An investigation into the quality of dentine bonding systems for accomplishing a durable bond

Microshear bond strength of self-adhesive composite to ceramic after mechanical, chemical and laser surface treatments

Objectives

This study aimed to assess the microshear bond strength of a repairing self-adhesive flowable composite to ceramic after mechanical, chemical and laser treatment of the ceramic surface.

Materials and Methods

Forty zirconia and forty feldspathic ceramic blocks measuring 8 x 8 x 2 mm were fabricated. Feldspathic blocks were divided into four groups of control (1), laser (2780 nm) (2), sandblasting + hydrofluoric (HF) acid + silane (3) and laser (2780 nm) + HF acid + silane (4). Zirconia blocks were also divided into four groups of control (1), laser (2780 nm) (2), sandblasting + Z-Prime Plus (3) and laser (2780 nm) + Z-Prime Plus (4). Vertise Flow composite was bonded to treated ceramic surfaces as a repairing material, then the samples were subjected to 1000 thermal cycles. Repair bond strength was measured by Instron machine and data were analyzed using one-way ANOVA and post hoc test (P < 0.05).

Results

Maximum and minimum bond strength values were observed in zirconia-control (22.57 ± 4.76 MPa) and feldspathic-control (8.65 ± 6.41 MPa) groups, respectively. There was no significant differences between subgroups within the zirconia or feldspathic groups (P > 0.05), however the bond strength of zirconia subgroups was significantly higher than that of feldspathic subgroups.

Conclusion

Vertise Flow provides relatively good bond strength to ceramic even with no surface treatment.

Evaluation of the caries-preventive effect of three orthodontic band cements in terms of fluoride release, retentiveness, and microleakage

This in vitro study was undertaken to evaluate the caries-preventive effect of three orthodontic band cements (a dual-curing resinmodified glass ionomer cement [RMGIC] and two light-curing polyacid-modified composite resin [compomer] cements) in terms of fluoride release, retentiveness, and microleakage after thermocycling. The RMGIC (Ortholy Band Paste [GC Ortholy, Inc., Tokyo, Japan]) showed a significantly higher amount of cumulative fluoride release over 180 days (p<0.001) and significantly greater tensile bond strength (p<0.001) than the compomer cements (Transbond Plus [3M Unitek, Monrovia, CA, USA] and Ultra Band-Lok [Reliance Orthodontic Products, Inc., Itasca, IL, USA]). Its bond strength was unaffected by thermocycling (2,000 cycles), indicating good retentiveness, whereas that of the compomer cements significantly decreased after thermocycling. Moreover, it had lower dyepenetration scores, indicative of less microleakage. These findings suggest that the RMGIC may have a better caries-preventive effect than the compomer cements and is suitable for long-term orthodontic banding.

Effect of adhesives and thermocycling on the shear bond strength of a nano-composite to coronal and root dentin

OBJECTIVES

To evaluate the effects of "etch & rinse" vs "self-etch" adhesives and thermocycling on the shear bond strength (SBS) of a nano-composite to coronal and root dentin.

MATERIALS AND METHODS

FIFTY-SIX EXTRACTED HUMAN MOLARS WERE mounted and ground to expose coronal and root dentin surfaces and were randomly divided into two groups according to adhesive system: SE--a two-step self-etch adhesive (Adper SE Plus, 3M ESPE) and ER-an etch & rinse adhesive (Adper Single Bond 2, 3M ESPE). The adhesives were applied to the coronal and root dentin of the mounted teeth. A nano-composite (Filtek Supreme XT, 3M ESPE) was applied to both dentin surfaces. The bonded specimens were stored in distilled water at 37 degrees C for 24 hours. Half of the bonded specimens were tested for SBS in a universal testing machine without thermocycling. The remaining specimens were thermocycled (500 cycles between 5 degrees C and 55 degrees C) prior to SBS testing. Two specimens from each group were kept for Scanning Electron Microscope evaluations of the adhesive interfaces. Failure modes were determined under a stereomicroscope. The mean SBS value of each group was calculated, and the results were subjected to ANOVA, Duncan test and Paired samples t-test (p = 0.05).

RESULTS

Thermocycling did not affect the SBS of coronal dentin for either adhesive. However, it affected the SBS of SE in root dentin (p < 0.05). The two different dentin substrates did not exhibit a significant difference except for higher values in root dentin with the SE group without thermocycling. The greatest number of cohesive failures was observed in root dentin with SE adhesive; however, the failure modes were mainly adhesive for the other groups.

CONCLUSION

The SE adhesive exhibited higher SBS values than the ER adhesive in root dentin. Thermocycling did not affect the SBS in coronal dentin for either adhesive but it decreased the SBS of SE in root dentin.

