Tensile bond strengths of four different dentin adhesives on irradiated and non-irradiated human dentin in vitro

Impact of Irradiation on the Adhesive Performance of Resin-Based Dental Biomaterials: A Systematic Review of Laboratory Studies

Head and neck cancers are a significant global health burden, with radiation therapy being a frequently utilized treatment. The aim of this systematic review was to provide a critical appraisal of laboratory studies that assessed the effect of irradiation on the adhesive performance of resin-based biomaterials. The analysis included 23 laboratory studies obtained from five databases, with most studies using human enamel, dentin, or both, and bonding procedures involving the fabrication of direct restorations, standardized specimens, bonding of orthodontic brackets, and luting of endodontic fiber posts. The protocols used for irradiation varied, with most studies exposing specimens made from extracted teeth to irradiation using cabinet irradiators to simulate treatment of head and neck cancer. The findings indicate that irradiation reduces the bond strength of dental adhesives and resin-based composites on flat, ground enamel and dentin specimens, with different adhesives and timing of irradiation having a significant impact on adhesive performance. Irradiation also increased microleakage in most studies. The effect of irradiation on marginal adaptation of direct resin-based composite restorations was inconclusive. This systematic review indicates that irradiation has detrimental effects on the adhesive performance of resin-based biomaterials and highlights the need for further clinical and laboratory studies evaluating the performance of adhesive materials and approaches to improve it.

The Effect of Radiotherapy on the Marginal Adaptation of Class II Direct Resin Composite Restorations: A Micro-computed Tomography Analysis

This laboratory study was designed to evaluate the marginal adaptation of Class II mesio-occluso-distal (MOD) restorations at the cervical region with micro-computed tomography (micro-CT). Two groups of restorations were compared: 1) those that had been exposed to radiotherapy before restoration was performed using a universal adhesive in etch-and-rinse and self-etch modes; and 2) those that had previously been restored using a universal adhesive in etch-and-rinse and self-etch modes and had subsequently undergone radiotherapy. Sixty intact human molars were randomly divided into groups according to irradiation status: no radiotherapy (control group); radiotherapy followed by restoration (radiotherapy-first group); and restoration followed by radiotherapy (restoration-first group). These three groups were then subdivided into two groups each on the basis of adhesive application type (etch-and-rinse and self-etch modes), for a total of six groups (n=10/group). Standardized Class II MOD cavities were prepared. A universal adhesive (Clearfil Universal Bond Quick, Kuraray, Okayama, Japan) was applied. The teeth were restored with resin composite (Estelite Posterior Quick, Tokuyama, Tokyo, Japan). The radiotherapy protocol was conducted with 60 gray (Gy) at 2 Gy/day, five days a week for six weeks. Adhesive defects were analyzed in distal and mesial views and evaluated with micro-CT (SkyScan 1174v2, Kontich, Antwerp, Belgium) on the basis of the volume of black spaces between the cavity walls and the restorative materials (mm3). The data were analyzed using the Kruskal-Wallis, Mann Whitney U and Wilcoxon tests (p<0.05). The radiotherapy protocol did not affect the marginal adaptation of the universal adhesive at the cervical regions. Regarding the application modes, for the radiotherapy-first group, the self-etch mode caused significantly higher adhesive defects than the etch-and-rinse mode at the dentin margin. For the no-radiotherapy group, the adhesive defects at the dentin margin were significantly higher than at the enamel margin with the application of the etch-and-rinse mode.

Impact of radiotherapy on the bond strength of different adhesive systems to human dentin

