Bond strength of self-adhesive flowable composite resins to dental tissues: A systematic review and meta-analysis of in vitro studies

A novel dental resin composite based on POSS and MDP-modified Zirconia: Preparation and evaluation

INTRODUCTION

The purpose of this study was to develop a novel dental resin composite by integrating polyhedral oligomeric silsesquioxane (POSS) with zirconia modified by 10-methacryloxydecyl dihydrogen phosphate (10-MDP).

METHODS

The resin matrix was synthesized in dark conditions. The experimental groups were designated based on the content of POSS incorporated into the resin matrix, with a concentration range of 2 wt% to 8 wt%. After thoroughly mixing the resin matrix, 5 wt% zirconia treated with 10-MDP was added.

RESULT

The FTIR spectra showed the appearance of new absorption bands, and the XPS(X-ray Photoelectron Spectroscopy) study confirmed the effectiveness of the surface treatment of zirconia. The resin composite exhibited optimal properties at a POSS concentration of 4 wt%, with significant improvements in flexural strength, compressive strength, and Vickers hardness compared to the control group. However, these properties decreased when the concentration exceeded that of the 4 wt % group. The incorporation of POSS significantly reduced the polymerization shrinkage of the resin composite. Moreover, none of the experimental resin composites exhibited cytotoxicity, indicating excellent biocompatibility.

CONCLUSION

We have succeeded in developing a new resin composite that significantly improves its performance when POSS is added at a concentration of <4wt%, and reaches its optimum level at a concentration of 4wt%.

CLINICAL SIGNIFICANCE

The development of this novel resin composite provides a new material option for clinical applications. The improved properties from this work show potential for developing an alternative material for clinical application.

Effects of mixing of europium oxide in resin composites on the fluorescence characteristics and mechanical properties

OBJECTIVE

The objective of this study is to disperse europium oxide (Eu2O3) in a resin composite (RC) using a planetary centrifugal mixer and assess its effects on photoluminescence and mechanical properties.

MATERIALS AND METHODS

A commercially available RC was mixed with Eu2O3 at various concentrations using a planetary centrifugal mixer. The fabricated samples were evaluated using scanning electron microscopy and a spectrofluorometer to assess their crystal structures, particle sizes, and photoluminescence properties. Vickers microhardness measurements were performed, along with a three-point bending test. Statistical analyses were performed to assess the mechanical properties.

RESULTS

The intensity of red fluorescence increased with the increase of europium oxide concentration. The fluorescence spectra at 613 and 620 nm exhibited higher intensities under excitation at 254 nm. Eu2O3 was dispersed in RC regardless of the Eu2O3 concentration, and no aggregation was observed. Regarding the mechanical properties, there were no significant differences in the flexural strength or modulus, and the Vickers hardness gradually increased with increasing Eu2O3 concentration.

CONCLUSION

To mix Eu2O3 with RC, visible fluorescence emission was observed even with increasing the Eu2O3 concentration, and the mechanical properties of RC were unaffected. Based on our study, a 15 wt% concentration of Eu₂O₃ is the appropriate concentration, as it achieves strong fluorescence emission without compromising the mechanical properties or color tone of the RC.

Comparing Polymerization Shrinkage Measurement Methods for Universal Shade Flowable Resin-Based Composites

Universal shade flowable composites have been introduced to mimic tooth structure with reduced color mismatch and reduced chair time and cost. However, the polymerization shrinkage of resin material may lead to sensitivity and restoration failure. The purpose of this study was to compare the polymerization shrinkage of recently introduced universal shade flowable resin-based composites using both wet and dry density methods. Using two measurement methods, ISO 17304 (wet method) and a gas displacement pycnometry system (dry method), the density of the unpolymerized and the polymerized RBCs were measured, and the polymerization shrinkage was calculated from the density difference. Scanning electron microscopy was used to visualize filler particles. The polymerization shrinkage showed significant differences between many materials. In particular, Bulk Base HARD II Medium Flow showed significantly lower polymerization shrinkage than all the other materials. Shrinkages measured by different methods were significantly different in all cases. The wet method measured a smaller shrinkage than the dry method in most cases, but the shrinkage measured for Gracefil LoFlow was larger with the wet method. Shrinkage between universal shade flowable resin-based composites significantly varied based on both material and measurement method. The polymerization shrinkage of resin-based composites is an important factor in biomimetic clinical dentistry, and work must be conducted to measure it accurately and with more standardization.