HEMA down-regulates procollagen alpha1 type I in human gingival fibroblasts

2-Hydroxyethyl methacrylate (HEMA) can be released from restorative materials and diffused into the tooth pulp over long periods of time. Although cytotoxicity due to high concentrations of monomers has been well studied, little is known about the risk of chronic toxicity resulting from low concentrations. The purpose of the study was to evaluate the effects of a minor toxic concentration of HEMA in the synthesis and expression of procollagen alpha1 type I produced by human gingival fibroblasts (HGF). HGF were exposed to 3 mM HEMA from 24 to 96 h. An MTT assay was performed to evaluate cell viability while reverse-transcriptase polymerase chain reaction (RT-PCR), real-time polymerase chain reaction (real-time PCR), and Western-blot analysis were carried out to evaluate the variability in the expression and synthesis of procollagen alpha1. Immunofluorescence was performed to detect the protein inside the cells. The results showed that there was a strong reduction of procollagen alpha 1 type I expression at 72 and 96 h. These findings demonstrate that, even if it does not reduce cell viability, 3 mM HEMA interferes both with the synthesis of the procollagen alpha 1 type I protein and its mRNA expression, suggesting that normal cell production and activity are modified by HEMA at concentrations below those which cause acute cytotoxicity.

Shear bond strength of one etch-and-rinse and five self-etching dental adhesives when used by six operators

OBJECTIVE

To test the hypothesis that some single-bottle self-etching adhesives bond as well to enamel and dentin as a typical two-bottle etch-and-rinse adhesive.

MATERIAL AND METHODS

Six operators used one two-bottle etch-and-rinse dentin adhesive (Scotchbond MP) and five all-in-one self-etching adhesives (iBond Gluma Inside, Clearfil S(3) Bond, iBond Experimental, Xeno IV, and G-BOND). Each operator carried out six bondings to enamel and six bondings to dentin with each adhesive. After 24 h of storage in water at 37 degrees C, bond strength was determined in shear.

RESULTS

The pooled results of all the adhesives revealed no significant difference (p>0.05) in bond strength between dentin and enamel. However, there were significant differences (p<0.0001) between the different adhesives. The etch-and-rinse adhesive did better than the self-etching adhesives when substrate was not an issue (pooled enamel and dentin results). On comparing the performance of the different adhesives, it became clear that there were significant interactions (p<0.0001) between substrates and products. There were also significant differences (p<0.0001) between operators, and the interaction between operators and products was significant (p<0.0002).

CONCLUSIONS

The tested etch-and-rinse adhesive did better than the tested self-etching adhesives. The shear bond strength results were also strongly affected by the operator as well as by the interaction between operator and used product. The pooled bond strength values of the different adhesives revealed no difference in bond strength to dentin versus enamel.

Shear versus micro-shear bond strength test: A finite element stress analysis

OBJECTIVES

This study aimed at comparing the stress distribution in shear and micro-shear test set-ups using finite element analysis, and suggesting some parameter standardization that might have important influence on the results.

METHODS

Two-dimensional plane strain finite element analysis was performed using MSCPatran and MSCMarc softwares. Model configurations were based on published experimental shear and micro-shear test set-ups and material properties were assumed to be isotropic, homogeneous and linear-elastic. Typical values of elastic modulus and Poisson's ratios were assigned to composite, dentin and adhesive. Loading conditions considered a single-node concentrated load at different distances from the dentin-adhesive interface, and proportional geometry (1:5 scale, but fixed adhesive layer thickness in 50microm) with similar calculated nominal strength. The maximum tensile and shear stresses, and stress distribution along dentin-adhesive interfacial nodes were analyzed.

RESULTS

Stress distribution was always non-uniform and greatly differed between shear and micro-shear models. A pronounced stress concentration was observed at the interfacial edges due to the geometric change: stress values farther exceeded the nominal strength and tensile stresses were much higher than shear stresses. For micro-shear test, the relatively thicker adhesive layer and use of low modulus composites may lead to relevant stress intensification. An appropriate loading distance was established for each test (1mm for shear and 0.1mm for micro-shear) in which stress concentration would be minimal, and should be standardized for experimental assays.

SIGNIFICANCE

The elastic modulus of bonded composites, relative adhesive layer thickness and load application distance are important parameters to be standardized, once they influence stress concentration.

Evaluation of thermal cycling and mechanical loading on bond strength of a self-etching primer system to dentin

OBJECTIVE

The aim of this study was to evaluate the in vitro durability and fracture modes of the tooth-resin interface following thermal cycling, fatigue load cycling (FLC) and micro-tensile bond strength testing (MTBS).

