Dentin bonding: overview of the substrate with respect to adhesive material

Bonding performance and interfacial adaptation of modern bulk-fill restorative composites after aging in artificial saliva: an in vitro study

OBJECTIVES

This study aimed at comparing the microtensile bond strength (MTBS) and interfacial adaptation of a modern self-curing and a light-curing restorative bulk-fill composite to a conventional composite applied with the layering technique.

METHODS

Forty-eight occlusal cavities were divided in three main groups (16/group) based on tested materials: (i) STELA, bulk-fill self-curing restorative (STELA, SDI Ltd.); (ii) 3 M-BULK, bulk-fill composite (Filtek One Bulk-Fill, 3 M Oral Care); and (iii) 3 M-CTR, a conventional composite (Filtek Supreme XTE, 3 M Oral Care). These were used in combination with their adhesives in self-etch (SE) or etch-and-rinse (ER) mode. Specimens stored in artificial saliva (24 h or 12 months) were evaluated for MTBS and fractography. The interfacial analysis was performed through confocal microscopy. ANOVA and Fisher's LSD post hoc tests were performed with a level of significance of 5%.

RESULTS

All the tested materials applied in ER mode presented (24 h) greater bond strength than in SE mode. Although all materials showed a significant drop in the bond strength after prolonged storage, STELA showed the highest bonding performance and interfaces with few gaps. 3 M-BULK had the lowest bond strength and an interface with several voids and gaps.

CONCLUSIONS

All materials were affected by interface degradation and bonding reduction over prolonged aging. However, their use in combination with adhesives applied in ER mode may offer greater immediate bonding performance.

CLINICAL RELEVANCE

The use of restorative light-curing bulk-fill composites may generate gaps at the bonding interface and voids. STELA may represent a suitable alternative to avoid such issues.

Dental Fiber-Post Systems: An In-Depth Review of Their Evolution, Current Practice and Future Directions

The field of dental medicine is constantly evolving and advancing toward minimally invasive techniques. Several studies have demonstrated that bonding to the tooth structure, particularly enamel, yields the most predictable results. In some instances, however, significant tooth loss, pulpal necrosis, or irreversible pulpitis may limit the options available to the restorative dentist. In these cases, placement of a post and core followed by a crown is the preferred treatment option, provided all requirements are met. This literature review provides an overview of the historical development of dental FRC post systems as well as a comprehensive examination of the currently available posts and their bonding requirements. In addition, it offers valuable insights for dental professionals seeking to understand the current state of the field and the prospects of dental FRC post systems.

Present status and future directions: The restoration of root filled teeth

This narrative review will focus on a number of contemporary considerations relating to the restoration of root filled teeth and future directions for research. Clinicians are now more than ever, aware of the interdependence of the endodontic and restorative aspects of managing root filled teeth, and how these aspects of treatment are fundamental to obtaining the best long-term survival. To obtain the optimal outcomes for patients, clinicians carrying out endodontic treatment should have a vested interest in the restorative phase of the treatment process, as well as an appreciation for the structural and biomechanical effects of endodontic-restorative procedures on restoration and tooth longevity. Furthermore, the currently available research, largely lacks appreciation of occlusal factors in the longevity of root filled teeth, despite surrogate outcomes demonstrating the considerable influence this variable has. Controversies regarding the clinical relevance of minimally invasive endodontic and restorative concepts are largely unanswered with respect to clinical data, and it is therefore, all too easy to dismiss these ideas due to the lack of scientific evidence. However, conceptually, minimally invasive endodontic-restorative philosophies appear to be valid, and therefore, in the pursuit of improved clinical outcomes, it is important that the efficacies of these treatment protocols are determined. Alongside an increased awareness of the preservation of tooth structure, developments in adhesive bonding, ceramic materials and the inevitable integration of digital dentistry, there is also a need to evaluate the efficacy of new treatment philosophies and techniques with well-designed prospective clinical studies.

Effects of dentin surface preparations on bonding of self-etching adhesives under simulated pulpal pressure

Objectives

This study evaluated the effects of different smear layer preparations on the dentin permeability and microtensile bond strength (µTBS) of 2 self-etching adhesives (Clearfil SE Bond [CSE] and Clearfil Tri-S Bond Universal [CTS]) under dynamic pulpal pressure.

