Assessment of Self-Adhesive Resin Composites: Nondestructive Imaging of Resin-Dentin Interfacial Adaptation and Shear Bond Strength

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.

Effect of varying functional monomers in experimental self-adhesive composites: polymerization kinetics, cell metabolism influence and sealing ability

The aim was to evaluate the effects of adding different functional monomers to experimental self-adhesive composites (SACs) on polymerization kinetics, cell metabolic activity, and sealing ability. SACs were formulated using urethane dimethacrylate as the base monomer and triethylene glycol dimethacrylate. Additionally, 10 wt.% of distinct functional monomers were added - 10-methacryloyloxydecyl dihydrogen phosphate, glycerol phosphate dimethacrylate (GPDM), 2-hydroxyethyl methacrylate (HEMA) or hydroxyethyl acrylamide (HEAA). ATR-FTIR was used to determine real-time polymerization kinetics (20 min,n= 3). The final extrapolated conversion and polymerization rates were determined (DC,max;Rp,max). TheDC,maxvalues were employed to calculate volumetric shrinkage. The MTT assay was performed on MDPC-23 cells using disc extracts at different concentrations (n= 8). Class V cavities were prepared in 60 sound human molars, assigned to six groups (n= 10), depending on the composite used and aging type (T0 or TC, if thermocycled for 10 000 cycles). One-way ANOVA, two-way, andKruskal-Wallistests were employed to treat the data (ɑ= 0.05). Varying the functional monomers had a large impact on DC,max, as confirmed by one-way ANOVA (p<0.001). The highest was obtained for HEMA (64 ± 3%). The HEMA and HEAA formulations were found to be significantly more toxic at concentrations below 100%. For microleakage, having a functional monomer or not did not show any improvement, irrespective of margin or aging period (Mann-Whitney U,p> 0.05). Larger functional monomers MDP and GPDM affected polymerization properties. Conversely, their acidity did not seem to be detrimental to cell metabolic activity. Regarding sealing ability, it seems that the functional monomers did not bring an advantage to the composites. Varying the functional monomer in SACs had a clear impact on the polymerization kinetics as well as on their cytotoxic potential. However, it did not confer better microleakage and sealing. Claiming self-adhesiveness based only on functional monomers seems dubious.

Effect of cigarettes smoke on bonded polymeric restorations: OCT study

Background

Up to date, the effect of cigarette smoke (CS) on the adhesive properties of the restorative materials bonded to tooth structure is still unclear. It is still questionable if it interferes with the durability and clinical success of these restorations. Few numbers of studies reported the assessment of microgaps of dental composite using cross-polarization optical coherence tomography (CP-OCT). The aim of this study was to evaluate the presence of interfacial microgaps between composite resin restoration and the tooth structure with or without exposure to CS under the CP-OCT.

Materials and methods

In this in-vitro study, a standardized round class-V cavities were prepared in twenty extracted, caries-free human molar teeth, and they were divided randomly into two groups (n = 10). Adhesive system (Gluma universal, Kulzer GmbH) was applied followed by filing the prepared cavities with flowable composite restoration (Charisma, Kulzer GmbH). Then, exposure to CS (40 cigarettes/day) was carried out for 14 days and the samples were stored in normal saline solution after each smoke exposure cycle. Next, all samples were immersed in ammoniac silver nitrate for 24 h, followed by immersion in a photo-developing solution for 8 h. Optical comparison was carried out by CP-OCT to assess microgaps percentage between smoke (SG) and non-smoke groups (NSG) at the axial walls (AW) and cavity floor (CF).

Results

Independent T-test showed that there was a significant difference between the two groups (SG, NSG) in AW microgaps percentage (p = 0.008), while there was no difference in CF (p = 0.15).

Conclusion

It can be inferred from the current finding that OCT can be used to predict the adaptability of the bonded restoration under the thermochemical influence. CS has a negative effect on the marginal integrity of the bonded polymeric restorations.

