bonding substrate assures higher critical loads to fracture than dentin. This influence gradually decreases as restoration thickened.

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.

Resistance of bonded premolars to four artificial ageing models post enamel conditioning with a novel calcium-phosphate paste

Background

This in vitro study compares a novel calcium-phosphate etchant paste to conventional 37% phosphoric acid gel for bonding metal and ceramic brackets by evaluating the shear bond strength, remnant adhesive and enamel damage following water storage, acid challenge and fatigue loading.

Material and Methods

Metal and ceramic brackets were bonded to 240 extracted human premolars using two enamel conditioning protocols: conventional 37% phosphoric acid (PA) gel (control), and an acidic calcium-phosphate (CaP) paste. The CaP paste was prepared from β-tricalcium phosphate and monocalcium phosphate monohydrate powders mixed with 37% phosphoric acid solution, and the resulting phase was confirmed using FTIR. The bonded premolars were exposed to four artificial ageing models to examine the shear bond strength (SBS), adhesive remnant index (ARI score), with stereomicroscopic evaluation of enamel damage.

Results

Metal and ceramic control subgroups yielded significantly higher (p < 0.05) SBS (17.1-31.8 MPa) than the CaP subgroups (11.4-23.8 MPa) post all artificial ageing protocols, coupled with higher ARI scores and evidence of enamel damage. In contrast, the CaP subgroups survived all artificial ageing tests by maintaining adequate SBS for clinical performance, with the advantages of leaving unblemished enamel surface and bracket failures at the enamel-adhesive interface.

Conclusions

Enamel conditioning with acidic CaP pastes attained adequate bond strengths with no or minimal adhesive residue and enamel damage, suggesting a suitable alternative to the conventional PA gel for orthodontic bonding.

Key words:Enamel etching, calcium phosphate, bracket bond strength, adhesive residue, enamel damage.

Nanoscale adhesion forces of glucosyltransferase B and C genes regulated Streptococcal mutans probed by AFM

Glucosyltransferases (Gtfs), represented by GtfB and GtfC, are important virulence factors of Streptococcus mutans and the major etiologic pathogens of tooth decay. However, the individual roles of gtfB and gtfC in the initial attachment of S. mutans are not known. We used atomic force microscopy to explore the contribution of gtfB and gtfC, as well as enamel-surface roughness, on the initial attachment of S. mutans. Adhesion forces of four S. mutans strains (wild-type, ΔgtfB, ΔgtfC, and ΔgtfBC), onto etched enamel surfaces, were determined. Force curves showed that, with increasing etching time from 0 to 10 s, the forces of all strains increased accordingly with acid-exposure time, the adhesion forces of wild-type strains were significantly greater than those of mutant strains (p < .05), and the forces of the three mutants were similar (p < .05). When the etching time was increased from 10 to 30 s, difference in force between 20 and 30 s was not observed, and adhesion forces among ΔgtfB, ΔgtfC, and wild-type strains were not significantly different when the etching time was >20 s (p > .05). These data suggest that the roughness and morphology of enamel surfaces may have a significant influence upon the initial attachment of bacteria, and that gtfB and gtfC are essential for the adhesion activity of bacteria. Furthermore, gtfB seems to be more important than gtfC for bacterial-biofilm formation, and gtfB inactivation is an effective strategy to inhibit the virulence of cariogenic biofilms.

Experimental study of brackets adhesion with a novel enamel-protective material compared with conventional etching

INTRODUCTION

A reliable adhesion between fixed devices and dental surfaces is a key factor for the clinical success of any orthodontic treatment. Adhesion preparation is associated with damages related to abrasive cleaning, enamel structure defacing caused by etching, enamel loss when removing resin remnants at orthodontic treatment finishing stage or when conditioning surface for adhesive failure and fractures at bracket removal.

AIM

The objective of this study was to compare the shear bond strength of metallic brackets to enamel adhered with a novel non-damaging and remineralizing material for enamel versus the traditional 37% phosphoric acid etching.

MATERIAL AND METHODS

75 Premolars collected from 15- to 40-years old healthy donors requiring extraction were collected. The teeth were then randomly divided into three groups (n = 25). One group was used for the experimental new method (EX), the second for the conventional phosphoric acid etching (PA) method and the third group was left without any treatment (NT). The metallic brackets were fixed with Transbond® XT adhesive and composite resin polymerized for 40 s with a halogen photocuring lamp. The shear bond strength was quantified by means of a universal testing machine at 1 mm/min crosshead speed and a load cell of 1 kN.

