Effect of saliva contamination on the bond strength of single-step and three-step adhesive systems

Effects of stamp material and restoration depth on the accuracy of direct composite resin restorations using stamp technique

OBJECTIVES

To evaluate the effects of different stamp materials and restoration depths on the accuracy of direct composite resin restorations using stamp technique.

METHODS

Eighty standard resin teeth were divided into four groups based on different stamp materials: flowable composite resin (FR), vinyl polydimethyl siloxane (VPS) for bite registration (VB), VPS for impression (VI) and transparent VPS (TV). Each material group was further divided into two subgroups based on restoration depth (1 and 2 mm; n = 10). Standardized Class I cavities were prepared and restored with the corresponding stamps. Pre- and post-treatment scans of each tooth were fitted using Geomagic Control X software, generating deviation distribution maps of the occlusal surface. The accuracy indicators, including mean height variation (MHV), root mean square (RMS), and proportions of height variation with different ranges (PHVrange), were recorded to evaluate the accuracy of restorations. Analysis of variance (ANOVA) were used for statistical analysis (α=0.05).

RESULTS

The type of stamp material significantly affected all accuracy indicators, while restoration depth did not show a significant effect on any of the indicators. MHV values ranged from 29.70 ± 5.88 μm to 63.52 ± 9.58 μm, and RMS values ranged from 62.78 ± 8.76 μm to 101.79 ± 13.17 μm, displaying a trend of FR0.2mm values (0.70 ± 0.50 % for 1 mm, 0.94 ± 0.47 % for 2 mm). In contrast, the TV groups exhibited the lowest PHV<0.05mm values (59.69 ± 10.23 % for 1 mm, 59.67 ± 5.70 % for 2 mm), while the VI groups showed the highest PHV>0.2mm values (7.34 ± 1.58 % for 1 mm, 8.20 ± 3.16 % for 2 mm).

CONCLUSIONS

The accuracy of direct composite resin restorations using stamp made of flowable composite resin was higher than that of all tested VPS materials, thereby reducing the need for occlusal adjustment and improving clinical efficiency. Besides, restoration depth had no significant impact on the accuracy of stamp technique, regardless of the stamp material used.

CLINICAL SIGNIFICANCE

The accuracy of direct composite resin restorations using stamp technique with different stamp materials varies. The flowable composite resin stamp exhibits higher accuracy compared with VPS stamps, reducing the need for occlusal adjustments.

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.

Influence of Surface Pretreatment on the Bond Strength of a Resin Luting Cement to Saliva-contaminated Enamel and Dentin

OBJECTIVES

This study aimed to evaluate the influence of surface pretreatment on the shear bond strength (SBS) of a resin luting cement to enamel and dentin with saliva contamination. The surface free energies (SFE) of the adherent surfaces were also determined.

METHODS AND MATERIALS

Bovine enamel and dentin were used in this study. For the saliva-contamination, human saliva was applied to the adherent surface for 60 seconds and then air-dried, and the specimens without saliva contamination served as controls. One group of contaminated surfaces was untreated (SC), and the others were pretreated with Katana Cleaner (KC), Multi Etchant (ME), or Ultra-Etch (UE). Fifteen specimens were prepared to measure the SBS for each test group.The mixed resin luting cement paste was applied to the alumina-blasted surface of a stainless-steel rod and placed on the prepared tooth surface. The luting cement was light irradiated for 40 seconds. The bonded specimens were stored for 24 hours at 37°C and half of the bonded specimens underwent 10,000 thermal cycles. The SBS and SFE of the specimens after different pre-treatments were measured.

RESULTS

The two-way ANOVA revealed that the factors of pretreatment agent and storage condition had a significant effect on the SBS to enamel and dentin. The SFE values of the SC group were significantly lower than those of the other groups in both enamel and dentin. The SFE of pretreated surface was material dependent.

CONCLUSIONS

A pretreatment agent containing functional monomers was shown to be effective in removing saliva contaminants and in creating an effective bonding surface for the resin luting cement.