The Influence of Chlorhexidine Gluconate Dentine Pre-Treatment on Adhesive Interface and Marginal Sealing

Background and Objectives: The aim of this in vitro study was to evaluate the combined effect of a 2% chlorhexidine aqueous solution and a universal adhesive system applied in self-etch and etch-and-rinse strategies on the composite resin-dentin interface. Materials and Methods: Class V cavities were prepared on the facial and lingual surfaces of forty caries-free molars extracted for orthodontic reasons. The samples were randomly divided into two groups corresponding to the used etching protocol: I-etch-and-rinse; II-self-etch. In each tooth, one cavity was assigned for the control subgroups -IA (n = 20) and IIA (n = 20)-adhesive only, and the opposite cavity was pretreated with a 2% chlorhexidine solution-Gluco CHeX Cerkamed-subgroups IB (n = 20) and IIB (n = 20). Both sets of groups were restored using a universal adhesive system (Single Bond Universal Adhesive, 3M-ESPE) and a bulk-fill composite resin (Filtek One Bulk Fill Restorative, 3M-ESPE). The roots and the pulp tissue were then removed, and a needle connected to a perfusor with 100 mL saline solution was used for pulp pressure simulation with a hydrostatic pressure of 20 cm H₂O. Cariogenic attack was simulated using a demineralizing solution for 3 days at a constant temperature of 25 °C. The teeth were then sectioned in a facial-lingual direction and the microleakages at the occlusal and cervical margins were registered and scored using an optical Carl-Zeiss AXIO Imager A1m microscope (Carl-Zeiss). The composite resin-dentin interface was analyzed using a SEM Vega Tescan LMH II. Statistical analysis was performed using the Kruskal-Wallis test with a significance level of p < 0.05. Results: Microleakage evaluation showed no significant differences among the study groups (p > 0.05). In subgroup IA, significant differences were recorded between occlusal and cervical margins (p < 0.05). Conclusions: Application of chlorhexidine on tooth substrate before using a universal bonding system in total etch or self-etch mode has no influence on the adhesive interface in the condition of cariogenic attack. The thickness of the adhesive resin layer seems to be less uniform when using chlorhexidine, but the morphological differences at the adhesive interface have no influence on the sealing capacity of the universal bonding system, regardless of the etching strategy.

Alternatives to amalgam: Is pretreatment necessary for effective bonding to dentin?

OBJECTIVE

The aim of this study was to determine whether pretreatment of the dentin surface is beneficial or not by analysis of the bond strengths of four self-adhesive restoratives and four restoration materials where pretreatment of dentin was necessary.

METHODS

Bovine incisors (n = 160) were ground flat on the labial surfaces to expose dentin using a grinder and silicon carbide (SiC) abrasive papers under running water. Between preparation and bonding procedures, the crowns were stored in Chloramine-T solution at 4 °C. Eight different restorative materials were studied: Activa BioActive (ABA), Cention Forte (CNF), Ceram.x Spectra ST (CXS), Riva self-cure (RSC), Equia Forte (EQF), Fuji II LC (FJI), Ketac Molar (KTM), Surefil one (SFO). Four materials required pretreatment of the dental hard tissue before placement, whereas the other four were self-adhesive (no pretreatment). The specimens were mounted vertically in plaster. A preload of 5 N was applied and the subsequent cross-head speed was 0.8 mm/min. Shear bond strengths (MPa) were calculated as the failure load divided by the bonding area. Failure modes were recorded as adhesive, cohesive or pretest. Data were statistically analyzed via ordinal regression for inference and Tukey's method to adjust for multiple comparisons. All computations were done using R version 4.1.2 (R Core Team 2021).

RESULTS

S_max (failure stress in MPa) of the combined groups with pretreatment were significantly higher than the self-adhesive materials. The highest frequency of pretest-failure was seen with FJI. Glass-ionomer cements without pretreatment were the only restoratives with pretest failures. Amongst materials without pretreatment, SFO had the highest bond strengths.

SIGNIFICANCE

The further reduction of the placement steps for materials used as an amalgam alternative, namely the omission of pretreatment of the dentin, results in these self-adhesive materials having lower bond strengths than materials that require pretreatment of the dentin.

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

STATEMENT OF PROBLEM

Although the clinical use of self-adhesive flowable composite resins is convenient, the decision to use flowable or conventional composite resin remains controversial.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the in vitro bond strength of self-adhesive flowable composite resins to enamel or dentin compared with conventional composite resins using etch-and-rinse or self-etch adhesive systems.

MATERIAL AND METHODS

Two independent reviewers performed searches in the PubMed (MEDLINE), Cochrane Wiley, Web of Science, Scopus, and Google Scholar databases for studies reporting on the bond strength of self-adhesive flowable and conventional composite resins to enamel and dentin published from January 2010 up to September 2020. A meta-analysis software program was used for the meta-analysis. Comparisons were conducted using standardized mean differences considering the random-effects model (α=.05).

