Dentin bonding as a function of dentin structure

Deep margin elevation in restorative dentistry: A scoping review

OBJECTIVES

Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web.

DATA

Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening.

SOURCES

This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information.

STUDY SELECTION

The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources.

CONCLUSIONS

DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to.

CLINICAL SIGNIFICANCE

With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.

Deep Margin Elevation: A Literature Review

A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.

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.

Ultrasonic Monitoring of Dentin Demineralization

Demineralization is a process of loss of minerals in the dental hard tissue that affects seriously the health of the patients, as it diminishes the tooth resistance, generating chewing problems by altering the occlusal structure, hypersensitivity, and pulpal problems. Demineralization can be produced by pathological processes as erosion or caries, or by surgical processes as etching. Due to the complexity of natural demineralization processes, it is mandatory to provide quantitative and standardized tests to allow their study in controlled laboratory conditions. Ultrasonic techniques are suitable for this purpose as they are nondestructive, quick, and provide localized mechanical information about the tissue, which is related with its degree of demineralization. In the present work, we evaluate the complete process of demineralization of the human dentin under controlled laboratory conditions using a pulse-echo ultrasonic technique. Up to 15 human dentin teeth have been demineralized with phosphoric acid at 10%. The time-of-flight measurements using the pulse-echo system allows to obtain the speed of sound in healthy (3415 m/s) and demineralized dentin tissue (1710 m/s), as well as to characterize the dynamical process of the acid penetration, which generates well-defined boundaries between two media (demineralized and mineralized dentin), showing very different mechanical properties. These boundaries advance in depth at an initial rate of [Formula: see text]/min, decelerating at -9.3 nm/min² until the whole demineralization of the sample is achieved. In addition, the technique allows to measure the relevance of the demineralization produced by the acid residues inside the tooth once it has been removed from the acidic solution. Beyond the assessment of artificial demineralization lesions under laboratory conditions, as demonstrated in this article, the proposed technique opens new approaches to the assessment of demineralization caused by natural caries in vivo.

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.

Current perspectives on dental adhesion: (3) Adhesion to intraradicular dentin: Concepts and applications

Adhesion science is one of the greatest contributions to restorative dentistry. Adhesion not only established the current principles of tissue preservation, but also allowed for the production of more hermetic and long-lasting restorations. Although adhesive strategies are routinely used in most clinical situations, adhesion to root dentin is still a major challenge. The presence of humidity together with less intertubular dentin are factors that limit the adhesive potential of root dentin. This situation is more unfavorable in endodontically treated teeth prepared for prefabricated or custom-made intraradicular posts; these procedures may alter the mechanical properties of teeth by modifying the viable dentin surface for adhesion. Also, contaminants deposited on the dentin surface are difficult to remove through conventional techniques. Moreover, root canal morphology has a very unfavorable C-factor, bringing undesirable effects resulting from polymerization contraction of resin-based materials. However, the differences between coronal and root dentin are not a barrier for dentin adhesion. Standardization of procedures and care during clinical steps are fundamental to the success of adhesion to coronal or intraradicular dentin. Thus, it is essential to know the anatomy of the root structure, the factors that interfere with intraradicular adhesion, as well as the current adhesive materials and techniques.

No correlation between two methodological approaches applied to evaluate cervical margin relocation

The study evaluated the quality of gingival margins created by cervical margin relocation (CMR) technique using different materials and assessed the consistency of the results obtained by two in vitro methods: microleakage test and scanning electron microscopy (SEM). Mesio-occlusal-distal cavities with subgingival proximal margins were prepared. Mesial margins were elevated supragingivally with total-etch adhesive and flowable composite (Group 1) or with universal adhesive and bulk-fill flowable composite (Group 2). Distal margins were not elevated. Teeth were restored with CAD/CAM overlays. Marginal quality was evaluated by microleakage test and SEM observation of epoxy resin replicas. Statistical analyses showed no significant correlations between microleakage scores and percentage of marginal integrity observed under SEM at CMR margins, lower microleakage scores at margins without CMR compared to CMR margins, lower microleakage scores in Group 2 than in Group 1 and no difference in SEM integrity between groups at CMR margins.

Six-month performance of restorations produced with the ethanol-wet-bonding technique: a randomized trial

This double-blind randomized controlled clinical trial evaluated the effectiveness of dentin pretreatment with 100% ethanol (EWBT - ethanol wet bonding technique) and different adhesive protocols in noncarious cervical lesions (NCCL) after 6 months. Patients presenting at least one NCCL were included. NCCLs (n=148) were randomly assigned to 4 groups: NE (Non-EWBT + three-step etch-and-rinse (Scotchbond Multi Purpose, 3M ESPE [MP]), E (EWBT + MP); EB (EWBT + [Bond - third step of MP]), and EU (EWBT + universal adhesive (Single Bond Universal, 3M ESPE). Conventional acid-etching (Condac 37%, FGM) and nanohybrid resin composite (Z350, 3M ESPE) were used. Trained and calibrated examiners (Kappa = 0.61) evaluated the restorations at baseline (7 days) and 6-month recall using the USPHS modified criteria. Data were subjected to Chi square (α = 0.05). Differences in the success rate were found for the treatments (p = 0.003). EB presented the lowest success rate compared with the other groups (p < 0.02). No significant differences were detected among NE, E, and EU (p > 0.49). The survival rates were 97.23%, 97.30%, 78.95%, and 97.30% for NE, E, EB, and EU, respectively. Regarding postoperative sensitivity, a significant reduction was found for groups E (p = 0.027) and EU (p < 0.01) after 6 months. After 6 months, EWBT associated to the hydrophobic adhesive system had the highest failure rate.