Assessment of Surface Roughness, Color, and Bonding Efficacy: Self-Adhesive vs. Conventional Flowable Resin

This in vitro study aimed to analyze the surface roughness (Ra) and color stability (ΔEab, ΔE00) following simulated mechanical brushing and to evaluate the microtensile (μTBS) of self-adhering resin flowable (SARF) to dentin. The selected materials were Constic, Yflow AS, and Tetric N flow (TNF/control). Thirty composite resin cylinders were fabricated for surface property evaluation. Ra and color were assessed both before and after simulated brushing. The thresholds of 50:50% perceptibility and acceptability of color differences in the evaluated resins were assessed. For μTBS analysis, fifteen molars were selected, sectioned to expose flat dentin surfaces, and restored according to the manufacturers' instructions for microtensile testing. There were statistically significant differences in Ra among the groups, with Constic exhibiting the highest Ra value (0.702 µm; p < 0.05), whereas Yflow AS presented the lowest Ra value (0.184 µm). No statistically significant difference in color was observed among the groups (p > 0.05). The 50:50% perceptibility and acceptability thresholds were set at 1.2 and 2.7 for ΔEab and 0.8 and 1.8 for ΔE 00. All the results fell within the acceptable limits. The mean μTBS values of Constic, Yflow AS, and TNF were 10.649 MPa, 8.170 MPa, and 33.669 MPa, respectively. This study revealed increased Ra and comparable color stability among all the tested composite resins after abrasion. However, the SARF exhibited lower μTBS compared to conventional using an adhesive system.

Shear Bond Strength of Self-Adhesive Versus Conventional Flowable Composites: An In Vitro Study

Aim

As an emerging yet underexplored innovation in dentistry, self-adhesive flowable composites (SAFCs) represent a promising and enduring advancement in the dental material technology. Our study aims to evaluate the shear bond strength of two SAFCs and the bonding of conventional flowable composite (CFC) to permanent dentin.

Materials and Methods

Thirty-six teeth were embedded in acrylic blocks, with the occlusal third removed to expose the underlying dentin. A cylindrical mold was positioned on the treated dentin surface and filled with the composite resin material to be evaluated. The prepared permanent dentin surfaces were randomly assigned to three groups based on the following application protocols: Group 1: Axo Uni Flow (AXIMACK, India); Group 2: Constic (DMG, Germany); and Group 3: 37% phosphoric acid etchant + Single Bond Universal + Filtek Z350 XT (3M ESPE, USA). The shear bond strength of the prepared specimens was measured by using a universal testing machine. The data were analyzed with Kruskal-Wallis one-way analysis of variance, followed by Dwass-Steel-Critchlow-Fligner pairwise comparisons.

Results

Filtek Z350 XT (3M ESPE, USA) demonstrated higher shear bond strength values when compared to Constic (DMG, Germany) and Axo Uni Flow (AXIMACK, India). A significant difference was found between these materials. However, the shear bond strength of the two SAFCs tested did not differ significantly.

Conclusion

The investigation's findings suggest that the SAFCs exhibited inferior shear bond strength compared with CFCs when bonded with permanent dentin.

Influence of etching mode on bonding performance of self-adhesive flowable resin composites to bovine teeth

This study aimed to evaluate the bonding performance of self-adhesive flowable resin composites (SARs) to bovine teeth. Three SARs, one experimental, and two commercially available products, were used. The study parameters were shear bond strength (SBS), microleakage, and scanning electron microscopy (SEM) evaluation of bonding interfaces. The SBS of the materials was 14.1-15.1 MPa to enamel, 22.2-23.2 MPa to etched enamel, and 7.4-10.7 MPa to dentin. Specimens with pre-etching showed lower microleakage scores than those without pre-etching. SEM images of the interfaces of the materials showed excellent adaptation regardless of the substrate or etching mode. The study results indicate that enamel pre-etching can improve the bonding performance of SARs.