A scoping review of the influence of clinical contaminants on bond strength in direct adhesive restorative procedures

OBJECTIVE

Clinical contamination during direct adhesive restorative procedures can affect various adhesive interfaces differently and contribute to bulk failure of the restorations. This review aims to summarise the current knowledge on the influence of a variety of clinical contaminants on the bond strength at various adhesive interfaces during adhesive restorative procedures and identify gaps in the literature for future research.

DATA AND SOURCES

An electronic database search was performed in PubMed and EMBASE to identify articles that investigated the influence of contaminants on direct restorative bonding procedures. A data-charting form was developed by two researchers to capture the key characteristics of each eligible study.

STUDY SELECTION

The initial search yielded 1,428 articles. Fifty-seven articles published between 1 Jan 2007 and 25 Oct 2023 were included in the final review. Thirty-three of the articles examined the influence of saliva contamination, twelve articles examined the influence of blood contamination, and twenty-five articles examined the influence of other contaminants.

CONCLUSION

Saliva contamination exerted less influence on the decrease in bond strength when self-etch systems were used, compared to when etch-and-rinse systems were used. Blood contamination adversely affected the bond strength at the interface between resin composite and dentine, and resin composite and resin-modified glass ionomer cement. Treating contaminated surfaces with water spray for 10-30 s followed by air drying could be effective in recovering bond strength following saliva and blood contamination.

CLINICAL SIGNIFICANCE

This scoping review provides a valuable overview of the range of potential clinical contaminants that can influence the bond strength between different interfaces in direct adhesive restorative procedures. Additionally, it identifies potential decontamination protocols that can be followed to restore and enhance bond strength.

Effect of contamination and decontamination methods on the bond strength of adhesive systems to dentin: A systematic review

INTRODUCTION

In a suitable condition, it is important to perform any dental restorative procedure using an operatory field isolated. Then, the aim of this study was to compare the bond strength of composite restorations to dentin affected by any contamination agent through a systematic review.

METHODS

This systematic review was performed following the PRISMA 2020 guidelines. The literature search was conducted until September 2022 by scanning the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts evaluated the bond strength of resin-based materials to permanent human dentin contaminated with blood or saliva were selected for full-text review. The risk of bias was assessed by the RoBDEMAT tool.

RESULTS

A total of 3750 papers resulted from the search from all databases. After the full-text reading, a total of 62 articles remained for the qualitative analysis. The contamination agents used were blood, saliva, and hemostatic agents. A great variety of protocols were used to contaminate the dentin surface, and the contamination process occurred in several steps of the bonding process, including before and after the etching process, after the primer application and after the adhesive application. Also, several decontamination procedures were tested, including reapplication of the etching material, rinsing with water, chlorhexidine or sodium hypochlorite and reapplication of the adhesive system.

CONCLUSION

Any contamination with blood or saliva impaired the bond strength of resin-based materials to dentin. Decontamination procedures including water-spray and reapplication of the bonding system could revert the impairment produced by the saliva or blood contamination. The use of hemostatic agents as a method of blood decontamination is not recommended.

CLINICAL SIGNIFICANCE

Clinicians should avoid contamination during a bonding procedure, otherwise, a reduction in the bond quality is expected.

Effects of an MDP-based surface cleaner on dentin structure, morphology and nanomechanical properties

OBJECTIVE

To analyze the effect of Katana™ Cleaner (KC) in nanomechanical and triboscopic properties of etched dentin.

METHODS

Dentin disks from human third molars were prepared. Two main groups of study were established in function of the etching conditioning, phosphoric acid (PA) and Clearfil SE Bond primer (CSEB). Four subgroups were tested within each group: i) untreated dentin (UD), ii) etched dentin (ED) [(PAED/CSEB)], iii) etched dentin contaminated with saliva (PAED+S)/(CSEB+S), and iv) etched and contaminated dentin treated with KC (PAED+S+KC)/(CSEB+S+KC). Nano-DMA testing and imaging, atomic force microscopy (AFM) analysis and nanoroughness (SRa) measurements were obtained. Field emission scanning electron microscopy (FESEM) images were also acquired.

RESULTS

Phosphoric acid etched dentin samples and those specimens contaminated with saliva (PAED+S) attained the highest SRa values, that decreased after Katana™ Cleaner application (PAED+S+KC). In the group of dentin treated with CSEB primer, all subgroups performed similar, except in CSEB+S that attained the highest SRa values. The treatment with KC restored the original values of complex modulus of the untreated dentin. KC application produced the lowest and the highest tan delta values on PAED and CSEB groups, respectively.