Aim: The aim of this study is to evaluate the effect of radiotherapy on the bond strength of resin-based composite restorations to dentin, performed either 24 h or 1 year before or after radiation. Methods: Ninety-six posterior teeth were randomly distributed into the following groups: IB (n = 16), irradiated teeth were restored 1 year after x-ray application; NB (n = 16), not irradiated teeth were stored for 1 year and then restored. IA (n = 32), teeth were restored and irradiated at 24 h or 1 year after the restoration. NA (n = 32), teeth were restored, not irradiated, and tested as IA. Eight samples from each group were randomly assigned to either the three-step or two-step etch-and rinse adhesive system procedure. The irradiated specimens were subjected to 60 Gy of x-ray radiation fractionally. The restored teeth were vertically sectioned, and 1-mm2 resin–dentin sticks were obtained and submitted to the microtensile bond strength test. The bond strength data were analyzed by two-way analysis of variance (ANOVA) followed by Tukey’s test (p < 0.05). Failure modes were examined by optical microscopy and scanning electron microscopy. Results: The IB group showed lower bond strength values compared to the NB group. The bond strength values between the adhesive systems were not statistically different. Conclusion: The application of radiation dose decreased the bond strength of the adhesive restorations to dentin when the bonding procedure was conducted 1 year after in vitro radiotherapy.

Efeito da radioterapia com raios x de alta energia sobre a resistência de união da dentina humana com resina composta – estudo in vitro

Objetivo: O objetivo deste estudo experimental é avaliar o efeito da radiação com raios X de alta energia na resistência de união entre dentina humana e resina composta. Métodos: Trinta terceiros molares humanos hígidos foram seccionados, produzindo superfícies oclusais planas de dentina, e distribuídos aleatoriamente em dois grupos (n=15): um não irradiado e restaurado com Resina Composta Filtek Z-250, 3M-ESPE® (G1, n=15 – grupo controle), outro irradiado e restaurado com Resina Composta Filtek Z-250, 3M-ESPE® (G2, n=15). O protocolo de radiação utilizado foi de 70 Gy no total. As amostras foram cortadas em palitos (área média de 1 mm2) e submetidas ao teste de microtração. Os dados foram comparados por meio do teste t-student (p <0,05). O padrão de fratura foi examinado em microscopia óptica e submetido ao teste exato de Fischer (p <0,05). Resultados: não houve diferença significativa entre o grupo de dentes não irradiados e irradiados (p=0,738). O grupo controle e o grupo irradiado apresentaram predominância no padrão de fratura de falhas coesivas em resina e/ou mistas e falhas adesivas foram verificadas somente no grupo dos dentes irradiados. Conclusões: A radiação não interfere significativamente na resistência de união da dentina humana restaurada com resina composta e que não houve influência significativa entre os grupos estudados em relação ao padrão de fratura.

Effect of ionizing radiation on properties of restorative materials

OBJECTIVE

To evaluate the effect of ionizing radiation from high energy X-ray on properties of restorative materials.

METHODS

Study materials (3M-ESPE) were: Z250-microhybrid resin-based composite (Filtek Z-250); Z350-nanofilled resin-based composite (Filtek Z-350XT); VIT-resin-modified glass ionomer cement (Vitremer); and KME-conventional glass ionomer cement (Ketac Molar Easymix). Sixty bar-shaped and cylinder-shaped specimens were fabricated from each material. Specimens were light activated (980mW/cm², Radii, SDI) for 60s (3×20s for Z250 and Z350) and 120s (3×40s for VIT) and thirty specimens from each shape were irradiated (IR) with 1.8Gy/day for 39days (total IR=70.2Gy). IR and non-irradiated (NI) specimens were evaluated for flexural strength (σ, n=30) followed by fractography (SEM), diametral tensile strength (DTS, n=30), hardness (H, n=10), surface roughness (R_a, n=10) and chemical composition (n=3). The IR effect on each material property was statistically analyzed using Student's t test (α=0.05). Data from σ and DTS were also analyzed using Weibull statistics.

RESULTS

IR significantly increased the mean σ values of VIT and KME and the mean DTS value of VIT (p<0.05). IR increased R_a and H values for VIT and decreased H value for Z-250 (p<0.05). The remaining materials and properties were not significantly affected by IR (p>0.05). There was no significant change on materials composition after IR.

SIGNIFICANCE

The recommended radiotherapy protocol for head and neck cancer altered some material properties, mainly for glass ionomer cements. Such variations on material properties are not related to chemical composition changes.