Effect of adhesive mode and chlorhexidine on microtensile strength of universal bonding agent to sound and caries-affected dentins

Objective:

The main objective of this study is to assess the effect of the adhesive mode and chlorhexidine (CHX) on the microtensile strength of a universal bonding agent to sound and caries-affected dentins.

Materials and Methods:

Six intact third molars and six decayed third molars were sectioned to obtain two middle dentin specimens per tooth. Prime and Bond Elect Universal (Dentsply) was applied to specimens in two different modes: Etch-and-rinse (ER, phosphoric acid for 15s) and self-etch (SE, no phosphoric acid). 2% CHX (Cavity Cleanser, Bisco) was applied to both dentins for 30 s. Specimens were randomly assigned into eight groups (n = 3) according to the treatments applied to sound and caries-affected dentins: SE; ER; SE + CHX; and ER + CHX. All specimens were restored with TPH Spectra High Viscosity (Dentsply) composite resin and sectioned to obtain specimens of 0.8 ± 0.1 mm². The microtensile bond strength test was conducted at 1 mm/min. The data were statistically analyzed by ANOVA and multiple comparisons’ test (α = 0.05).

Results:

There was no significant difference between sound dentin and caries-affected dentin (P = 0.132). The highest bond strength was obtained with the application of the ER (31.81MPa). SE + CHX promoted the lowest bond strength with no statistical difference to ER + CHX (P > 0.05).

Conclusions:

ER mode for the universal bonding agent yielded the highest bond strength to sound and caries-affected dentins. CHX reduced the bond strength to both dentins regardless the application of phosphoric acid.

Clinical Significance:

The universal bonding agent increased the bond strength to sound and caries-affected dentins when applied by the ER mode.

Effect of 830 nm Diode Laser Irradiation of Root Canal on Bond Strength of Metal and Fiber Post

OBJECTIVE AND BACKGROUND

The correct selections of the cementing agent, the endodontic post material and placement protocol are critical to provide an increased longevity of the teeth that went through endodontic treatment. The irradiation with diode laser before post cementation, can promote an antimicrobial effect. However, there is a lack of information about the effect of 830 nm diode laser on the post bond strength. This study analyzed the effect of dentin root canal irradiation with high-intensity diode laser, at 830 nm, operating in continuous or pulsed mode, on the retention of metal or fiber posts, cemented with self-etching resinous composite (Panavia F) and zinc phosphate cement (ZnPO₄).

MATERIALS AND METHODS

Human roots were irradiated with diode laser (continuous and pulsed mode). The fiber posts were luted with Panavia F and the metal posts with Panavia F or ZnPO₄ cement. Specimens were sectioned into three sections (cervical, middle, and apical). The bond strength was measured by a push-out mechanical analysis. For the statistical analysis, a three-way ANOVA test was applied following a Tukey's pairwise comparison with a significance level of p = 0.05.

RESULTS

The irradiated groups presented higher bond strength compared with nonirradiated group (p < 0.05), and the cervical and middle thirds presented higher on bond strength than the apical. The association of metal post and Panavia F presented higher bond strength when irradiated on continuous mode (p < 0.05). Fiber post and Panavia F presented higher bond strength associated to pulsed mode. The mode seems not to make a significant difference.

CONCLUSIONS

These results corroborate the importance of the post bond to dentin and root canal debris removal to increase the tooth longevity. It was shown that the dentin to post bond strength were enhanced by the diode laser irradiation either on continuous or pulsed modes.

Evaluation of the effect of different post materials and adhesive systems on the bonding strength of short-post technique for primary teeth

BACKGROUND

The most important process in treating grossly decayed teeth, including decay in the pulp, is the ability to hold a retainer in for a short time.

AIM

The aim of this study was to investigate the bond strengths of different adhesive systems and post materials on primary teeth.

DESIGN

One hundred and twenty extracted maxillar primary central incisor teeth were randomly divided into two main groups (total-etch and self-etch adhesive systems) and five subgroups (1: control-nanohybrid composite resin, 2: pre-impregnated glass fiber, 3: unsaturated glass fiber, 4: polyethylene fiber, 5: short-fiber reinforced composite resin). The push-out test was performed using a universal testing machine with a crosshead speed of 0.5 mm/min.

RESULTS

No statistically significant difference was detected between the two different adhesive systems and five different materials in terms of the maximum values measured for fractures in the specimens when both the adhesive materials and the short-post materials were evaluated separately (P > 0.05). However, as a result of multiple comparisons made, it was found that statistical differences between the groups applying the total-etch adhesive system occurred in Groups 3 and 5. The highest push-out test values were measured in Group 5 and Group 1, and the lowest value in Group 3. Although the fracture type distribution in the total-etch adhesive system groups was not statistically different based on the material used (χ²  = 11,865; P = 0.309), the self-etch adhesive systems did show differences (χ²  = 28,463; P < 0.001). Both the total-etch and the self-etch adhesive system groups showed mostly adhesive failures.

CONCLUSION

The fiber-reinforced and nanohybrid composite resin had higher values in the short-post technique, and there was no significant difference between the different fiber posts.

Cervical margin relocation in indirect adhesive restorations: A literature review

PURPOSE

The aim of this review was to summarize the existing scientific literature investigating on cervical margin relocation technique (CMR) performed prior to the adhesive cementation of the indirect restorations.

STUDY SELECTION

An electronic search with no date restriction was conducted in the MEDLINE database, accessed through PubMed. The following main keywords were used: "cervical margin relocation", "coronal margin relocation", "deep margin elevation" and "proximal box elevation".