Citric Acid Conditioning as an Alternative to EDTA for Growth Factors Release and Stem Cell Response in Regenerative Endodontics: A Systematic Review of In Vitro Studies

INTRODUCTION

Citric acid (CA) conditioning may be a promising alternative to ethylenediaminetetraacetic acid (EDTA) in regenerative endodontic procedures, as reported to improve growth factors' release from dentin. This review systematically investigated the effect of CA conditioning on the growth factors release from dentin and cell behavior compared to EDTA conditioning.

METHODS

Searches were conducted (PubMed/MEDLINE, Scopus, Web of Science, Embase, SciELO, Cochrane Library, and grey literature) until May-2023. Only in vitro studies that evaluated the effects of CA on growth factors' release from dentin and cell behavior outcomes compared to EDTA were included. The studies were critically appraised using a modified Joanna Briggs Institute's checklist. Meta-analysis was unfeasible.

RESULTS

Out of the 335 articles screened, nine were included. Among these, three studies used dentin discs/roots from permanent human teeth; the rest combined them with stem cells. 10% CA for 5 or 10 minute was the most used protocol. Meanwhile, EDTA concentrations ranged from 10% to 17%. In eight studies examining the release of growth factors, five reported a significant release of transforming growth factor-β after dentin conditioning with 10% CA compared to 17% EDTA. Regarding cell behavior (6 studies), three studies assessed cell viability. The findings revealed that 10% CA conditioning showed cell viability similar to those of 17% EDTA. Additionally, in two out of three studies, it was observed that 10% CA conditioning did not affect cell morphology. The studies had a low risk of bias.

CONCLUSIONS

The use of 10% CA to condition dentin for 5-10 minutes resulted in a notable transforming growth factor -β1 release, but its cell responses were similar to those of EDTA.

12-Month flexural mechanical properties of conventional and self-adhesive flowable resin composite materials

The aim of this study was to investigate the 12-month flexural mechanical properties of 23 flowable resin-based composites (FRBC) that included 5 self-adhesive FRBC materials. Specimens were evaluated following ISO 4049:2019 guidelines, but additionally stored in physiologic 0.2M phosphate buffered saline solution being tested at 24 h, 1 week, 1 month, and at 3-, 6-, 9-, and 12-months. While some deviation and degradation were noted at testing intervals, conventional FRBC materials overall demonstrated greater flexural strength than the self-adhesive and compomer materials. Three self-adhesive materials and the compomer were below recommended ISO 4049:2019 flexural strength values at 24 h with another after 6 months storage. Conventional FRBC materials, except at 1 month, overall demonstrated increased flexural modulus than the self-adhesive FRBC materials. Although results were material dependent, conventional FRBC materials demonstrated overall greater flexural mechanical properties as compared to the self-adhesive FRBC materials and the compomer evaluated.

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.

Effects of polishing procedures on optical parameters and surface roughness of composite resins with different viscosities

The aims of this study were to evaluate the optical properties of flowable and injectable composites after polishing, such as translucency (translucency parameter [TP], TP₀₀), opalescence (OP-BW), chroma (C*ab), refractive index (RI), and change in surface roughness (Ra, Rz). Ninety disc-shaped samples were prepared from micro-hybrid, flowable, and injectable composites and divided into 3 groups according to the polishing systems (n=10). The RI was measured with an Abbe refractometer, and optical measurements were performed with a spectrophotometer. The surface roughness was measured with a two-dimensional profilometer. Data were analyzed with the generalized linear model method and two-way analysis of variance. The results showed that the polishing procedure did not significantly impact the RI (p=0.987). Injectable composite had the highest translucency (TP=28.67; TP₀₀=13.49) and opalescence (OP-BW=13.11); showed the lowest C*ab value (17.95). Also, the effects of the composite type and polishing procedure on surface roughness were statistically significant (p=0.047 and p<0.001).