STATISTICAL ANALYSIS USED

Tests of normality, adjustment of the data to a root square, a one-way ANOVA and Tukey tests were performed.

RESULTS

Statistically significant differences between the NT (1.4 MPa), PA (32.1 MPa) and EX (9.7 MPa) groups were observed.

CONCLUSIONS

The experimental material for conditioning human enamel induces calcium phosphates crystals on the enamel surface and improves the bond strength in comparison to the NT group.

On the method of revealing enamel structure by acid etching. Aspects of optimization and interpretation

The study aimed at finding an optimal combination of acid concentration and etching time when nitric acid is used as etchant for the study of the finer details of human dental enamel structure. Four hundred 2-3-mm-thick segments of facio-lingually sectioned human third molar crowns were assigned to 20 groups with 20 specimens in each group, each group differing with respect to acid concentration (0.1, 1, 2.5, and 5%) and etching time (15, 30, 45, 90, and 180 s). After etching and preparation, specimens were observed in the scanning electron microscope (SEM). Surface roughness/topography increased with increasing acid concentration and increasing etching time, but not in a linear fashion; generally, prisms tended to go from flat-surfaced to cone-shaped and prism sheaths from fissure-like to wedge-shaped. Intragroup variations and intergroup similarities were considerable. The two major enamel factors determining the etch effect are crystal orientation and prism sheath properties. Other factors, such as distribution of porosities and crystal quality, also contribute probably. Slight to moderate topography is best for observing the finer enamel structure, for example, etching with concentrations in the range 0.1-1% and with etching times in the range 15-90 s, the stronger the acid, the shorter the time. The depth effect of nitric acid is judged to be relatively small. Considerable variations in expression of prism cross-striations were observed. SEM observations of acid-etched enamel in carefully selected planes are a powerful method for the study of enamel structure, bearing in mind the artifactual aspects of the observed surface.

Immediate enamel bond strength of universal adhesives to unground and ground surfaces in different etching modes

The purpose of this study was to determine the immediate bond effectiveness of universal adhesives to unground and ground enamel surfaces in different etching modes, through shear bond strength (SBS) tests and scanning electron microscopy observations. Three universal adhesives, a conventional two-step self-etch adhesive, and a conventional single-step self-etch adhesive were compared. Human enamel specimens from lower anterior teeth were divided into four groups and subjected to the following treatments: (i) unground enamel in self-etch mode; (ii) ground enamel in self-etch mode; (iii) unground enamel in etch-&-rinse mode; and (iv) ground enamel in etch-&-rinse mode. Bonded assemblies were subjected to SBS testing. All the adhesives showed significantly higher SBS values in etch-&-rinse mode than in self-etch mode, regardless of whether enamel was unground or ground. The influence of the enamel surface condition on SBS was different in different etching modes. Without pre-etching, all tested materials showed lower SBS values in unground enamel than in ground enamel. In etch-&-rinse mode, no significant differences in SBS values were observed between unground enamel and ground enamel for any of the adhesives tested. Phosphoric acid pre-etching before application of self-etch adhesives to an unground enamel surface is essential to enhance initial enamel bond effectiveness.

Is buffalo enamel a suitable substrate for bond strength tests?

Aim

The aim of this study was to compare the bonding strength of dental materials in buffalo (Bubalus bubalis var. kerebau), bovine, and human enamel and the susceptibility of these substrates in acid etching.

Materials and methods

A total of 20 human third molars, 20 bovine incisors, and 20 buffalo incisors were used in a mechanical assay of microshear. The substrates were demineralized via conditioning with 37% phosphoric acid, and the ultra-morphological pattern of each substrate was analyzed by scanning electron microscopy.

Results

The results showed that there was no significant difference in adhesive bonding strength values between buffalo and human enamel (P≥0.05), with a fracture pattern of mixed type for all experimental groups.

Conclusion

The results indicate that buffalo enamel is similar to human dental substrate in tests of adhesive bonding strength and also show a similar behavior in the acid conditioning of the enamel.

Staining protocols to improve the detection of composite restorations in human identification

INTRODUCTION

The improvement of aesthetic properties of dental materials has hampered the work of forensic experts in cases of identification. Even in dental practice, the identification of the margins of restorations has become a challenge.