RESULTS

Seven in vitro studies and 5 clinical reports investigating on CMR are taken into consideration for the present review. The most frequently investigated parameter in almost all of the in vitro studies was the marginal adaptation of the indirect restorations. One study additionally assessed the influence of CMR on the fracture behavior of the restored teeth and one study assessed the bond strength of the indirect composite restoration to the proximal box floor. Clinical reports provided documentation with a detailed description of the treatment protocol. In the current literature no randomized controlled clinical trials or prospective or retrospective clinical studies on CMR technique could be found.

CONCLUSIONS

On the basis of the reviewed literature, it can be concluded that currently there is no strong scientific evidence that could either support or discourage the use of CMR technique prior to restoration of deep subgingival defects with indirect adhesive restorations. Randomized controlled clinical trials are necessary to provide the reliable evidence on the influence of CMR technique on the clinical performance, especially on the longevity of the restorations and the periodontal health.

In vivo and in vitro Permeability of One-step Self-etch Adhesives

Adhesive dentistry should effectively restore the peripheral seal of dentin after enamel removal. We hypothesize that non-rinsing, simplified, one-step self-etch adhesives are effective for minimizing dentin permeability after tooth preparation procedures. Crown preparations in vital human teeth were sealed with Adper Prompt, Xeno III, iBond, or One-Up Bond F. Epoxy resin replicas were produced from polyvinyl siloxane impressions for SEM examination. Dentin surfaces from extracted human teeth were bonded with these adhesives and connected to a fluid-transport model for permeability measurements and TEM examination. Dentinal fluid droplets were observed from adhesive surfaces in resin replicas of in vivo specimens. In vitro fluid conductance of dentin bonded with one-step self-etch adhesives was either similar to or greater than that of smear-layer-covered dentin. TEM revealed water trees within the adhesives that facilitate water movement across the polymerized, highly permeable adhesives. Both in vitro and in vivo results did not support the proposed hypothesis.

Evaluating the shear bond strength of enamel and dentin with or without etching: A comparative study between dimethacrylate-based and silorane-based adhesives

BACKGROUND

Silorane-based composites and their specific self-etch adhesive were introduced to conquest the polymerization shrinkage of methacrylate-based composites. It has been shown that additional etching of enamel and dentin can improve the bond strength of self-etch methacrylate-based adhesives but this claim is not apparent about silorane-based adhesives. Our objective was to compare the shear bond strength (SBS) of enamel and dentin between silorane-based adhesive resin and a methacrylate-based resin with or without additional etching.

MATERIAL AND METHODS

40 sound human premolars were prepared and divided into two groups: 1- Filtek P60 composite and Clearfil SE Bond adhesive; 2- Filtek P90 composite and Silorane adhesive. Each group divided into two subgroups: with or without additional etching. For additional etching, 37% acid phosphoric was applied before bonding procedure. A cylinder of the composite was bonded to the surface. After 24 hours storage and 500 thermo cycling between 5-55°C, shear bond strength was assessed with the cross head speed of 0.5 mm/min. Then, bonded surfaces were observed under stereomicroscope to determine the failure mode. Data were analyzed with two-way ANOVA and Fischer exact test.

RESULTS

Shear bond strength of Filtek P60 composite was significantly higher than Filtek P90 composite both in enamel and dentin surfaces (P<0.05). However, additional etching had no significant effect on shear bond strength in enamel or dentin for each of the composites (P>0.05). There was no interaction between composite type and additional etching (P>0.05). Failure pattern was mainly adhesive and no significant correlation was found between failure and composite type or additional etching (P>0.05).

CONCLUSIONS

Shear bond strength of methacrylate-based composite was significantly higher than silorane-based composite both in enamel and dentin surfaces and additional etching had no significant effect on shear bond strength in enamel or dentin for each of the composites. The mode of failure had no meaningful relation to the type of composite and etching factor.

KEY WORDS

Shear bond strength, adhesive, composite resin, silorane, methacrylate.

Effect of different adhesive strategies on the post-operative sensitivity of class I composite restorations

Objective:

To evaluate the post-operative sensitivity of occlusal restorations using different dentin adhesives performed by an undergraduate and a post-doctorate dentist.

Materials and Methods:

One hundred and eighty-eight molar occlusal restorations were placed in 39 patients (ages between 18 and 30) using 3 different kind of adhesive systems; Optibond FL (OBF), Clearfil Protect Bond (CPB), and iBond (IB) by a post-doctorate dentist or a fifth-year dental student according to the manufacturers’ instructions. Post-operative sensitivity to cold and air was evaluated using a Visual Analog Scale (VAS) after 24 hours, 30, 90, and 180 days. Data were analyzed using the Mann-Whitney U and Friedman tests (P < 0.05).

Results:

Post-operative sensitivity scores for OBF and CPB were higher for the dental student (P < 0.05), while IB scores did not differ statistical significantly according to the operator (P > 0.05).

Conclusion:

Operator skill and experience appears to play a role in determining the outcome of post-operative sensitivity of multi-step adhesive systems although the post-operative sensitivity was low. It is suggested that the less experienced clinicians (rather than experienced clinicians) should better use the self-etching dentin bonding systems with reduced application steps to minimize the potential risk of post-operative sensitivity of dental adhesives.