CONCLUSION

Katana™ Cleaner provided equally mature dentin surfaces after any of the etching methods. Tan delta increased when Katana™ Cleaner was applied on the dentin surface previously etched and contaminated with saliva, regardless the kind of etchant, thus facilitating the dissipation of energy for elastic recoil during loading.

CLINICAL SIGNIFICANCE

Katana™ Cleaner application after saliva contamination originated similar low roughness levels, regardless the type of etching method. Both complex and storage moduli were similar, after Katana™ Cleaner application, in any case.

Evaluation of different decontamination procedures on bond strength to sound and caries affected dentin using "no-wait" universal adhesive

BACKGROUND

Current study aimed to evaluate the effect of different decontamination procedures on micro-shear bond strength (μSBS) of sound (SoD) and caries-affected dentin (CAD) of two universal adhesives after blood-saliva contamination.

METHODS

One hundred and eighty bovine anterior teeth were prepared and allocated into the respective groups according to tested dentin substrates [SoD, CAD], universal adhesives [Clearfil Bond Universal Quick (UBQ), All-Bond-Universal (ABU)], adhesive contamination stage [none, contamination before and after adhesives light-curing], and according to decontamination procedures [no decontamination, water rinsing, adhesive rebond, Ethylenediaminetetraacetic acid (ETDA) and chlorhexidine (CHX) application]. Universal adhesives were applied according to manufacturer instructions in self-etch (SE) bonding mode. Four composite microrods were built for each tooth. Specimens were kept in distilled water for 24 hours at 37°C before testing μSBS. Four-way ANOVA and Tukey HSD tests were used for data analysis.

RESULTS

A statistically significant difference between contamination stages of both universal adhesives at different decontamination procedures for SoD and CAD. Highest μSBS was recorded for UBQ control group at SoD, while the least was recorded for light-cured ABU upon water rinsing decontamination procedure of CAD.

CONCLUSIONS

Proper cavity isolation is mandatory to avoid possible contamination which can dramatically affect μSBS. CHX is a potent cavity decontaminant that can restore different dentin substrates bond strength. EDTA presents a promising substitute. UBQ adhesive showed better bonding performance than ABU to both dentin substrates. Application of regular cavity decontamination approaches is highly advised in daily practice to avoid possible detrimental effect of accidental cavity contamination.

Longevity of gold restorations in posterior teeth: A retrospective study up to 10-years

OBJECTIVE

In this retrospective clinical study, we investigated the long-term survival and success of indirect gold restorations, placed by undergraduate students.

MATERIAL AND METHODS

The study included 72 gold restorations in 45 patients, placed in a five-year period between 2009 and 2013. Two experienced dentists performed the evaluation following the FDI criteria after 5 to 10 years. Kaplan-Meier test was used for longevity analysis of success and survival. Data were tested for normality with Shapiro-Wilk test. Cox regression analysis, with significance level appointed at p ≤ .05, was performed using success and survival of restorations as dependent variables. Annual failure rates (AFRs) were calculated.

RESULTS

Overall, 72 indirect gold restorations prepared in posterior teeth were assessed, with an observation time from 63 months to 117 months. The mean service time was 88.1 months and the median 87 months. No failures, but 2 repairs, were observed during the first five years. From 5 to 10 years 1 replacement and 1 more repair occurred. The survival and success rates of gold restorations were calculated at 9 years with 98.6% and 91%, respectively. Restorations placed on premolars had higher survival and success rates compared to molars. Three cases were categorized as repairs: in two cases, a root canal treatment was needed and, in one other, an occlusal perforation of the restoration was observed.

CONCLUSIONS

Posterior indirect gold restorations placed by dental undergraduate students showed a highly predictable clinical performance in terms of success and survival. These results are comparable with survival rates reported in literature for restorations cemented in general dental practices.

CLINICAL SIGNIFICANCE

Casted gold restorations placed from dental students in an undergraduate setting show high survival rates, similar to professional dentists.