Materials and Methods

Human third molars were cut into crown segments. The dentin surfaces were prepared using 4 armamentaria: 600-grit SiC paper, coarse diamond burs, superfine diamond burs, and carbide burs. The pulp chamber of each crown segment was connected to a dynamic intra-pulpal pressure simulation apparatus, and the permeability test was done under a pressure of 15 cmH₂O. The relative permeability (%P) was evaluated on the smear layer-covered and bonded dentin surfaces. The teeth were bonded to either of the adhesives under pulpal pressure simulation, and cut into sticks after 24 hours water storage for the µTBS test. The resin-dentin interface and nanoleakage observations were performed using a scanning electron microscope. Statistical comparisons were done using analysis of variance and post hoc tests.

Results

Only the method of surface preparation had a significant effect on permeability (p < 0.05). The smear layers created by the carbide and superfine diamond burs yielded the lowest permeability. CSE demonstrated a higher µTBS, with these values in the superfine diamond and carbide bur groups being the highest. Microscopic evaluation of the resin-dentin interface revealed nanoleakage in the coarse diamond bur and SiC paper groups for both adhesives.

Conclusions

Superfine diamond and carbide burs can be recommended for dentin preparation with the use of 2-step CSE.

Universal dental adhesives: Current status, laboratory testing, and clinical performance

Increasing demand for simplified and user-friendly adhesive systems has led to the development of a new class of adhesives termed as Universal Adhesives (UAs). The term "Universal" reflects manufacturers' claims that these adhesives can be applied with any adhesion strategy and offer the versatility of use with a variety of direct and indirect restorative materials. The aim of this review was to synthesize the literature regarding the current status of UAs, their adhesion potential to various substrates and their performance in different restorative situations. In vitro studies, clinical trials and systematic reviews were identified utilizing controlled vocabulary and keyword searches in Medline and EMBASE databases. About 282 studies (272 in vitro studies; 11 clinical studies) were included. Available laboratory and clinical evidence does not support the claim that UAs can be used with any adhesive strategy. Although, they can chemically bond to various tooth and direct/indirect restorative substrates, the stability of this bond is material-dependent and subject to hydrolytic degradation. Hence, additional measures are still needed to ensure long-term durability. which undermines the versatility of UAs. The lack of long-term data regarding the clinical performance of UAs further complicates clinical decision-making. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2121-2131, 2019.

Clinical Evaluation of Fiber-Reinforced Composite Restorations in Posterior Teeth - Results of 2.5 Year Follow-up

Objectives:

The aim of this study was to evaluate the clinical performance of posterior composite restorations reinforced by bulk base of short-fiber composite (everX Posterior, GC Corporation).

Methods:

Thirty-six short fiber-reinforced composite restorations were placed in premolar and molar teeth of 33 patients. Eight of the teeth were vital and 28 were non-vital. Average follow up time of the restorations was 30.6 months (2.5 years), ranging from 16.2 to 51.3 months (1.3 - 4.3 years).

Results:

One restoration failed during the follow-up period due to secondary caries, at time point 39.5 months. Three fillings had minor fractures during the follow-up. The overall survival rate of the restorations was 97.2% and success rate (no maintenance needed) was 88.9%, respectively.

Conclusion:

Posterior composite restorations with a bulk base of short-fiber composite showed good clinical performance in the short term evaluation.

Effects of the Residues from the Endodontic Sealers on the Longevity of Esthetic Restorations

The substances used in the root canal treatment, especially sodium hypochlorite solution and oxidant agents, can negatively interfere on the bond strength of the adhesive systems to dentin and on the dental crowns fracture resistance.(1,2).

Effects of blood contamination on microtensile bond strength to dentin of three self-etch adhesives

This study evaluated the effects of blood contamination and decontamination methods during different steps of bonding procedures on the microtensile bond strength of two-step self-etch adhesives to dentin. Sixty extracted human molars were ground flat to expose occlusal dentin. The 60 molars were randomly assigned to three groups, each treated with a different two-step self-etch adhesive: Clearfil SE Bond, AdheSE and Tyrian SPE. In turn, these groups were subdivided into five subgroups (n = 20), each treated using different experimental conditions as follows: control group-no contamination; contamination group 1-CG1: primer application/ contamination/primer re-application; contamination group 2-CG2: primer application/contamination/wash/dry/primer re-application; contamination group 3-CG3: primer application/adhesive application/light curing/contamination/ adhesive re-application/light curing; contamina- tion group 4-CG4: primer application/adhesive application/light curing/contamination/wash/ dry/adhesive re-application/light curing. Composite buildup was performed using Z250. After 24 hours of storage in distilled water at 37 degrees C, the bonded specimens were trimmed to an hourglass shape and serially sectioned into slabs with 0.6 mm2 cross-sectional areas. Microtensile bond strengths (MTBS) were assessed for each specimen using a universal testing machine. The data were analyzed by two-way ANOVA followed by a post hoc LSD test. SEM evaluations of the fracture modes were also performed. The contaminated specimens showed lower bond strengths than specimens in the control group (p < 0.05), with the exception of CG1 in the Clearfil SE group and CG2 and CG3 in the Tyrian SPE group. Among the three self-etch adhesives, the Tyrian SPE group exhibited a significantly lower average MTBS compared to the Clearfil SE Bond and AdheSE (p < 0.05) groups. Based on the results of the current study, it was found that blood contamination reduced the MTBS of all three self-etch adhesives to dentin, and water-rinsing was unable to overcome the effects of blood contamination.