Influence of powdered dentin on the shear bond strength of dentin bonding systems

This study evaluated the effect of different amounts of dentin powder (DP) mixed in Clearfil SE Bond (CSB) or Single Bond (SB) on adhesion to dentin. Human third molars (n=96) were sectioned to expose the mid-coronal dentin and divided into eight experimental groups (n=12 per group), namely, Group 1: CSB, Group 2: CSB+1.5 mg DP, Group 3: CSB+3 mg DP, Group 4: CSB+4.5 mg DP, Group 5: SB, Group 6: SB+1.5 mg DP, Group 7: SB+3 mg DP, and Group 8: SB+4.5 mg DP. Filtek Z250 composite was bonded onto dentin, and all specimens were subjected to shear bond strength test at a crosshead speed of 1 mm/min. Highest bond strength was obtained in Groups 1, 2, and 3 (15.1, 13.5, and 16.4 MPa respectively; p>0.05) and the lowest in Groups 6, 7, and 8 (5.5, 5.6, 4 MPa; p>0.05). DP addition, regardless of amount, adversely affected the bond strength of SB. Bond strength of CSB was not affected when 1.5 or 3 mg of DP was added.

Effect of phosphoric acid etching on the shear bond strength of two self-etch adhesives

OBJECTIVE

To evaluate the effect of optional phosphoric acid etching on the shear bond strength (SBS) of two self-etch adhesives to enamel and dentin.

MATERIAL AND METHODS

Ninety-six bovine mandibular incisors were ground flat to obtain enamel and dentin substrates. A two-step self-etch adhesive (FL-Bond II) and a one-step self-etch adhesive (BeautiBond) were applied with and without a preliminary acid etching to both the enamel and dentin. The specimens were equally and randomly assigned to 4 groups per substrate (n=12) as follows: FL-Bond II etched; FL-Bond II un-etched; BeautiBond etched; BeautiBond un-etched. Composite cylinders (Filtek Z100) were bonded onto the treated tooth structure. The shear bond strength was evaluated after 24 hours of storage (37°C, 100% humidity) with a testing machine (Ultra-tester) at a speed of 1 mm/min. The data was analyzed using a two-way ANOVA and post-hoc Tukey's test with a significance level of p<0.05. A field emission scanning electron microscope was used for the failure mode analysis.

RESULTS

Both adhesives evidenced a significant decrease in the dentin SBS with the use of an optional phosphoric acid-etching step (p<0.05). Preliminary phosphoric acid etching yielded significantly higher enamel SBS for FL-Bond II (p<0.05) only, but not for BeautiBond. FL-Bond II applied to un-etched dentin demonstrated the highest mean bond strength (37.7±3.2 MPa) and BeautiBond applied to etched dentin showed the lowest mean bond strength (18.3±6.7 MPa) among all tested groups (p<0.05).

CONCLUSION

The use of a preliminary acid-etching step with 37.5% phosphoric acid had a significant adverse effect on the dentin bond strength of the self-etch adhesives evaluated while providing improvement on the enamel bond strength only for FL-Bond II. This suggests that the potential benefit that may be derived from an additional etching step with phosphoric acid does not justify the risk of adversely affecting the bond strength to dentin.

Dentin adhesion and MMPs: a comprehensive review

This review examines the fundamental processes responsible for the aging mechanisms involved in the degradation of resin-bonded interfaces, as well as some potential approaches to prevent and counteract this degradation. Current research in several research centers aims at increasing the resin-dentin bond durability. The hydrophilic and acidic characteristics of current dentin adhesives have made hybrid layers highly prone to water sorption. This, in turn, causes polymer degradation and results in decreased resin-dentin bond strength over time. These unstable polymers inside the hybrid layer may result in denuded collagen fibers, which become vulnerable to mechanical and hydrolytical fatigue, as well as degradation by host-derived proteases with collagenolytic activity. These enzymes, such as matrix metalloproteinases and cysteine cathepsins, have a crucial role in the degradation of type I collagen, the organic component of the hybrid layer. This review will also describe several methods that have been recently advocated to silent the activity of these endogenous proteases.

Effect of MTAD on the shear bond strength of self-etch adhesives to dentin

Background:

As the use of different irrigants to eliminate residual debris and smear layer in the field of endodontic is unavoidable, by considering the effect of irrigants on the bond strength of resin composite restorations, this study was designed to evaluate the effect of a mixture of a tetracycline isomer, an acid, and a detergent (MTAD) on the shear bond strength of two self-etch adhesives, Clearfil SE Bond and Adper Prompt L- Pop to dentin.

Materials and Methods:

The crowns of 80 extracted premolars were transversally sectioned to expose dentin. Flat dentin surfaces were wet abraded with 320-grit abrasive paper and randomly assigned to eight groups according to two self-etch adhesive and four dentin surface treatments: direct application over smear layer (no treatment), etching with 35% phosphoric acid for 15s, 1 min 5.25% NaOCl/1 min MTAD and 20min 1.3% NaOCl/5min MTAD. Shear bond strength was tested 24 h after storage in distilled water at 37°C in incubator. Data were analyzed using one-way ANOVA followed by duncan post-hoc (α=0.05).

Results:

Phosphoric acid etching prior to SE Bond application significantly decreased the shear bond strength to dentin (P<0.05). Application of MTAD clinical protocol (20min 1.3% NaOCl/5min MTAD) did not significantly decrease the shear bond strength of self-etch adhesives to dentin (P=0.745)

Conclusions:

Based on the results of present investigation, it seems that the use of clinical protocol of 1.3% NaOCl as a root canal irrigant and a 5-min application of MTAD as a final rinse to remove the smear layer has no adverse effect on the shear bond strength of self-etch adhesives to dentin.

Shear bond strength of porcelain laminate veneers to enamel, dentine and enamel-dentine complex bonded with different adhesive luting systems

OBJECTIVES

The aim of this study was to evaluate the shear bond strength of porcelain laminate veneers to 3 different surfaces by means of enamel, dentine, and enamel-dentine complex.