Comparative Assessment of Different Pre-Treatment Bonding Strategies to Improve the Adhesion of Self-Adhesive Composites to Dentin

The aim of this study is to compare the adhesive interface formed in dentin, using self-adhesive composites applied with different bonding strategies, by testing the microtensile bond strength (μTBS) and ultramorphology through the use of light microscopy. Permanent, sound human molars were randomly allocated to six experimental groups. The groups included a negative control group, where only etching was performed via EtchOnly; a positive control group where an adhesive was applied, OptiBondFL (OBFL); and an experimental group where a primer was applied using a co-curing strategy together with a composite (Primer_CoCuring). The samples were sectioned into microspecimens for μTBS (n = 8) and into 1-mm thick slabs for light microscopy using Masson’s trichrome staining protocol (n = 3). The statistical analysis included a two-way ANOVA for μTBS data and Tukey’s HSD was used as a post-hoc test (significance level of 5%; SPSS v. 26.0). The results of the μTBS revealed that the self-adhesive composite (F = 6.0, p < 0.018) and the bonding strategy (F = 444.1, p < 0.001) significantly affected the bond strength to dentin. However, their interactions were not significant (F = 1.2, p = 0.29). Etching dentin with no additional treatment revealed the lowest μTBS (VF_EtchOnly = 2.4 ± 0.8 MPa; CC_EtchOnly = 2.0 ± 0.4 MPa), which was significantly different from using a primer (VF_CoCu = 8.8 ± 0.8 MPa; CC_CoCu = 6.3 ± 1.0 MPa) or using the full adhesive (VF_OptiBondFL = 22.4 ± 0.3 MPa; CC_OptibondFL = 21.2 ± 0.4 MPa). Microscopy images revealed that the experimental Primer_CoCuring was the only group with no collagen fibers exposed to the dentin−composite interface. Overall, the use of a primer, within the limitations of this study, increased the bonding of the self-adhesive composite and provided sufficient infiltration of the collagen based on light-microscopic imaging.

Influence of the self-adhering strategy on microhardness, sorption, solubility, color stability, and cytotoxicity compared to bulk-fill and conventional resin composites

OBJECTIVES

To analyze and compare, in vitro, the microhardness, sorption, solubility, color stability, and cytotoxicity of three types of resin composites: self-adhesive (SARC) (Dyad Flow (DF)/Kerr), bulk-fill (Filtek Bulk Fill Flow (FBF)/3 M ESPE), and conventional (Filtek Z350XT Flow (Z350)/3 M ESPE).

MATERIALS AND METHODS

Thirty cylindrical specimens were prepared using a split metal mold (15 mm × 1 mm), divided into 3 groups (n = 10) according to the material used. Vickers hardness (VH) was calculated from three indentations (300gf/15 s) per specimen. The sorption and solubility were measured according to the ISO 4049:2009 specification after storing in distilled water for 7 days. The color of each resin composite was measured using a portable digital spectrophotometer according to the CIELAB system. After a 7-day immersion in coffee, the color variation (∆E) was calculated. Following the ISO 10993:2012, the cytotoxicity in Vero cells was evaluated through the MTT assay. The results were analyzed using the Kruskal-Wallis test to compare the studied groups. The Wilcoxon test was used to compare the assessments in each studied group. For cytotoxicity analysis, the data were compared by the ANOVA test (α = 0.05).

RESULTS

DF showed the lowest VH (28.67), highest sorption (0.543 µg/mm³) and solubility (1.700 µg/mm³), and higher ∆E after 7 days of coffee immersion (p = 0.008). The resin composites studied were considered non-cytotoxic.

CONCLUSIONS

The SARC presented inferior mechanical and physical-chemical properties than bulk-fill and conventional resin composites, with comparable cytotoxicity against Vero cells.

CLINICAL RELEVANCE

The simplification of the clinical protocol of SARC can minimize the number of possible failures during the restorative technique. However, considering their inferior physical and mechanical properties, their coverage with materials of higher mechanical properties and physical-chemical stability should be considered.