Effect of Different Bur Grinding on the Bond Strength of Self–etching Adhesives

In some self-etching systems, selecting the proper bur type for cutting dentin is important for improving bond strength.

Influence of Delayed Placement of Composites Over Cured Adhesives on Dentin Bond Strength of Single-application Self-etch Systems

The delay in placement of composite over single-application self-etching adhesive systems was a crucial factor influencing dentin bond strength compared to a composite placed immediately after the polymerization of adhesives.

Effect of bur type and conditioning on the surface and interface of dentine

The purpose of this in vitro study was to evaluate the surface and resin-dentine interface characteristics of permanent tooth dentine cut with diamond or carbide burs and treated with phosphoric acid (PA) or an acidic conditioner. Labial surfaces of permanent incisors were prepared into dentine with high-speed carbide or diamond burs and divided into two halves. Phosphoric acid 36% was applied on one half and non-rinse conditioner (NRC) was applied on the other half. Ten randomly selected scanning electron microscopy (SEM) fields from each specimen (n = 15) were evaluated. Occlusal surfaces of third molars were divided in two halves for evaluation of the resin-dentine interface. The halves were randomly assigned to one of each conditioner and restored with Prime & Bond NT/Spectrum. Ten specimens were analysed by SEM to evaluate hybrid layer formation and interfacial seal. We observed that surfaces prepared with carbide bur presented less residual smear plugs (P < 0.05) than surfaces prepared with diamond burs. Surfaces conditioned with NRC, which is a smear layer modifier, presented more residual smear plugs than surfaces conditioned with PA (P < 0.05). Treatment with PA resulted in more sealed interfaces than specimens treated with NRC. Within the limitations of this study the results showed that carbide burs leave a surface that is more conducive to bonding than diamond burs.

Comparison of depth of dentin etching and resin infiltration with single-step adhesive systems

OBJECTIVES

Adhesion of resin composites to dentin is currently believed to result from impregnation of adhesive resin into superficially demineralized dentin. The purpose of this study was to use micro-Raman spectroscopy and scanning electron microscopy (SEM) to investigate the extent of resin penetration into etched dentin with single-step adhesive systems.

METHODS

Adhesive systems used were One-Up Bond F (Tokuyama Dental) and Reactmer Bond (Shofu, Inc.). A self-etching primer system Mac Bond II (Tokuyama Dental) was employed as a control. Resin composites were bonded to bovine dentin with the adhesive systems, and specimens were sectioned parallel to dentinal tubules. Raman spectra were successively recorded along a line perpendicular to the dentin-adhesive interface in steps of 0.2 microm and the spectra were obtained. SEM observations of the resin-dentin interface were also conducted.

RESULTS

The dentin-resin interface of single-step adhesive systems showed a gradual transition in the relative amount of adhesive from the resin side to dentin side. The widths of resin penetration into demineralized dentin detected by Raman microscopy were greater than those obtained by the morphological analysis using SEM.

CONCLUSIONS

From the results of this study, a gradual variation in the composition of the dentin-resin interface was detected, and the degree of resin impregnation observed with SEM observation was less than that detected with the Raman microscopy.

Effect of dentin conditioners on the microtensile bond strength of a conventional and a self-etching primer adhesive system

OBJECTIVE

To investigate the effect of different dentin treatments on the microtensile bond strength of a self-etching primer and a simplified, total-etch adhesive system.

METHODS

Flat dentin surfaces were created on extracted human third molars. The surfaces were treated with one of the following conditioners: self-etching primer for 20 s (Clearfil SE Primer), 37% phosphoric acid for 15 s or 0.5 M EDTA for 30 s. Conditioned surfaces were then bonded with either Clearfil SE Bond or Single Bond followed by resin composite (Z250) build-ups constructed incrementally. Application of SE Primer was included when Clearfil SE Bond was used, after phosphoric acid and EDTA conditioning. After 24 h storage in water at 37 degrees C, the teeth were longitudinally sectioned across the bonded interface to produce beams with 1.0 mm2 of adhesive area, tested with the microtensile method at a rate of 0.5 mm/min. Data were analyzed using two-way ANOVA and Tukey's test.