METHODS

One hundred thirty-five extracted human maxillary central teeth were used, and the teeth were randomly divided into 9 groups (n=15). The teeth were prepared with 3 different levels for bonding surfaces of enamel (E), dentine (D), and enamel-dentine complex (E-D). Porcelain discs (IPS e.max Press, Ivoclar Vivadent) of 2mm in thickness and 4mm in diameter were luted to the tooth surfaces by using 2 light-curing (RelyX Veneer [RV], 3M ESPE; Variolink Veneer [VV], Ivoclar Vivadent) and a dual-curing (Variolink II [V2], Ivoclar Vivadent) adhesive systems according to the manufacturers' instructions. Shear bond strength test was performed in a universal testing machine at 0.5mm/min until bonding failure. Failure modes were determined under a stereomicroscope, and fracture surfaces were evaluated with a scanning electron microscope. The data were statistically analysed (SPSS 17.0) (p=0.05).

RESULTS

Group RV-D exhibited the lowest bond strength value (5.42±6.6MPa). There was statistically no difference among RV-D, V2-D (13.78±8.8MPa) and VV-D (13.84±6.2MPa) groups (p>0.05). Group VV-E exhibited the highest bond strength value (24.76±8.8MPa).

CONCLUSIONS

The type of tooth structure affected the shear bond strength of the porcelain laminate veneers to the 3 different types of tooth structures (enamel, dentine, and enamel-dentine complex).

CLINICAL SIGNIFICANCE

When dentine exposure is necessary during preparation, enough sound enamel must be protected as much as possible to maintain a good bonding; to obtain maximum bond strength, preparation margins should be on sound enamel.

Morphology of the dentin on primary molars after the application of phosphoric acid under different conditions

The aim of this study was to evaluate changes in the superficial dentin pattern of primary teeth after applying different phosphoric acid concentrations and conditioning times. Twenty-four dentin surfaces were divided in 4 groups with 10 teeth each: GI -no treatment; GII to GIV -phosphoric acid at 37%, 32%, and 10% respectively. The samples were divided into two halves: one treated for 7 seconds (T1) and the other one for 15 seconds (T2). They were submitted to scanning electronic microscopy (SEM). A reticule was superimposed upon the images to randomly select dentinal tubules measured in µm². The conditioning times did not cause significant differences in the mean diameter values of the dentin tubules within each test group: GII (T1= 4.86; T2= 4.70); GIII (T1 = 3.83; T2= 3.08); GIV (T1= 5.04; T2= 5.23). Comparing different groups, there were no differences in T1. The same results were observed in T2, except for GIV which presented higher mean diameter values than GIII. The extent of acid conditioning did not influence tubule opening within groups. When different types of acids where compared, only the 10% phosphoric acid showed upper tubule opening than 32% phosphoric acid. The dentin pattern varied according to the type of acid used for conditioning.

The Effect of Oxalate Desensitizers on the Microleakage of Resin Composite Restorations Bonded by Etch and Rinse Adhesive Systems

The effect of oxalate desensitizer application after acid etching on the dentinal marginal sealing ability of resin composite restorations may be adhesive-specific.

Effect of Surface Treatments and Different Adhesives on the Hybrid Layer Thickness of Non-carious Cervical Lesions

The quality of the hybrid layer created in non-carious cervical sclerotic lesions may determine the longevity of cervical composite restorations.

New developments in dental adhesion

Numerous simplified adhesives have been introduced to the dental market within the last few years, sometimes without comprehensive testing to validate the performance claimed by the respective manufacturers. Mild self-etch adhesives are unable to etch enamel to provide adequate retention for bonded restorations. Although high early resin-dentin bond strength values can be achieved with some self-etch adhesives, their resistance to thermal and mechanical stresses over time is disappointing. In light of the current drawbacks attributed to all-in-one self-etch adhesives, etch-and-rinse adhesives are still the benchmark for dental adhesion in routine clinical use. This article summarizes current issues and factors related to the performance of adhesives.

Effect of various surface treatments on the microleakage and ultrastructure of resin-tooth interface

This study evaluated the effect of collagen removal and sodium ascorbate treatment of acid-etched dentin on the microleakage and ultrastructure of resin-tooth interface under moist and dry conditions using an acetone-based 1 bottle adhesive system. Class V cavities were made on the buccal surfaces of 90 premolars scheduled for orthodontic extraction. The cavities were etched with 37% phosphoric acid (DPI tooth conditioning gel/India) for 15 seconds. The teeth were divided into six groups with 15 teeth each. In Group 1, the etched surface was blot dried with a dry cotton pellet, leaving it visibly moist, and Prime & Bond NT (Dentsply Detrey/ Germany) was applied. In Group 2, after acid conditioning, the cavity surface was air dried for five seconds, followed by application of Prime & Bond NT. In Group 3, 3% NaOCl (Hyposol, Prevest Denpro Ltd/India) was applied to the acid-conditioned cavity surface for two minutes. The surface was blot dried before bonding. In Group 4, after NaOCl treatment, the surface was air dried for five seconds, followed by application of the bonding agent. In Group 5, 10% sodium ascorbate (chemically pure) was applied to the NaOCl-treated acid conditioned tooth surface for one minute. The surface was blot dried before bonding. In Group 6, after sodium ascorbate treatment as in Group 5, the cavity surface was air dried for five seconds before bonding. The cavities were restored with the hybrid composite Spectrum TPH (Dentsply Detrey, Konstanz, Germany). The teeth were extracted immediately after restoration, and the specimens were prepared for microleakage testing using 2% methylene blue dye and for scanning electron microscopic evaluation. The results of the dye penetration were analyzed with Kruskal-Wallis non-parametric analysis followed by the Mann-Whitney U test at a significance level of p = 0.05. After acid etching, the conventional acid etched groups and groups with NaOCl treatment demonstrated extensive leakage. Sodium ascorbate treatment of the NaOCl-treated dentin significantly reduced microleakage. No statistically significant difference between moist and dry bonding was observed in all groups. Although resin tag penetration improved in both the NaOCl-treated and NaOCl/ascorbate-treated groups, an absence of gap at the resin dentin interface was observed only for the NaOCl/ascorbate-treated groups.