Evaluation of bond strength of a conventional adhesive system in irradiated teeth

Abstract Introduction One of the most common treatments of head and neck cancer patients is radiotherapy, a treatment method which uses ionizing radiation beam and destroys tumor cells, minimizing damage to neighbor cells. Purpose To evaluate the bond strength of a conventional adhesive system in irradiated teeth. Method 24 third human molars, 12 of which were randomly exposed to radiation and prepared from the removal of occlusal enamel, then exposed to a flat dentine surface. The adhesive system Stae was applied according to the manufacturer’s instructions. Next, two 2 mm increments of resin were implemented. The samples were hemi sectioned specimens, originating shapped toothpick. To evaluate the bond strength, a micro tensile test was done with 500N load and speed of 0.5 mm/minute. Result There was no statistically significant difference between the bond strength of teeth which were or were not exposed to radiation and which used a conventional adhesive system. Conclusion Although the radiation doses applied may cause some alterations in microscopic range in dental tissues, it can be concluded that these alterations do not influence in the bond strength in dentin of irradiated teeth.

Tensile Bond Strengths of Two Adhesives on Irradiated and Nonirradiated Human Dentin

The aim of this study was to assess the effect of radiotherapy on bond efficiency of two different adhesive systems using tensile bond strength test. Twenty extracted teeth after radiotherapy and twenty nonirradiated extracted teeth were used. The irradiation was applied in vivo to a minimal dose of 50 Gy. The specimens of each group were randomly assigned to two subgroups to test two different adhesive systems. A three-step/etch-and-rinse adhesive system (Optibond FL) and a two-steps/self-etch adhesive system (Optibond XTR) were used. Composite buildups were performed with a nanohybrid composite (Herculite XTR). All specimens were submitted to thermocycling ageing (10000 cycles). The specimens were sectioned in 1 mm(2) sticks. Microtensile bond strength tests were measured. Nonparametric statistical analyses were performed due to nonnormality of data. Optibond XTR on irradiated and nonirradiated teeth did not show any significant differences. However, Optibond FL bond strength was more effective on nonirradiated teeth than on irradiated teeth. Within the limitations of an in vitro study, it can be concluded that radiotherapy had a significant detrimental effect on bond strength to human dentin. However, it seems that adhesive choice could be adapted to the substrata. According to the present study, the two-steps/self-etch (Optibond XTR) adhesive system tested could be more effective on irradiated dentin compared to three-steps/etch-and-rinse adhesive system (Optibond FL).

Application of chlorhexidine, fluoride and artificial saliva during radiotherapy: an in vitro study of microleakage in Class V restorations

BACKGROUND

The aim of this study was to evaluate the effect on microleakage in Class V restorations of daily applications of artificial saliva, fluoride mouthrinses and chlorhexidine to irradiated bovine teeth.

METHODS

Class V cavities were created in 60 bovine teeth. The teeth were divided randomly into two groups: the first group (n = 30) was subjected to radiotherapy until the teeth had received a total accumulated dose of 60 Gy; the second group (n = 30) was used as a control group. Both groups were divided into three subgroups (n = 10): in Group A teeth were submerged in Xeros Dentaid(®) artificial saliva; Group B teeth were submerged in a solution of 1% amine fluoride; Group C teeth were submerged in 0.12% chlorhexidine. All treatments were applied three times a day for six weeks. Afterwards microleakage into the composite restorations was measured using MIP4 image software.

RESULTS

It was seen that radiation caused increases in microleakage in composite restorations. Statistically significant differences were found in the artificial saliva group (p = 0.013) and the chlorhexidine group (p = 0.023).

CONCLUSIONS

Microleakage in composite restorations was greater among radiated teeth.

Parotid gland-recovery after radiotherapy in the head and neck region--36 months follow-up of a prospective clinical study

Background

The aim of the present study was to evaluate the recovery potential of the parotid glands after using either 3D-conformal-radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) by sparing one single parotid gland.

Methods

Between 06/2002 and 10/2008, 117 patients with head and neck cancer were included in this prospective, non-randomised clinical study. All patients were treated with curative intent. Salivary gland function was assessed by measuring stimulated salivary flow at the beginning, during and at the end of radiotherapy as well as 1, 6, 12, 24, and 36 months after treatment. Measurements were converted to flow rates and normalized relative to rates before treatment. Mean doses (D_mean) were calculated from dose-volume histograms based on computed tomographies of the parotid glands.