OBJECTIVE

To establish protocols to improve the visual contrast between teeth and composites using dyes.

METHOD

Anterior and premolar human teeth were chosen (n = 40) and class V cavities were made in the lingual/palatal and buccal surfaces. Ten commercially available dyes were dissolved in distilled water. Three protocols were proposed using phosphoric acid (Gphos) and hydrofluoric acid (Ghydro) for 60 s followed by application of the dye for 20 s. The control group (Gcontrol) was acid free, i.e. only distilled water was applied. Data was analysed using Kruskal-Wallis and Dunn´s tests.

RESULTS

Analyses showed that darker dyes, such as crystal violet, methylene blue, malachite green and neutral red, had better results (p < 0.001). The composite brand did not influence the results (p > 0.05). Both Gphos and Ghydro were effective in discriminating restorations when compared to Gcontrol (p > 0.001). No differences were detected between Gphos and Ghydro protocols (p > 0.05). In Gphos, the enamel surface was stained leaving the restoration without pigmentation. Oppositely, in Ghydro the composite filling was coloured, but not the enamel. In Gcontrol, both enamel and restoration were stained indistinctively.

CONCLUSION

Tooth etching with either phosphoric or hydrofluoric acids was suitable to discriminate the presence of aesthetic dental fillings.

Effect of a self-etching primer containing 4-META and sodium sulfite after phosphoric acid etching on bonding strength of MMA-TBB resin to human enamel

PURPOSE

The aim of this study was to evaluate the shear bond strength and durability of MMA-TBB resin to human enamel applied a self-etching primer with phosphoric acid etching.

METHODS

A self-etching primer (Teeth primer, TP) containing 4-methacryloyloxyethyl trimellitate anhydride (4-META) and sodium sulfite and two etchants having different phosphoric acid concentrations (K-etchant gel, KE, 35-45%: Red gel, RG, 20-25%) were used as treatment agent, and MMA-TBB resin was used as luting agent. Enamel surfaces were treated with six methods which were as follow: KE, RG, TP, KE+TP, and RG+TP. After enamel specimens were bonded with MMA-TBB resin and stored in distilled water for 24h, the shear bond strength test was done at 0 thermocycling or 20,000 thermocycling. These results were statistically verified with Steel-Dwass multiple comparisons and Man-Whitney U test.

RESULTS

The shear bond strength of TP group, KE+TP group, and RG+TP group were significantly higher than KE group and RG group in pre-thermocycling. KE+TP group and RG+TP group were significantly higher than other groups in post-thermocycling.

CONCLUSIONS

Applying TP with phosphoric acid etching can increased shear bond durability despite difference of phosphoric acid concentrations (35-45% or 20-25%).

Enamel gloss changes induced by orthodontic bonding

OBJECTIVE

The purpose of this study was to assess enamel gloss changes induced by orthodontic bracket bonding with a light-cured composite or a light-cured resin-reinforced glass ionomer cement.

SETTING

The Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Greece.

DESIGN

Laboratory study.

METHODS

A total of twenty extracted upper human first premolars were included in this study and each tooth served as a control for itself. Their buccal surfaces were subjected to 60^o-angle gloss measurement (G%60) with a standardized and secure repeated analysis of the same site. After baseline evaluation, a bracket was bonded on the buccal surface of each tooth. Half of the specimens were bonded with acid-etching and a light-cured composite whereas the other half with a light-cured resin-reinforced glass ionomer cement without prior enamel conditioning. Gloss measurements were repeated after bracket debonding and removal of the composite/glass ionomer cement with an 18-fluted carbide bur. Gloss differences between the two measurement conditions (baseline and post-debonding) were analyzed through linear regression with standard errors derived using the bootstrap method. Level of significance was set at a < 0.05.

RESULTS

A statistically significant difference was detected between the tested groups for the outcome of interest. Teeth bonded with light-cured composite exhibited larger enamel gloss changes as compared to resin-reinforced glass ionomer cement (β = 0.74; 95% CIs: 0.10, 1.38; p = 0.02).

CONCLUSIONS

Bracket bonding with two common bonding protocols (acid-etching with a light-cured composite vs. no etching with resin reinforced glass-ionomer cement) and subsequently debonding and adhesive removal with an 18-fluted carbide bur induced enamel gloss changes.