Clinical performance of a self-etch adhesive in Class V restorations made with and without acid etching

OBJECTIVES

To evaluate the clinical performance of a self-etching adhesive in Class V carious lesions with and without acid etching procedures.

METHODS

A total of 183 Class V carious cavities with incisal margins in enamel and gingival margins in cementum were selected and restored with Futurabond NR self-etch adhesive and resin composite Grandio. Restorations were made using three different techniques; after etching of the enamel, after etching the whole cavity for 20s and without acid etching (control). The restorations were evaluated at baseline, 1 and 2 years using USPHS criteria.

RESULTS

No loss of restorations was recorded after 1 and 2 years for all the three restorative techniques. There was no significant difference between the baseline and 2-year results for any of the tested technique. However, restorations made after acid etching showed less marginal discoloration at the enamel margins.

CONCLUSION

The clinical performance of Futurabond NR self-etch adhesive was excellent after 2 years. Acid etching of the enamel margin or the whole cavity did not improve the overall quality of the restorations, but displayed less marginal discoloration.

Effect of simulated pulpal pressure on dentin permeability and adhesion of self-etch adhesives

OBJECTIVES

Dentin bonds made with one-bottle etch-and-rinse and self-etch adhesives are affected by the formation of interfacial blisters, porosities and deterioration. The first objective of this study was to evaluate the fluid flow through resin-dentin interfaces created by self-etching adhesives applied to deep dentin using a replica technique and by directly measuring dentin permeability (P). The second objective was to examine the effect of intrapulpal pressure on the microtensile bond strength of these adhesives.

METHODS

A fluid-transport model was used to measure the fluid permeability (%P) through different adhesives. Impressions of bonded dentin were taken with a polyvinylsiloxane impression material to monitor fluid transudation from the surface of the adhesive. Positive replicas were fabricated for SEM examination. Two groups of resin-bonded specimens (pulpal pressure versus no pulpal pressure) were created for microtensile bond strength evaluation. Adhesive application was performed under 0 cm H(2)O. Pulpal pressure group was submitted to 20 cm H(2)O of pulpal pressure during build-up procedures.

RESULTS

Clearfil Protect Bond exhibited the lowest permeability and fewest numbers of fluid droplets over the surface of the bonded dentin. G-Bond and Clearfil-S3 Bond were more permeable than Clearfil Protect Bond. One Up Bond F was the most permeable adhesive. A highly significant correlation was observed between the relative permeability of these adhesives (%P) and the number of fluid droplets on the adhesive surfaces. The application of pulpal pressure significantly reduced bond strength.

SIGNIFICANCE

Resin-dentin bonds created by contemporary self-etch adhesives are susceptible to fluid permeation induced by pulpal pressure. HEMA-based adhesives showed the largest reductions in bond strengths after pulpal pressure application.

Scanning electron microscopy and energy-dispersive X-ray analysis of self-etching adhesive systems to ground and unground enamel

The morphological analysis of the ground and unground enamel was treated with three different self-etching adhesive systems. Ultrastructural features were observed by using the field emission scanning electron microscope (FESEM) in combination with Energy Dispersive X-Ray Spectroscopy (EDS) analysis. Thirty extracted human molars were used for this study. Teeth were divided into two groups. In the first group unground enamel was etched with either Clearfil SE Bond (Kuraray-Japan), G Bond (GC-Japan) or Tri S Bond (Kuraray-Japan) according to the manufactures instructions. In the second group ground enamel was treated as above. In addition 24 ungrounded and grounded enamel specimens were etched and bonded with the three self-etching adhesives and restored with composite resin (Clearfil ST-Kuraray). Then they were cross-sectioned and interfacial analysis was done with the combination of EDS analysis. Etching patterns of the enamel varied according to the self-etching adhesive. Clearfil SE Bond produced micro-irregular etching pattern creating crater like area in ground enamel while other two produced mild etching pattern. All three adhesives produced incomplete etching on unground enamel. Interfacial studies showed demineralization for the bonding agent penetration and the formation of hybrid layer. The self-etching adhesives produced different specific SEM morphologies on unground and ground enamel.

Single-bottle adhesives behave as permeable membranes after polymerisation. II. Differential permeability reduction with an oxalate desensitiser

OBJECTIVES

This study examined the changes in hydraulic conductance and ultrastructure of dentine bonded with simplified etch-and-rinse adhesives to oxalate desensitiser pre-treated acid-etched dentine.

METHODS

Human dentine disks were acid-etched, treated with an oxalate desensitiser (BisBlock, Bisco), and bonded with One-Step (OS), Single Bond (SB), OptiBond Solo Plus (OB) or Prime and Bond NT (PB). Similar disks from each group were acid-etched, and bonded without oxalate pre-treatment. Hydraulic conductance of the specimens was measured at 20 cm of water pressure and analysed with nonparametric statistical methods. Epoxy resin replicas of the smear layer-covered dentine and bonded dentine were examined with SEM for the extent of fluid transudation. Specimens bonded under perfusion were examined with TEM after tracer immersion.