METHODS

Twenty-four human molars were divided into two groups. In group A, coronal dentin was ground flat with #600-grit SiC paper, Clearfil Linerbond.2V (LB.2V) adhesive was applied and a crown fabricated with Clearfil AP-X resin composite. Samples were loaded in the FLC simulator and thermal cycle device. In group B, Class I cavities were prepared with a diamond bur and the cavity restored with LB.2V/AP-X. Samples were simultaneously subjected to FLC and thermal cycling. After storage of the specimens in water for 1 week, MTBS tests were performed, and fracture modes examined by SEM.

RESULTS

For group A, MTBS were approximately 40 MPa with cohesive failures in the bonding resin of all specimens. Neither thermal nor mechanical stressing altered bond strengths on flat dentin surfaces. In group B, MTBS in the unstressed control group was 21 MPa with cohesive failures in the resin. As both thermal and mechanical stresses increased, there was a significant decrease in bond strength (16 MPa, P<0.05) and the fractures were seen in the resin-dentin interface and hybrid layer.

SIGNIFICANCE

Surface preparation, C-factor, cavity depth, the dentin substrate and character of the smear layer strongly influence the bond strength values after thermal and fatigue loading. The FLC simulator in combination with MTBS testing provides meaningful in vitro evaluation of dentin bonding durability.

The effects of dentin permeability on restorative dentistry

The permeability properties of dentin determine its sensitivity and the degree of pulpal response to restorative procedure materials and microleakage. Most pulpal reactions are due to bacteria or bacterial products that permeate across dentin. These reactions can be prevented if dentin is sealed with resins as soon as it is exposed. In the future, restorative dentists may employ topical application of biologic growth factors to permeate across dentin to modify the formation of reactionary or reparative dentin, thereby lowering dentin permeability and protecting the pulp.

Fractured surface characterization: wet versus dry bonding

OBJECTIVE

Fractographic analysis was conducted to evaluate the resin-dentin bond structures made under wet and dry conditions.

METHODS

Resin-dentin bonded specimens were prepared using two adhesive resin systems (Single Bond/SB; 3M and All Bond 2/AB2; Bisco Inc) under wet and dry conditions. The specimens were sectioned perpendicular to the adhesive interface to produce a square bar-shaped specimen (adhesive area: 0.9 mm(2)) by means of a diamond saw. The mean bond tensile test was then conducted at a crosshead speed of 1.0 mm/min. The mean bond strengths were statistically compared with two-way ANOVA and Fisher's PLSD test (p<0.05). Subsequently, the fractured surfaces of all specimens were examined using SEM and the area fractions of failure modes (%) were measured using an image analyzer on SEM microphotographs.

RESULTS

No significant differences in tensile-bond strength were observed between SB (60.1+/-16.4MPa) and AB2 (69.8+/-17.4MPa) (p>0.05) under wet conditions. However, the bond strength either of SB or AB2 made under wet conditions was significantly greater than those made under dry conditions (SB: 26.2+/-12.5MPa and AB2: 6.8+/-3.3MPa) (p<0.05). Under fractographic analysis, the major portion at the fractured surface was occupied by the cohesive failure of bonding resin and the resin composite for the wet conditions, and the top of the hybrid layer for the dry conditions in both systems.

SIGNIFICANCE

The interaction between the top of the hybrid layer and the bonding resin influenced the bond integrity.

Shear strength after ethylenediaminetetraacetic acid conditioning of dentin

On the basis of previous studies, it was hypothesized that a chelating agent such as ethylenediamine-tetraacetic acid (EDTA) in a saturated aqueous solution (24%) can function as a dentin conditioning agent with exposure times comparable to that of phosphoric acid without compromising shear bond strength. Thirty caries-free human third molars, divided equally between two groups, were used. In group one, four experimental surfaces were prepared on each tooth, and cylindrical copper matrixes with a diameter of 5 mm were attached to the prepared surfaces. The experimental surfaces were then treated with a 24% EDTA gel for 30, 60, 120, or 240 sec, respectively. Dentin was bonded with All Bond 2, after which a flowable composite was added and light-cured. In group two, which served as control, two surfaces were prepared on each tooth. One surface was left unetched, whereas the other side was treated with 24% EDTA-gel for 30 sec. A shear bond strength test was performed at a crosshead speed of 1 mm/min until the composite debonded. There was no statistically significant difference (P< 0.89) between results of the shear bond strength test for the different EDTA conditioning times. The control group showed a significant difference in shear bond strength between untreated surfaces and surfaces conditioned for 30 sec with EDTA. Thus, the results indicate that the duration of EDTA gel conditioning of dentin surfaces need not exceed that of phosphoric acid in clinical practice to obtain an acceptable level of bond strength.