Comparison of two different debonding techniques in orthodontic treatment

Aim

The purpose of this research is to investigate whether and how the adhesive bond failure site varied in relation to the material used for the orthodontic bonding and debonding technique applied.

Materials and methods

Two different methods of orthodontic debonding were included in our survey; cutters for orthodontics and debonding plier. Three different materials for the adhesion of the bracket: composite light curing, self-curing composite and glass ionomer cement. The remaining amount of adhesive on the tooth surface is an important parameter that gives information on how the location of the posting site varied during the debonding. 60 dental elements, maxillary and mandibular, previously extracted for orthodontic reasons, as well as periodontal, were included in our research. We investigated a possible significant correlation between different variables (debonding technique and materials for membership) and the ARI index.

Conclusions

The use of orthodontic cutters or debonding pliers does not affect the adhesive bond failure site and both techniques have a tendency to leave a significant amount of adhesive on the surface enamel. In the resin-reinforced glass ionomer cements, detachment occurs at the interface enamel-adhesive and this pattern of detachment increases the risk of the enamel damage during debonding. In both types of composite resins (photopolymerizable or self-curing), the detachment occurs at the interface bracketing adhesive. In this case the amount of remaining adhesive material on the tooth must be removed with further methods, which in addition, increase the risk of iatrogenic injury as well as the working hours.

Confocal microscope analysis of depth of etch between self-limiting and traditional etchant systems

OBJECTIVE

To see whether there is an advantage to using a self-limiting phosphoric acid etchant versus a traditional 34% phosphoric acid etchant for bonding by measuring the depth of etch at multiple time intervals.

MATERIALS AND METHODS

A total of 25 bovine teeth were mounted and etched on the facial surface with two different etchants: standard 34% phosphoric acid and a self-limiting 35% phosphoric acid etchant at varied time intervals of 15, 30, 60, 90, and 120 seconds. Teeth were scanned using a three-dimensional laser confocal scanning microscope prior to etching and scanned again after etching to determine the depth of enamel etched compared to the baseline enamel surface prior to etching.

RESULTS

The 34% phosphoric acid etchant etched significantly deeper than the self-limiting etch. Etch times exceeding 30 seconds also etched significantly deeper for both types of etchant.

CONCLUSION

The etch depth of the self-limiting etchant was consistently less than the standard etchant. Both types of etchant etched deeper after 30 seconds, but the depth of etch at 120 seconds was not different than at 60 seconds, indicating that both etchants are somewhat self-limiting in depth. Therefore, there is no advantage to using the self-limiting etchant.

Effect of sodium sulfite, carboxylic monomer, and phosphoric acid etching on bonding of tri-n-butylborane initiated resin to human enamel

The purpose of the present study is evaluation of bonding durability of tri-n-butylborane (TBB) initiated resin without 4-methacryloyloxyethyl trimellitate anhydride (4-META) joined to human enamel. Ground human enamel was bonded with TBB resin under six surface conditions: 1) as ground, 2) primed with Teeth Primer, 3) sodium sulfite solution, 4) 4-META solution, 5) acetone-water, and 6) phosphoric acid etching. Pre- and post-thermocycling bond strengths and change in strength after thermocycling were compared. Etching enamel with 35-45% phosphoric acid enhanced bonding durability between enamel and TBB-initiated resin. Priming with Teeth Primer or 4-META solution improved bond strength between enamel and TBB-initiated resin. Sodium sulfite had little effect on enamel bonding in the present bonding systems.

Effect of a self-etching primer and phosphoric acid etching on the bond strength of 4-META/MMA-TBB resin to human enamel

The purpose of this study was to evaluate the shear bond strength and durability of 4-META/MMA-TBB resin to human enamel. A self-etching primer that contained 4-META (Teeth Primer, TP) and 35-45% or 60-65% concentrations of phosphoric acid (K-Etchant Gel, KE, and Super Bond C&B Red Activator, RA) were used as the surface treatment agents. A methyl methacrylate (MMA)-based self-polymerizing resin (Super-Bond C&B) was used as a luting agent. The shear bond strength was determined both pre and post thermocycling. The results were statistically analyzed with a non-parametric procedure. The post-thermocycling shear bond strength of the TP group was significantly higher than that of other groups, and that of the KE group was significantly higher compared with the RA group. These results demonstrated that 4-META was effective. Furthermore, when the degree of tooth demineralization was compared, surface treatment with less demineralization using TP was the most effective treatment.