RESULTS

OB and PB exhibited a highly significant reversal of the reduced hydraulic conductance obtained with BisBlock on unbonded acid-etched dentine. Profuse water transudation across the bonded dentine was observed from the replicas. Adhesive interfaces were covered with spherical globules that interfered with dentine hybridization. Conversely, no significant difference in hydraulic conductance was observed in SB, between Bisblock pre-treated, unbonded and bonded acid-etched dentine. Significantly lower hydraulic conductance was shown on application of OS to Bisblock-treated acid-etched dentine. Water transudation was sparse, interfering surface globular structures were absent, and only angular subsurface crystals were seen in the dentinal tubules.

CONCLUSIONS

Convective water fluxes through dentine may be reduced by applying Bisblock to acid-etched dentine before bonding with One-Step or Single Bond. However, reducing adhesive permeability with the use of oxalate desensitiser is not applicable to low acidity adhesives such as OptiBond Solo Plus and Prime and Bond NT.

Microtensile adhesion of sealants to intact enamel

Contamination of etched enamel with saliva has been shown to result in sealant failure. Hydrophilic adhesives improve retention of sealants when enamel is contaminated.

OBJECTIVE

The objective of the present study was to characterize the adhesion of two sealants to unprepared enamel etched with phosphoric acid or conditioned with the all-in-one, self-etch adhesive Adper Prompt L-Pop.

METHODS

The two proximal enamel surfaces of 16 sound molars were assigned to four conditioning regimens: (1) 35% phosphoric acid for 15 s; (2) Adper Prompt L-Pop, one layer light-cured prior to sealant placement; (3) Adper Prompt L-Pop, two layers light-cured prior to sealant placement; and (4) Adper Prompt L-Pop, one layer co-cured with sealant. One of two sealants, i.e. Clinpro or Delton DDS, was applied, light-cured, followed by a composite build-up to provide support for microtensile bond testing.

RESULTS

The highest mean bond strengths were obtained when Adper Prompt L-Pop was applied in two layers and light-cured prior to the insertion of Clinpro Sealant. Co-cure of Adper Prompt L-Pop with either sealant resulted in bond strengths which were not significantly different from those of the phosphoric acid control. The use of Adper Prompt L-Pop in one layer cured prior to sealant placement resulted in statistically lower bond strengths than any other application technique regardless of the sealant used. Clinpro Sealant resulted in statistically higher bond strengths than Delton DDS Sealant.

CONCLUSIONS

Application of one layer of Adper Prompt L-Pop co-cured with the sealant resulted in bond strengths similar to those obtained with phosphoric acid etching.

Secondary caries-like lesions at fissure sealings with Xeno III and Delton—an in vitro study

OBJECTIVES

The aim of the study was to establish a bacterial based in vitro caries model to test the caries preventive effect of fissure sealants and to investigate whether a self-etching adhesive (Xeno III) used as fissure sealant is equally effective in preventing secondary caries compared to a conventional sealant (Delton) when applied on saliva contaminated and non-contaminated fissures.

METHODS

Forty caries-free upper premolars were randomly divided into two groups. Group A was sealed with a conventional resin-based fissure sealant (Delton) after phosphoric acid etching. Group B was sealed with a self-etching adhesive (Xeno III) without prior etching. To simulate the clinical situation of saliva contamination, the distal part of each tooth was slightly moistened with saliva before sealant application. After thermo-cycling, the specimens were exposed to a cariogenic Streptococcus mutans biofilm in an artificial mouth model. Depths of demineralization were measured on serial sections by confocal laser scanning microscopy. If a demineralization was detected underneath the whole fissure sealing the sample was rated as 'total failure'.

RESULTS

Significantly higher numbers of total failures could be found in the Xeno III group compared to the Delton group in areas without saliva contamination. On contaminated areas, no significant difference could be found. There was no significant difference regarding the depth of the primary carious lesions between groups.

CONCLUSION

The study supports our recent findings that our caries model is capable to produce secondary caries-like lesions at fissure sealings. Based on the present in vitro data, it cannot be recommended to use the self-etching adhesive Xeno III solely as a fissure sealant.

One-year tensile bond strengths of two self-etching primers to bovine enamel

PURPOSE

The purpose of this study was to evaluate the enamel bond strengths of two self-etching primer systems and a total-etch self-priming adhesive system at 24 hours and after a 1-year period of storage in water at 37 degrees C.

MATERIALS AND METHODS

An experimental self-etching priming system (ABF, Kuraray Medical, Tokyo, Japan), Clearfil SE Bond (Kuraray), and One-Step (Bisco, Schaumburg, IL, USA) were used as the adhesive systems. Eleven bovine incisors stored frozen were ground with 600-grit SiC paper, bonded as recommended by the manufacturers, and restored with Clearfil AP-X (Kuraray) or Renew (Bisco). After 24 hours in water at 37 degrees C, the teeth were sectioned into 0.7 mm-thick slabs that were trimmed and tested for microtensile bond strength using a tabletop tester (EZ test, Shimadzu, Kyoto, Japan) at a crosshead speed of 1 mm/min. Alternate slices were either tested at 24 hours or kept in an incubator at 37 degrees C for 1 year prior to testing. The data were analyzed using paired t-test (p < .05).

RESULTS

Differences in bond strengths were not significant at 24 hours. After 1 year, ABF and Clearfil SE Bond had significantly higher mean bond strengths than at 24 hours (p < .001).

CONCLUSIONS

Enamel bond strengths of the total-etch two-step adhesive remained stable, and the bond strengths of the two self-etching primer systems increased with time.

CLINICAL SIGNIFICANCE

Although self-etching primers create a milder etching pattern than does phosphoric acid, the results of this study suggest that the ones evaluated in this study produce stable bond strengths over a 1-year period.