RESULTS

The highest bond strength mean was found for the combination SE Primer/Single Bond (58.5+/-20.8 MPa), followed by the EDTA/Clearfil SE Bond (47.8+/-15.1 MPa) and phosphoric acid/Single Bond (40.9+/-14.3 MPa). The remaining combinations showed statistically similar (p>0.05) tensile bond strength.

SIGNIFICANCE

The bond performance of the adhesives tested was dependent on the dentin conditioner. Pre-treatment with a mild etchant such as 0.5 M EDTA improved the bond strength of Clearfil SE Bond. Single Bond performed better when a self-etching primer was used as the dentin conditioner, probably by preventing the formation of a defective zone at the base of the hybrid layer. Overall results indicate that higher bond strengths can be achieved by conditioning dentin with milder etchants, suggesting that deeper demineralization may prevent proper resin infiltration, hence compromising the bond.

In vitro study of endodontic post cementation protocols that use resin cements

STATEMENT OF PROBLEM

Sodium hypochlorite (NaOCl) may alter resin bond strength by deproteination of demineralized dentin collagen.

PURPOSE

To analyze the effect of NaOCl treatment on bond adhesion and tensile strength of different post cementation protocols in vitro.

MATERIAL AND METHODS

The periconductual dentin of 120 single-rooted, caries-free, unrestored human teeth was etched with 37% orthophosphoric acid. The teeth in Group I (60) were left untreated, and the teeth in Group II (60) were treated with 10% NaOCl. Four post-cementation protocols were examined (15 teeth in each) for Groups I and II: ED Primer dentin adhesive + Panavia 21 Ex; ED Primer dentin adhesive + Dual Cement; Panavia 21 Ex; and Dual Cement. For each condition, resin tags, hybrid layers over the periconductual dentin and post surface, were analyzed by scanning electron microscopy (SEM). Specimens were loaded with a uniaxial tensile force using an electromechanical testing machine until cement failure. Bond adhesion and tensile strength with different protocols were examined statistically using multiple analysis of variance at a significance level of alpha<.05.

RESULTS

SEM revealed morphologic differences; Group II exhibited cylindrical, solid tags and Group I, tapered, hollow tags. Uniaxial tensile strength tests showed that in Group I, Panavia 21 Ex cement was strongest, whereas in Group II, this protocol was the weakest and Dual Cement with adhesive was the strongest. In Group II, Panavia 21 Ex diminished the tensile bond strength; however, combination with dentin adhesive increased it.

CONCLUSION

Within the limitations of this study, NaOCl treatment did not significantly alter tensile bond strength, but when combined with the dentin adhesive ED Primer, a significant rise in strength resulted. A positive relationship existed between increased tag numbers and higher tensile bond strength.

Characterization of sound human dentin particles of sub-millimeter size

OBJECTIVES

To obtain small dentin particles to provide material for the characterization of dentin. To study the interaction of etchants with dentin not covered by a smear layer and bonding agents.

METHODS

Sound human dentin particles of sub-millimeter sizes were obtained by room temperature high-pressure fragmentation. Smear-layer free particles of three different average sizes were obtained by sieving. Surface areas were measured by the BET method. Simultaneous thermogravimetric and differential thermal analysis was carried out on all specimens and etched samples. Densities were measured by helium pycnometry.

RESULTS

On average, the water, organic and mineral contents show the expected proportions. The more dense particles tend to be in the smaller sized fractions. Thus dentin particles of average size 100 microm have a density of 2.482(0.002) g/ml which is statistically different from the 300 microm average sized particles with 2.306(0.002) g/ml. However, the respective measured specific surface areas of 2.54(0.01) and 2.50(0.02) m(2)/g are not found to be statistically different. The specific surface areas of dentin particles increase upon etching, the increase being related to acid strength. Thermal analysis of acid-etched 200 microm diameter particles shows up to 75% loss of carbonate and only 30% loss of phosphate.

SIGNIFICANCE

Smear-layer free dentin particles which have not been exposed to heat by grinding can be obtained by room temperature high-pressure fragmentation. Such sub-millimeter sized dentin particles can be acid-etched to significantly increase their specific surface area. Thermogravimetry used to analyze carbonate and phosphate contents gives new insight to the buffering action of human dentin.