RESULTS

Twenty-two studies were considered for the meta-analysis. Immediate and long-term bond strength to enamel was improved when a conventional composite resin was used in combination with an adhesive system (P<.001). Bond strength to dentin was improved by using an adhesive system in combination with a conventional composite resin (P<.001).

CONCLUSIONS

The bond strength of self-adhesive flowable composite resins is lower than that of conventional composite resins, indicating limited ability to bond to enamel and dentin.

The effect of flowable composite lining and dentin location on microtensile bond strength and internal fracture formation

The objective of this study was to determine the effect of flowable composite lining and dentin location on internal dentin fracture formation in the microtensile bond strength (MTBS) test using swept-source optical coherence tomography (SS-OCT). MTBS test beams (1.0×1.0 mm) were prepared from human superficial and deep dentin, which was bonded with a self-etch adhesive (Clearfil SE Bond) and hybrid composite resin (Clearfil AP-X), with or without flowable lining (Clearfil Majesty ES-Flow). We tested 4 groups according to placement technique (with vs. without flowable liner) and dentin (superficial vs. deep) locations. Cross-sectional 2D images of the bonded interface were obtained before and after the MTBS test. Internal dentin fracture after MTBT was observed as a bright zone in SS-OCT. Flowable lining significantly reduced internal fracture formation in dentin (p<0.05). Dentin location significantly influenced MTBS (p<0.05), and this was reduced by flowable lining usage.

Shear Bond Strength of Self-Adhesive Flowable Composite, Conventional Flowable Composite and Resin-Modified Glass Ionomer Cement to Primary Dentin

Objectives:

This study aimed to compare the shear bond strength (SBS) of self-adhesive and conventional flowable composites and resin-modified glass-ionomer cement (RMGIC) to primary dentin.

Materials and Methods:

In this in vitro, experimental study, the buccal surface of 48 primary canine and first molar teeth was longitudinally sectioned to expose dentin. The teeth were randomly divided into three groups (n=16) of 37.5% phosphoric acid+ OptiBond+ Premise Flow composite (group 1), Vertise Flow composite (group 2) and RMGIC (group 3). A plastic cylindrical mold was placed on the exposed dentin and filled with restorative materials. The samples were then immersed in distilled water at 37°C for 24 hours, subjected to 1000 thermal cycles between 5–55°C and underwent SBS test. The mode of failure was determined under a stereomicroscope. Data were analyzed using one-way ANOVA and Tukey’s test.

Results:

A significant difference was noted in SBS of the groups (P<0.05). The SBS of conventional flowable composite was significantly higher that of RMGIC and self-adhesive flowable composite (P<0.05). The difference in SBS of RMGIC and self-adhesive flowable composite was not significant (P>0.05). Failure at the dentin-restoration interface (adhesive failure) had the highest frequency in groups 1 and 2. The frequency of adhesive failure was 100% in group 3.

Conclusion:

Within the limitations of this study, the conventional flowable composite yielded the highest SBS to primary dentin. Self-adhesive flowable composite and RMGIC showed the lowest SBS with no significant difference with each other.

Bonding performance of self-adhesive flowable composites to enamel, dentin and a nano-hybrid composite

This study aimed to analyze bond strengths of self-adhesive flowable composites on enamel, dentin and nano-hybrid composite. Enamel, dentin and nano-hybrid composite (Venus Diamond, Heraeus Kulzer, Germany) specimens were prepared. Three self-adhesive composites (Constic, DMG, Germany; Fusio Liquid Dentin, Pentron Clinical, USA; Vertise Flow, Kerr Dental, Italy) or a conventional flowable composite (Venus Diamond Flow, Heraeus Kulzer, Germany, etch&rinse technique) were applied to enamel and dentin. Nano-hybrid composite specimens were initially aged by thermal cycling (5000 cycles, 5-55 °C). Surfaces were left untreated or pretreated by mechanical roughening, Al₂O₃ air abrasion or silica coating/silanization. In half of the composite specimens, an adhesive (Optibond FL, Kerr Dental, Italy) was used prior to the application of the flowable composites. Following thermal cycling (5000 cycles, 5-55 °C) of all specimens, shear bond strengths (SBS) and failure modes were analyzed (each subgroup n = 16). Statistical analysis was performed by ANOVAs/Bonferroni post hoc tests, Weibull statistics and χ ²-tests (p < 0.05). SBS (MPa) of the self-adhesive composites on enamel and dentin were significantly lower (enamel: < 5, dentin: < 3) than those of the conventional flowable composite (enamel: 13.0 ± 5.1, dentin: 11.2 ± 6.3), and merely adhesive failures could be observed. On the nano-hybrid composite, SBS were significantly related to the pretreatment. Adhesive application improved SBS of the conventional, but not of the self-adhesive composites. The self-adhesive composite groups showed less cohesive failures than the reference group; the occurence of cohesive failures increased after surface pretreatment. Bonding of self-adhesive flowable composites to enamel and dentin is lower than bonding to a nano-hybrid composite.