Results

Patients were grouped according to the D_mean of the spared parotid gland having the lowest radiation exposure: Group I - D_mean < 26 Gy (n = 36), group II - D_mean 26-40 Gy (n = 45), and group III - D_mean > 40 Gy (n = 36). 15/117 (13%) patients received IMRT. By using IMRT as compared to 3D-CRT the D_mean of the spared parotid gland could be significantly reduced (D_mean IMRT vs. 3D-CRT: 21.7 vs. 34.4 Gy, p < 0.001). The relative salivary flow rates (RFSR) as a function of the mean parotid dose after 24 and 36 months was in group I 66% and 74%, in group II 56% and 49%, and in group III 31% and 24%, respectively. Multiple linear regression analyses revealed that the parotid gland dose and the tumor site were the independent determinants 12 and 36 months after the end of RT. Patients of group I and II parotid gland function did recover at 12, 24, and 36 months after the end of RT.

Conclusions

If a D_mean < 26 Gy for at least one parotid gland can be achieved then this is sufficient to reach complete recovery of pre-RT salivary flow rates. The radiation volume which depends on tumor site did significantly impact on the D_mean of the parotids, and thus on the saliva flow and recovery of parotid gland.

Oral streptococci growth on aging and non-aging esthetic restorations after radiotherapy

The aim of this study was to examine Streptococcus mutans biofilm growth on both aged and non-aged restorative dental resins, which were submitted to therapeutic irradiation. Sixty-four disks of an esthetic restorative material (Filtek Supreme) were divided into 2 groups: aged group (AG) and a non-aged group (NAG). Each group was subdivided into 4 subgroups: non-irradiated and irradiated with 10Gy, 35Gy, and 70Gy. The biofilms were produced by Streptococcus mutans UA159 growing on both AG and NAG surfaces. The colony-forming units per mL (CFU/mL) were evaluated by the ANOVA and the Tukey LSD tests (α=0.05). AG presented smaller amounts of CFU/mL than the NAG before irradiation and after 10Gy of irradiation (p<0.05). AG irradiated with 35 and 70Gy showed increased amount of bacterial biofilm when compared to non-irradiated and 10Gy-irradiated disks (p<0.05). The exposure to ionizing radiation at therapeutic doses promoted changes in bacterial adherence of aged dental restorative material.

Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study

INTRODUCTION

Radiation-related caries is a disease with high potential of teeth destruction in patients who have undergone radiotherapy in the head and neck region. Also, it is a challenge for dentistry due to high rates of recurrent caries and early restorations failure.

PURPOSE

This study aims to analyze the early restoration failures in order to better understand the etiology of dental restorations reduced longevity in irradiated teeth.

METHODS

Fifteen restored permanent teeth extracted from 11 patients who had finished head and neck radiotherapy were studied. Sections from each tooth were prepared and a qualitative description of the interface between restorations and dentin was performed by using polarized light microscopy and scanning electron microscopy.

RESULTS

Unfavorable anatomical shape of restorations, residual caries, and secondary caries affecting dentin adjacent to restorative materials were widely found. The morphological patterns of these carious lesions were similar to conventional dentin lesions with superficial demineralized zone and translucent zone.

CONCLUSIONS

Early dental restoration failure in teeth affected by radiation-related caries may have the same etiological factors from ordinary dental restoration failure and direct radiogenic damage to dentition would not be essential to early restorations failure in radiation-related caries.

Bond strengths of two conventional glass-ionomer cements to irradiated and non-irradiated dentin

This study evaluated the influence of irradiation on the dentin shear bond strength of two conventional glass ionomer cements (GICs). Thirty extracted molars were bisected in the mesio-distal direction. One-half of 20 teeth were irradiated with 60 Gy (5 days/week) for 6 weeks, and then GIC was placed on the irradiated dentin surface (Groups A1, B1). For the other halves of these tooth specimens, the GICs were first placed on their dentin surfaces and then the specimens irradiated (Groups A2, B2). The remaining 10 teeth were bisected and used as non-irradiated controls (Groups C1, C2). The GIC-dentin shear bond strengths were examined. Groups A2 and B2 had significantly lower bond strengths than groups A1, B1, C1, and C2 (p < 0.05). No significant differences were found among groups A1, B1, C1, and C2 (p > 0.05). In conclusion, irradiation may have an adverse effect on the bond strength of GICs depending on the application sequence.