Meta-analytical review of factors involved in dentin adherence

Literature data on adherence tests of dentin-bonding systems (DBS) may differ widely, even for the same DBS. The problem of bond testing is that materials are seldom compared with a standard, and experimental conditions often vary. We sought to identify the parameters that influence this variability. Using inclusion and exclusion criteria, we conducted a meta-analytical review of 75 articles, published between 1992 and 1996 in SCI reviews, that give bond strength data for 15 dentin-bonding agents of the so-called third and fourth generations. Seventeen selected parameters were classified into four groups: Group A includes factors related to the dentin substrate (i.e., nature of teeth); group B, composite and bonding area (i.e., composite stiffness); group C, storage conditions of the bonded samples (i.e., thermocycling); and group D, test design (i.e., crosshead speed). For each report, the experimental features, the bond strength means and standard deviations, and the failure mode were extracted and tabulated. Statistical Analysis System software was used to perform Pearson correlation analysis and analysis of variance, with bond strength as the dependent variable and experimental conditions as the independent variables. The meta-analytical review highlighted the significant influence of various parameters in the different groups: origin of dentin, types of teeth, pulpal pressure, tooth storage temperature, maximum storage time of teeth, and dentin depth in group A; type and stiffness of composite and bonding area in group B; storage of bonded samples (medium, temperature, and time) in group C, and testing mode and crosshead speed in group D. A significant positive correlation was observed between the mean bond strength and the rate of cohesive failure. It can be concluded from this study that some of these parameters should be controlled by the use of a standardized protocol. Unfortunately, the substrate-related variables are more difficult to control, even though their influence is consistent.

Influence of cross-head speed on resin-dentin shear bond strength

OBJECTIVE

To evaluate the influence of different cross-head speeds on shear bond strength test on the dentin surface.

METHODS

One hundred and twenty extracted bovine incisors were embedded in polystyrene resin. The specimens were prepared by wet grinding with 320-, 400- and 600-grit Al2O3 paper exposing dentin. After the application of the adhesive system Single Bond (3M) to etched dentin, the composite resin Z-100 (3M) was applied and light cured. The specimens were randomly assigned to four groups (n=30). The shear bond strength tests were performed with an EMIC DL 500 universal testing machine at four different cross-head speeds: 0.50 (A); 0.75 (B); 1.00 (C); and 5.00 mm/min (D).

RESULTS

The mean values of shear bond strength in MPa (SD) were: A, 11.78 (3.91); B, 11.82 (4.78); C, 16.32 (6.45); D, 15.46 (5.94). The data were analyzed with one-way ANOVA and Tukey's test (alpha=0.05). The results indicated that A=B<C=D. The fracture pattern was evaluated by visual analysis in a stereomicroscope (25x). The percentage of fractures that occurred at the adhesive interface were: A, 92.5%; B, 91.6%; C, 70.0%; D, 47.0%. The Student's t-test to percentages (alpha=0.05) indicated that there were no significant differences among A, B and C; A and B differed from D, and there was no significant difference between C and D.

SIGNIFICANCE

Different cross-head speeds may influence the shear bond strength and the fracture pattern in dentin substrate. Shear bond strength using cross-head speeds of 0.50 and 0.75 mm/min should be preferred.

Sealing and dentin bond strength of adhesive systems in selected areas of perfused teeth

OBJECTIVES

(1) Test the sealing capacity and tensile strength of various adhesive systems: Scotch Bond 1 (Single Bond in USA)(SB1)+Z100, Syntac Sprint (SYN)+Tetric Ceram, Prime and Bond 2.1 (PB21)+TPH Spectrum, F2000 (Adhesive+Compomer) (F2000) and Optibond Solo (OPT)+Prodigy, to perfused teeth (30 cm distilled H2O), in select areas. (2) Determine the relationship between sealing ability and size of adhesive area (BA) with tensile strength (TS).

METHODS

Segments of human third molars (n=67) sealed with amalgam on their coronal side were connected to a perfusion system (30 cm distilled H2O), to measure the basal permeability. Access cavities were drilled through the amalgam to expose dentin (area range: 8.7-20.8 mm2) and measure the permeability of that area. Cavities were sealed with one of the test materials and permeability measured prior to tensile testing. The percentage of decrease in permeability (PPD) that occurred with the different combinations of materials was also measured. RESULTS. TENSILE STRENGTH: there were no statistically significant differences among groups. PERMEABILITY: ANOVA showed that there were statistically significant differences in the mean % decrease in permeability (PPD) among groups (p=0.018). Student-Newman-Keuls test (p<0.05) detected that the mean PPD of F2000 ranked statistically higher than that of SB1. Relationship among variables: a linear correlation was found defined by the formula TS=7.47+0.008 x PPD-0.23 x BA, with a significance of the model p=0.0097.