Polymer-Based Direct Filling Materials

After a brief review of current restorative materials and classifications, this article discusses the latest developments in polymer-based direct filling materials, with emphasis on products and studies available in the last 10 years. This will include the more recent bulk fill composites and self-adhesive materials, for which clinical evidence of success, albeit somewhat limited, is already available. The article also introduces the latest cutting edge research topics on new materials for composite restorations, and an outlook for the future of how those may help to improve the service life of dental composite restorations.

Trends in restorative composites research: what is in the future?

Clinical trials have identified secondary caries and bulk fracture as the main causes for composite restoration failure. As a measure to avoid frequent reinterventions for restoration replacement, composites with some sort of defense mechanism against biofilm formation and demineralization, as well as materials with lower susceptibility to crack propagation are necessary. Also, the restorative procedure with composites are very time-consuming and technically demanding, particularly concerning the application of the adhesive system. Therefore, together with bulk-fill composites, self-adhesive restorative composites could reduce operator error and chairside time. This literature review describes the current stage of development of remineralizing, antibacterial and self-healing composites. Also, an overview of the research on fiber-reinforced composites and self-adhesive composites, both introduced for clinical use in recent years, is presented.

The Use of Optical Coherence Tomography in Dental Diagnostics: A State-of-the-Art Review

Optical coherence tomography provides sections of tissues in a noncontact and noninvasive manner. The device measures the time delay and intensity of the light scattered or reflected from biological tissues, which results in tomographic imaging of their internal structure. This is achieved by scanning tissues at a resolution ranging from 1 to 15 μm. OCT enables real-time in situ imaging of tissues without the need for biopsy, histological procedures, or the use of X-rays, so it can be used in many fields of medicine. Its properties are not only particularly used in ophthalmology, in the diagnosis of all layers of the retina, but also increasingly in cardiology, gastroenterology, pulmonology, oncology, and dermatology. The basic properties of OCT, that is, noninvasiveness and low wattage of the used light, have also been appreciated in analytical technology by conservators, who use it to identify the quality and age of paintings, ceramics, or glass. Recently, the OCT technique of visualization is being tested in different fields of dentistry, which is depicted in the article.

Limited interaction of a self-adhesive flowable composite with dentin/enamel characterized by TEM

OBJECTIVES

A new category of composite which does not require any acid etching or bonding protocol prior to application has been introduced. The purpose of this study was to characterize the interfacial ultra-structure at enamel and dentin surfaces by means of transmission electron microscopy (TEM).

METHODS

Non-carious human third molars were randomly divided into 6 groups (bur-cut dentin, SiC-ground dentin, fractured dentin, bur-cut enamel, SiC-ground enamel, and un-cut enamel). After preparation of the respective surfaces, the self-adhesive flowable composite (Vertise Flow, Kerr) was applied. Non-demineralized/demineralized and non-stained/stained sections of 70-90nm were prepared following common TEM-specimen processing procedures. Additional specimens were immersed in an ammoniacal silver nitrate solution.

RESULTS

The composite-dentin interface was free of voids and no de-bonding occurred during specimen preparation. For bur-cut and SiC-ground dentin, no surface demineralization was observed and the smear contained residual hydroxyapatite. On fractured dentin (i.e. without smear interference), a very thin interaction area of 100-200nm without apparent signs of surface demineralization was seen. When the composite was bonded to enamel, a distinct separation between the self-adhesive composite and enamel was present in all three groups. A tight interaction, yet without distinct dissolution of hydroxyapatite, could only be seen in some regions at bur-cut enamel where smear was absent or sparse. Silver nitrate infiltration was associated with the presence of smear.

SIGNIFICANCE

The self-adhesive composite showed limited interaction with smear-covered substrates and aprismatic enamel, which explains its inferior diminished bonding capacity in comparison with current adhesives.