Influence of pressure application before light-curing on the bond strength of adhesive systems to dentin

This study evaluated the influence of defined pressure application before light-curing on the tensile bond strength (TBS) of two adhesive systems to wet and perfused dentin. Bonding sites were analyzed by scanning electron microscopy (SEM) to assess morphological changes. Dentin discs from 120 human third molars were prepared in such a way to allow simulation of intrapulpal pressure. The specimens were randomly assigned to 6 groups (n=20) according to different experimental conditions. The adhesive systems (ScotchbondTM Multi-Purpose and Syntac®) were applied either to wet or perfused dentin. In the latter, compression was applied before adhesive light-curing . TBS was recorded using an universal testing machine. Qualitative examination of the bonding sites was performed by SEM after dissolving the dentin with 50% nitric acid. Pressure application prior to light-curing resulted in a remarkable decrease of TBS for Syntac®, while no significant change was observed for ScotchbondTM MP. SEM analysis showed no considerable lengthening of the resin tags after pressure application. These findings suggest that application of adhesive systems to dentin under pressure before light-curing had no positive effect on TBS.

Radiation-related damage to dentition

Because of typical tissue reactions to ionising radiation, radiotherapy in the head and neck region usually results in complex oral complications affecting the salivary glands, oral mucosa, bone, masticatory musculature, and dentition. When the oral cavity and salivary glands are exposed to high doses of radiation, clinical consequences including hyposalivation, mucositis, taste loss, trismus, and osteoradionecrosis should be regarded as the most common side-effects. Mucositis and taste loss are reversible consequences, usually subsiding early post-irradiation, whereas hyposalivation is commonly irreversible. Additionally, the risk of rampant tooth decay with its sudden onset and osteonecrosis is a lifelong threat. Thus, early, active participation of the dental profession in the development of preventive and therapeutic strategies, and in the education and rehabilitation of patients is paramount in consideration of quality-of-life issues during and after radiotherapy. This Review focuses on the multifactorial causes of so-called radiation caries and presents possible treatment strategies to avoid loss of dentition.

Tensile bond strength of different adhesive systems between bone and composite compared: an in vitro study

INTRODUCTION

The aim was to compare tensile bond strength of three dentine adhesive systems (Excite, Clearfil New Bond, Etch & Prime 3.0) and two cyanoacrylate adhesives (Cyano Veneer, Histoacryl) to animal bone in vitro.

MATERIAL AND METHODS

Specimens from five porcine mandibles (diameter 9 mm) with a total thickness of 4mm (+/-0.5mm) and a cortical layer of 1.5mm (+/-0.2mm) were prepared using trephine burs under constant water cooling and under standardized conditions. They were assigned to five experimental groups. Tensile bond strength of five different adhesive agents (Clearfil New Bond, Etch & Prime 3.0, Excite, Histoacryl and Cyano Veneer was measured 15 min after application and after light curing of a composite material (Tetric Ceram, colour A2) added thereupon using a universal testing machine. Qualitative control was performed by scanning electron microscopy, while examining loaded and unloaded specimens.

RESULTS

The measured tensile bond strength was as follows: Clearfil New Bond 8.00 MPa (+/-1.36 MPa), Etch & Prime 3.0 4.05 MPa (+/-1.52 MPa), Excite 2.96 MPa (+/-1.34 MPa), Histoacryl 5.22 MPa (+/-2.00 MPa), Cyano Veneer 4.56 MPa (+/-0.76 MPa). Clearfil New Bond showed significantly higher bond strength than the other four adhesives. Scanning electron microscopy analysis of unloaded specimens showed mixed modes of fracture. As regards the loaded specimens, no tag formation as known for dentine was found.

CONCLUSION

Within the limitations of an in vitro investigation it can be concluded that dentine adhesive systems might be useful for bone bonding. Tensile bond strength of the dentine adhesive systems tested on bone is comparable to that evaluated for dentine in earlier investigations.