SIGNIFICANCE

None of the materials studied reduced permeability up to 100%. They all produced low tensile bond strengths (maximum mean value of groups: 5.51 MPa (OPT)).

Nominal shear or fracture mechanics in the assessment of composite-dentin adhesion?

This study addresses the anticipated problem of discriminating among high-performing dentin adhesives. The simplicity of the nominal shear bond test, despite being heavily criticized, has made it a routine procedure for the determination of bonding efficacy. A fracture mechanics approach has been suggested as a better assessment of bonding efficacy (Versluis et al., 1997). However, experimental complexity is a major limitation. It is hypothesized that a new, simplified interfacial fracture toughness test (Lin, 1994) will evaluate bonding agents differently if compared with the traditional shear bond test. Therefore, the objective of this study was to compare the performances of six dentin bonding agents subjected to the interfacial fracture toughness test (critical plane strain energy release rate) or to the nominal shear bond test (shear bond strength). Their performances were also characterized by scanning electron micrography of the fracture surfaces for evidence of dentin cohesive failure. Statistical analyses showed only marginal differences between these determinants of the two tests. However, when the analysis was applied only to the materials that had 100% frequency of dentin cohesive failure in shear testing, which also had high bonding efficacy, the difference in adhesive strengths between the two tests became significant. The reliability of the nominal shear test is questioned when dentin cohesive failure occurs, which usually is associated with high bonding efficacy. Since it is expected that bonding efficacy will increase further, the interfacial fracture toughness test is the preferred methodology to distinguish among high-performing dentin adhesives.

Thermal cycling procedures for laboratory testing of dental restorations

OBJECTIVES

Exposure of restorations in extracted teeth to cyclic thermal fluctuations to simulate one of the many factors in the oral environment has been common in many tracer penetration, marginal gap and bond strength laboratory tests. Temperature changes used have rarely been substantiated with temperature measurements made in vivo and vary considerably between reports. Justification and standardization of regimen are required.

DATA, SOURCES AND STUDY SELECTION

An assessment of reports describing temperature changes of teeth in vivo is followed by an analysis of 130 studies of laboratory thermal cycling of teeth by 99 first authors selected from 25 journals. A clinically relevant thermal cycling regimen was derived from the in vivo information, and is suggested as a benchmark standard.

CONCLUSIONS

Variation of regimens used was large, making comparison of reports difficult. Reports of testing the effects of thermal cycling were often contradictory, but generally leakage increased with thermal stress, although it has never been demonstrated that cyclic testing is relevant to clinical failures. However, should this be done, the standard cyclic regimen defined is: 35 degrees C (28 s), 15 degrees C (2 s), 35 degrees C (28 s), 45 degrees C (2 s). No evidence of the number of cycles likely to be experienced in vivo was found and this requires investigation, but a provisional estimate of approximately 10,000 cycles per year is suggested. Thermal stressing of restoration interfaces is only of value when the initial bond is already known to be reliable. This is not the case for most current restorative materials.

Effect of intrinsic wetness and regional difference on dentin bond strength

OBJECTIVES

The aim of this investigation was to determine the influence of intrinsic wetness on regional bond strengths of adhesive resins to dentin.

METHODS

Human caries-free third molars were randomly divided into three groups for bonding: Group 1--no pulpal pressure; Group 2--pulpal pressure of 15 cm H2O; and Group 3--dentin dried overnight in a desiccator. Clearfil Liner Bond II (Kuraray) or One Step (Bisco) adhesive resins systems were applied to the flat dentin surfaces and the teeth were restored with APX resin composite (Kuraray). After 24 h in water at 37 degrees C, the specimens were sectioned into 0.7 mm thick slabs and divided into three regional subgroups according to the remaining dentin thickness and visual criteria: pulp horn, center, and periphery. The slabs were then trimmed for the micro-tensile bond test and subjected to a tensile force and crosshead of 1 mm/min. The data were analyzed with ANOVA and Fisher's PLSD test at a confidence level of 95%. The fracture modes were determined under a scanning electron microscope (JXA-840, JEOL, Japan).

RESULTS

No significant regional difference was observed for the Group 1 and 2 specimens restored with Clearfil Liner Bond II (p > 0.05). However, bond strengths significantly decreased at the pulp horn region of the Group 1 and 2 specimens restored with One Step (p > 0.01). All bond strengths of Group 3 decreased significantly and regional differences were not evident (p > 0.05).