Tensile Bond Strength and Marginal Integrity of a Self-adhering and a Self-etch Adhesive Flowable Composite after Artificial Thermomechanical Aging

Aim

This study aims to compare the self-etch adhesive (SEA) and self-adhesive flowable composite (SAF) concerning tensile bond strength (TBS) and marginal integrity by microleakage (µ LK) test in deciduous molars after artificial thermomechanical aging.

Materials and methods

120 extracted primary molars were collected. Sixty teeth were mounted for testing TBS. Teeth were restored using SAF (n = 30) and SEA-conventional flowable (CF) composite (n = 30) and subjected to artificial thermal aging. Half the teeth (n = 15) from each material were subjected to mechanical loading (SEA-TBS-L and SAF-TBS-L). The specimens with no-load (NL) served as control (SEA-TBS-NL and SAF-TBS-NL). Class V cavity prepared and restored with SAF (n = 30) and SEA-CF (n = 30) to test µ LK after thermal aging. The subgroups were as same as the TBS based on with or without mechanical loading (SEA-µ LK-L, SEA-µ LK-NL, SAF-µ LK-L, SAF-µ LK-L; n = 15 each). µ LK was determined by employing the dye immersion technique.

Results

Concerning TBS, there is a significant difference between SEA and SAF with load or no load. Concerning µ LK, there is a significant difference between the materials under loading and no difference was found when not mechanically loaded. Also, concerning both TBS and µ LK, a significant difference was observed between the load and no-load subgroups within each material.

Conclusion

SAF exhibited higher TBS than the SEA. Mechanical loading not only adversely affected the TBS but also increased the µLK of the compared materials.

Clinical Significance

Restoring the primary teeth with SAF not only shortens the laborious operatory time but also yields good clinical serviceability with the good bond strength and minimal µ LK, thus preventing premature loss of teeth and consequential malocclusion.

How to cite this article

Kamatchi M, Ajay R, Gawthaman M, et al. Tensile Bond Strength and Marginal Integrity of a Self-adhering and a Self-etch Adhesive Flowable Composite after Artificial Thermomechanical Aging. Int J Clin Pediatr Dent 2022;15(2):204-209.

Bond Strength of Self-Adhesive Flowable Composites and Glass Ionomer Cements to Primary Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

Background: Conventional composites are largely used in pediatric restorative dentistry and demonstrate successful clinical outcomes. However, the need for simplification of operative steps in young or uncooperative children demands reliable alternatives. Therefore, the aim of the present systematic review and meta-analysis was to evaluate the in vitro bond strength of glass ionomer cements (GICs) and self-adhesive flowable composites (SFCs) on deciduous teeth. Methods: A comprehensive literature search according to the PRISMA checklist was manually and electronically performed by two independent reviewers through the following databases: MEDLINE/PubMed, Google Scholar, Scopus, and Embase, to include in vitro studies comparing GICs and SFCs bond strength values of restorations on primary teeth. In addition, three groups of meta-analyses were conducted using random-effects models. Results: Three articles meeting the inclusion criteria were selected and subjected to both qualitative and quantitative assessment. No statistically significant difference was found between SFC versus GIC; however, both groups significantly differed with conventional flowable composites (CFs). Conclusions: Despite the absence of significant difference in bond strength values, SFCs may be considered a valid alternative to GICs in the restoration of deciduous teeth, although CFs proved better in vitro performances.

Rheological and Mechanical Properties of Resin-Based Materials Applied in Dental Restorations

Resin-based materials have been prevalent for dental restorations over the past few decades and have been widely used for a variety of direct and indirect procedures. Typically, resin-based dental materials are required to be flowable or moldable before setting and can provide adequate mechanical strength after setting. The setting method may include, but is not limited to, light-curing, self-curing or heating. In this review, based on different indications of resin-based dental materials (e.g., dental filling composite, dental bonding agent, resin luting cement), their rheological and mechanical properties were reviewed. Viscous and flexible properties were focused on for materials before setting, while elastic properties and mechanical strength were focused on for materials after setting. At the same time, the factors that may affect their rheological and mechanical properties were discussed. It is anticipated that the insightful information and prospections of this study will be useful to the future development and fabrication of resin-based dental restorative materials.