Single-bottle adhesives behave as permeable membranes after polymerization. I. In vivo evidence

OBJECTIVES

This study tested the hypothesis that single-bottle total-etch adhesives are effective in reducing dentine permeability under in vivo conditions.

METHODS

Crown preparations on vital human teeth were performed under local analgesia as part of the treatment plan for prosthetic rehabilitation. Four single-bottle adhesives (Single Bond, 3M ESPE; Excite DSC, Ivoclar Vivadent; Prime and Bond NT Dual-Cure, Dentsply DeTrey and One-Step, Bisco Inc.) were applied to the cut dentine after acid-etching. Polyvinyl siloxane impressions were taken, using an ultra-low viscosity impression material, of the smear layer-covered dentine before applying the adhesives to deep vital dentine, and after adhesive placement. Additional impressions were taken of the adhesive-sealed dentine following the removal of the provisional prostheses after a 7-10 day period. Epoxy resin replicas of the crown preparations were examined with scanning electron microscopy to evaluate the extent of dentinal fluid transudation during pre-bonded, immediately bonded and post-bonded periods.

RESULTS

Dentinal fluid transudation from localised areas that were close to the dental pulp was universally observed from all epoxy resin replicas, irrespective of the adhesive employed. The transudation of dentinal fluid from the control smear layer-covered dentine of each crown preparation was comparatively mild when compared to the extent that was observed after total-etching and application of the single-bottle adhesive. Dentinal fluid droplets were specifically located over the surface of the adhesive layer. Continuous transudation of dentinal fluid occurred even after the removal of the provisional prostheses, and was considerably more profuse in subjects who opted for the fitting of the permanent prostheses without the use of a local anaesthetic solution.

CONCLUSION

Single-bottle adhesives, because of their lack of a comparatively more hydrophobic bonding resin layer, behave as permeable membranes after polymerisation. They permit the continuous transudation of dentinal fluid and do not provide a hermetic seal in vital deep dentine. Although the relatively slow rate of diffusion of dentinal fluid is unlikely to result in post-operative cold sensitivity, it may interfere with the optimal polymerisation of dual-cured or auto-cured composites or resin cements in both direct and indirect restorations.

Osmotic blistering in enamel bonded with one-step self-etch adhesives

One-step self-etch adhesives behave as permeable membranes after polymerization, permitting water to move through the cured adhesives. We hypothesize that osmotic blistering occurs in bonded enamel when these adhesives are used without composite coupling. Tooth surfaces from extracted human premolars were bonded with 5 one-step self-etch adhesives. They were immersed in distilled water or 4.8 M CaCl(2), and examined by stereomicroscopy, field-emission/environmental SEM, and TEM. Water blisters were observed in bonded enamel but not in bonded dentin when specimens were immersed in water. They collapsed when water was subsequently replaced with CaCl(2). Blisters were absent from enamel in specimens that were immersed in CaCl(2) only. Water trees were identified from adhesive-enamel interfaces. Osmotic blistering in enamel is probably caused by the low water permeability of enamel. This creates an osmotic gradient between the bonded enamel and the external environment, causing water sorption into the interface.

Resin bonding to cervical sclerotic dentin: a review

Several reports have indicated that resin bond strengths to noncarious sclerotic cervical dentine are lower than bonds made to normal dentine. This is thought to be due to tubule occlusion by mineral salts, preventing resin tag formation. The purpose of this review was to critically examine what is known about the structure of this type of dentine. Recent transmission electron microscopy revealed that in addition to occlusion of the tubules by mineral crystals, many parts of wedge-shaped cervical lesions contain a hypermineralised surface that resists the etching action of both self-etching primers and phosphoric acid. This layer prevents hybridisation of the underlying sclerotic dentine. In addition, bacteria are often detected on top of the hypermineralised layer. Sometimes the bacteria were embedded in a partially mineralised matrix. Acidic conditioners and resins penetrate variable distances into these multilayered structures. Examination of both sides of the failed bonds revealed a wide variation in fracture patterns that involved all of these structures. Microtensile bond strengths to the occlusal, gingival and deepest portions of these wedge-shaped lesions were significantly lower than similar areas artificially prepared in normal teeth. When resin bonds to sclerotic dentine are extended to include peripheral sound dentine, their bond strengths are probably high enough to permit retention of class V restorations by adhesion, without additional retention.

Effect of MTAD on the Bond Strength to Enamel and Dentin

The purpose of this study was to compare the effect of MTAD (a mixture of a tetracycline isomer [doxycycline], an acid [citric acid], and a detergent [Tween 80]) and phosphoric acid on the bond strength to enamel and dentin using a conventional OptiBond Solo Plus dentin adhesive system. One hundred flat surfaces (50 enamel/50 dentin) were prepared for bonding. Specimens were embedded in acrylic with the flat surface exposed. One of the following surface treatments was applied before bonding composite with Optibond Solo Plus (Kerr Corp): 1 min NaOCl/1 min EDTA; 1 min NaOCl/1 min MTAD; 30 s etch with H3PO4 (positive control), 2 min saline (negative control), or 20 min NaOCl/5 min MTAD (clinical protocol for MTAD). Shear bond strength was tested 30 min after bonding. Data were analyzed using a one-way ANOVA followed by the Student-Newman-Keuls multiple comparison method. Surface pretreatment with acid etch resulted in the greatest enamel bond strengths (p < 0.05). All surface pretreatments were superior to saline for dentinal bonding (p < 0.05). On the basis of our findings, it appears that teeth endodontically treated with the MTAD protocol for clinical use (20 min 1.3% NaOCl/5 min MTAD) may not need any additional dentin conditioning before the application of the dental adhesive.