SIGNIFICANCE

The dentin adhesive system should be chosen according to the substrate and region to be bonded, since bond strengths can vary according to the intrinsic wetness, region, and the adhesive system.

The influence of cross-sectional shape and surface area on the microtensile bond test

OBJECTIVES

The purpose of this study was to determine the effect of the cross-sectional area shape (cylindrical vs. rectangular) and the bonding surface area on the microtensile bond strengths and stress distribution of four dentin adhesive systems (Scotchbond MP Plus, OptiBond FL, OptiBond Solo, One-Step). In addition, finite element analysis (FEA) models were developed to investigate stress distributions.

METHODS

Extracted human molars were cut vertically and the occlusal enamel removed; one-half of the tooth was used for rectangular specimens, the other half for cylindrical specimens. The occlusal dentin was bonded according to the manufacturers' directions and covered with a block of resin composite. For the cylindrical specimens, the bonded dentin was shaped with a diamond bur on a lathe to produce specimens of area 1.1, 1.5 or 3.1 mm2 at the bonded interface. The rectangular specimens were sectioned to obtain bar-shaped specimens, which were shaped to produce hour-glass shaped specimens with the same area as the round specimens. Bonds were stressed in tension at a speed of 1 mm min-1. The mean bond strengths were compared using two-way ANOVA, one-way ANOVA, LSD and Student's t tests. The fractured surfaces were examined by scanning electron microscopy, and the frequencies of the fracture modes were compared using the Kruskal-Wallis and Mann-Whitney U tests. FEA models were created simulating the cross-sectional areas for bonding to determine the stress distribution.

RESULTS

The 3.1 mm2 bonding area groups showed significantly lower bond strengths than the 1.1 mm2 bonding area groups (p < 0.05), except for the rectangular specimens using Scotchbond MP Plus and One-Step. Most cylindrical specimens of bonding area 1.1 or 1.5 mm2 exhibited adhesive failure at the interface between the dentin and the adhesive resin. No differences were determined between cylindrical and rectangular specimens. The fracture mode matched the stress distribution patterns calculated from the FEA modeling.

SIGNIFICANCE

The results indicate that the test methods using small surface areas produce higher bond strengths than those using larger surface areas, and that cross-sectional shape has little effect. This is probably a result of fewer defects occurring in the small-area specimens.

Dentine permeability and dentine adhesion

OBJECTIVES

The objectives of this paper are to review the structure of dentine as it pertains to adhesive bonding and to describe the importance of resin permeation into dentinal tubules and into spaces created between collagen fibrils by acid-etching during resin bonding. The advantages and disadvantages of separate acid-etching, priming and adhesive applications are discussed.

DATA SOURCES

Although not an exhaustive review, the concepts included in the review were obtained from the dentine bonding literature.

STUDY SELECTION

Attempts were made to critically evaluate what is known about dentine permeability and adhesion and what remains to be discovered. Speculations were made on a number of controversial issues that are not yet resolved.

CONCLUSIONS

Acid-etching of dentine produces profound changes in the chemical composition and physical properties of the matrix which can influence the quality of resin-dentine bonds, their strength and perhaps their durability.

Mapping of tubule and intertubule surface areas available for bonding in Class V and Class II preparations

OBJECTIVES AND METHODS

The aim of this in vitro study was to evaluate the morphology of dentine in Class V and the Class II preparation walls in terms of tubule orientation, density and increase in surface area after conditioning. Six circular V-shaped preparations were cut at the cementum-enamel junction (CEJ) of anterior teeth and six Class II cavities with the cervical margin 1 mm below the CEJ were prepared in posterior teeth. The preparations were conditioned with 10% maleic acid. The samples were directly studied by SEM. The observations were organized according to location in the preparation, tubule density was counted and the increase in area available for bonding after acid etching was calculated.

RESULTS

Dentine morphology of Class V and Class II preparation walls was mostly regular according to predictable patterns. Between the tubules, along the walls of the cavity, the etched dentine surface exhibited a porous network of collagen fibers. More than 50% of Class V and Class II cavity surface presented oblique or parallel tubule orientation with respect to the cut surface. Because of the presence of a structureless cementum layer. the morphology of the cervical area turned out to be less predictable. The tubule density varied considerably in different regions of the preparations. The intertubular dentine surface area increased after conditioning in Class V preparations from 20.9% to 50.3% on the walls where tubules were cut parallel to their long axis, and from 5.8% to 47.8% where tubules were cut perpendicularly. These same values for Class II preparations ranged from 0.6% to 46.4% on the walls where tubules were cut parallel to their long axis, and 29.8% of the tubules were cut perpendicularly.

CONCLUSIONS

Based on this morphological investigation, the increase in intertubular dentine surface area might very well be responsible for the enhanced bond strength after acid etching of dentine, but not all areas exhibited equal responses to etching. In particular, the bonding substrate at the gingival margins may contribute little in terms of micromechanical retention.

Adaptation and radiographic evaluation of four adhesive systems

OBJECTIVES

The purpose of this study was to compare microleakage, gap formation, thickness of the adhesive layer and its radiographic appearance associated with four adhesive restorative procedures for class I cavities.

METHODS

Adhesive systems with easy handling characteristics were selected for the restoration of class I cavities in extracted third molars. Bitewing radiographs were taken of each tooth and four observers were asked to assess the presence of the adhesive layer. Microleakage, gap width and the thickness of the adhesive layer of each restoration were measured upon sectioning of the teeth.

RESULTS

Microleakage in the experimental restorations was minimal. The thickness of the adhesive layers and gap formation varied among different adhesive systems. The adhesive system with self-etching primer produced the highest percentage gap-free restorations. Thick adhesive layers could be detected on the radiograph. ROC analysis of the results validates the diagnosis from the radiograph.

CONCLUSIONS

The four restorative systems performed well in the prevention of microleakage. The use of a resin modified glass-ionomer cement base did not prevent gap formation compared with the all-etch bonding systems used in this study. The presence of an adhesive layer contributed to the prevention of gap formation, independently of the bonding system used. Thick adhesive layers could be detected on the radiograph.

Why do shear bond tests pull out dentin?

It is widely accepted that a dentin shear bond test which pulls out dentin must mean that the adhesive strength is superior to the cohesive strength of the dentin. Using numerical modeling techniques, Van Noort et al. (1988, 1989) and DeHoff et al. (1995) alerted the scientific community that there were massive stress concentrations in the familiar dentin bond test. It is not inconceivable that these localized high tensile stresses could initiate cracks which diverge monolithically into dentin, leaving the interface unchallenged. To test this hypothesis, we developed a failure accumulation simulation program which determined localized failure interactively "on the fly" with a finite element solver, and also included brittle behavior, adhesive and cohesive failure, stochastic response, and dynamic remeshing. All of the familiar dentin bond variables were included in the simulation. A parallel experimental dentin bond test validation was run, and the fractography was examined in the scanning electron microscope for mode of failure. The simulation confirmed the tensile monolithic fracture hypothesis. It is also confirmed that dentin pull-out was partly due to the biomechanics of the test and did not necessarily mean superior adhesive strength or even that the cohesive strength of the dentin was reduced. There is clear need for a new technology for the evaluation of biological interfaces, and the present work has shown the vital role of numerical modeling in the interpretation of such experimental procedures.

The use of organic compounds of phosphorus in clinical dentistry

Organic compounds of phosphorus have been developed for a range of applications in clinical dentistry. These include dentine bonding agents, restorative materials and therapeutic agents, such as active ingredients in anticaries mouthwashes. A characteristic feature of all of these applications is the good bonding of the phosphorus compound to the tooth. This review highlights the progress that has been made to date in preparing functional and durable organophosphorus bonding agents and cements, and includes coverage of recent synthetic work aimed at preparing improved organophosphorus molecules for this application. The review concludes that this remains a promising field of chemistry to explore in the search for improved, clinically useful dental materials.

Shear bond strength of four dentinal adhesives applied in vivo and in vitro

OBJECTIVES

The purpose of this study was to determine whether dentine bonding performed under clinical conditions is as reliable as laboratory bonding.

METHODS

Freshly cut dentine was used in vivo or in vitro as a substrate for the bonding of various adhesive systems. Bond strength was measured in shear loading.

RESULTS

Clearfil Liner Bond, Optibond and All Bond 2 showed better results when applied in vivo than in vitro. Scotchbond Multipurpose showed the opposite effect but the bond strength was, for both conditions, superior to the other three products. Only All Bond 2 presented statistically significant differences in bond strength between in vivo and in vitro applied bonding.

CONCLUSIONS

The results indicate that, with the new hydrophilic dentine bonding systems, in vitro application does not lead to substantially different results when compared with, in vivo application.

Influence of temperature and relative humidity on early bond strengths to dentine

The effect of temperature and relative humidity (RH) on the early tensile bond strengths to bovine dentine of two bonding systems (Liner Bond System, and Scotchbond Multi-purpose), and an experimental system (KB-110) were tested. Two environmental conditions, room temperature (23 degrees C/50% RH) and oral temperature (30 degrees C/80% RH), were used in a controlled temperature and humidity chamber. Bond strengths were recorded immediately after, 10 min and 24 h following light curing. The tensile bond strengths did not vary between the two test conditions, but the mode of fracture was observed to change. The 30 degrees C/80% RH condition exhibited a slightly greater degree of adhesive type failures compared with the 23 degrees C/50% RH group. This was particularly so for the experimental system, indicating that different bonding systems may be more or less sensitive to changes in RH and temperature. Failures occurred partially or totally within the resin composite at the early test times, and it was concluded that the bond strengths of the systems tested tended to exceed the early cohesive strengths of the resin composite.

New adhesives in Class V restorations under combined load and simulated dentinal fluid

OBJECTIVES

This study compared the efficacy of three dentinal adhesives using the "all etch" technique (All-Bond 2, Bisco; Scotchbond MP,3M Dental Products Co.; OptiBond, Kerr) with a dentinal adhesive which still uses phosphoric acid to condition enamel and a self-etching primer for dentin (A.R.T.-Bond, Coltene/Whaledent).

METHODS

Eight V-shaped mixed Class V restorations were placed per group in extracted human premolars. The restorations were subjected to 1,200,000 mechanical occlusal cycles (max. force 49 N; frequency 1.7 Hz) and 3,000 simultaneous thermal cycles (5-50-5 degrees C). Dentinal fluid was simulated using 1:3 diluted horse serum and fed into the pulp chamber both during restoration and loading. Percentages of "continuous margin" were assessed on SEM replicas of enamel and dentinal margins at 200x magnification immediately before and after stressing, respectively.

RESULTS

No significant differences were observed before stress between the materials either in enamel or in dentin. After stress, however, OptiBond and A.R.T.-Bond performed significantly better in dentin than the two other adhesives (Kruskal-Wallis, Mann-Whitney; p < 0.05). Although high initial values were observed, All-Bond 2 and Scotchbond MP were not stress-resistant under simulated physiological conditions.

SIGNIFICANCE

The predicted clinical potential of All-Bond 2 and Scotchbond MP is inferior to that of OptiBond and A.R.T.-Bond.

Bond strength and microleakage of current dentin adhesives

OBJECTIVES

The purpose of this in vitro study was to evaluate shear bond strengths and microleakage of seven current-generation dentin adhesive systems.

METHODS

Standard box-type Class V cavity preparations were made at the cemento-enamel junction on the buccal surfaces of eighty extracted human molars. These preparations were restored using a microfill composite following application of either All-Bond 2 (Bisco), Clearfil Liner Bond (Kuraray), Gluma 2000 (Miles), Imperva Bond (Shofu), OptiBond (Kerr), Prisma Universal Bond 3 (Caulk), Scotchbond Multi-Purpose (3M), or Scotchbond Dual-Cure (3M) (control). Lingual dentin of these same teeth was exposed and polished to 600-grit. Adhesives were applied and composite was bonded to the dentin using a gelatin capsule technique. Specimens were thermocycled 500 times. Shear bond strengths were determined using a universal testing machine, and microleakage was evaluated using a standard silver nitrate staining technique.

RESULTS

Clearfill Liner Bond and OptiBond, adhesive systems that include low-viscosity, low-modulus intermediate resins, had the highest shear bond strengths (13.3 +/- 2.3 MPa and 12.9 +/- 1.5 MPa, respectively). Along with Prisma Universal Bond 3, they also had the least microleakage at dentin margins of Class V restorations.

SIGNIFICANCE

No statistically significant correlation between shear bond strength and microleakage was observed in this study. Adhesive systems that include a low-viscosity intermediate resin produced the high bond strengths and low microleakage. Similarly, two materials with bond strengths in the intermediate range had significantly increased microleakage, and one material with a bond strength in the low end of the spectrum exhibited microleakage that was statistically greater. Thus, despite the lack of statistical correlation, there were observable trends.

Comparison of the marginal integrity of in vivo and in vitro Class II composite restorations

In the present study Class II resin composite restorations were placed under in vivo and in vitro conditions. For the in vivo part. Class II preparations were cut in teeth destined for extraction for orthodontic reasons. The preparations were completed with the gingival margin in enamel and restored using six different combinations restorative techniques and materials. The teeth were extracted after 4-6 weeks. In the in vitro part similar preparations were cut in extracted teeth and restored using the selected material-technique combinations. The in vitro specimens were thermocycled and mechanically loaded at 125 N for a total of 4000 cycles. All in vivo and in vitro samples were stored in a dye solution, sectioned and inspected for microleakage. Microleakage was observed in all the in vivo specimens with only 60% of the in vitro specimens demonstrating microleakage. These results indicate the limitation of laboratory investigations in predicting the microleakage performance of Class II composite resin restorations under clinical circumstances.