An alternative method to reduce polymerization shrinkage in direct posterior composite restorations

BACKGROUND

Polymerization shrinkage is one of dental clinicians' main concerns when placing direct, posterior, resin-based composite restorations. Evolving improvements associated with resin-based composite materials, dental adhesives, filling techniques and light curing have improved their predictability, but shrinkage problems remain.

METHODS

The authors propose restoring enamel and dentin as two different substrates and describe new techniques for placing direct, posterior, resin-based composite restorations. These techniques use flowable and microhybrid resin-based composites that are polymerized with a progressive curing technique to restore dentin, as well as a microhybrid composite polymerized with a pulse-curing technique to restore enamel. Combined with an oblique, successive cusp buildup method, these techniques can minimize polymerization shrinkage greatly.

CONCLUSIONS

Selection and appropriate use of materials, better placement techniques and control polymerization shrinkage may result in more predictable and esthetic Class II resin-based composite restorations.

CLINICAL IMPLICATIONS

By using the techniques discussed by the authors, clinicians can reduce enamel microcracks and substantially improve the adaptation of resin-based composite to deep dentin. As a consequence, marginal discoloration, recurrent caries and postoperative sensitivity can be reduced, and longevity of these restorations potentially can be improved.

Vascular response of current and potential dental etchants

This study investigated the hemostatic properties of current and potential dentin conditioners by observing the contraction of blood vessels using the rat carotid artery model. Four different agents (3M Scotchbond etchant, NRC, RC-Prep, File-Eze) were used. Dose-dependent contractions/relaxations of the test materials were first compared with epinephrine, followed by administration of papaverine, which was used to reverse epinephrine-induced contractions. In all sequences, the contraction or relaxation forces produced by the test and control materials were recorded using a force displacement transducer. RC-Prep was the only agent to produce epinephrine-like contractions (vasoconstriction) in the rat carotid artery. No contraction could be achieved with 3M etchant. Dose-dependent relaxations were observed with 3M etchant, which eventually led to collapse of the vessel wall; afterward, no response could be achieved with administration of adrenalin. File-Eze and NRC also did not cause vasoconstriction. Both materials caused dose-dependent relaxations in the smooth muscle. However, subsequent administration of adrenalin and papaverine caused dose-dependent contractions and relaxations, respectively, showing that these etchant effects did not lead to collapse of the vessel wall, as did 3M etchant.

Effects of different re-wetting techniques on dentin shear bond strengths

PURPOSE

For contemporary hydrophilic resin adhesive systems, bonding to dentin is improved if the substrate is maintained in a hydrated state following acid-etching. The purpose of this study was to compare the dentin shear bond strengths of two single-bottle adhesives (one acetone-based and one ethanol-based) applied under different etched-dentin conditions: dry, wet, or dry and re-wetted with different solutions.

MATERIALS AND METHODS

Bovine incisors (N = 120) were mounted in acrylic, polished to 600-grit, and randomly assigned to 12 groups (n = 10). Dentin was etched for 15 seconds using 35% phosphoric acid, rinsed, and either blot-dried, air-dried, or air-dried and re-wetted with different solutions (distilled water, Gluma Desensitizer, Aqua-Prep, and 5% glutaraldehyde in water). Two adhesives (Single Bond and Prime & Bond NT) were applied to each of the surface conditions following manufacturers' instructions. After adhesive application and curing, composite was applied in a No. 5 gelatin capsule and light-cured. Specimens were loaded in shear, using an Instron at 5 mm per minute. Shear bond strengths were calculated by dividing the failure load by the bonded surface area. Data were subjected to analysis of variance (ANOVA) and a post hoc Tukey test.

RESULTS

Mean shear bond strengths ranged from 12.5 to 26.6 MPa for Single Bond and from 5.6 to 14.7 MPa for Prime & Bond NT. Significant differences were found in both groups of materials (p < .001). The three highest mean bond strengths were obtained (in order) on dentin that was re-wetted with Gluma Desensitizer, re-wetted with Aqua-Prep, or never dried. Differences between these surface conditions were not statistically significant for either material.

Bonding to dentin with a self-etching primer: the effect of smear layers

OBJECTIVE

The purpose of this study was to investigate the effect of smear layers on the tensile bond strength to human dentin. Bond strength was determined on dumbbell-shaped specimens to determine the feasibility for clinical use of a self-etching primer.

METHODS

The dentin of extracted human teeth was exposed by grinding with either #180 or #600 abrasive paper. A self-etching primer was then applied to the prepared dentinal surfaces and left undisturbed for 30s. It was then air-dried and a photocured bonding agent applied and irradiated for 20s. A composite resin was then added to the primed dentin and light-cured for 60s to complete the bonded assemblies. Mini-dumbbell specimens (3.0 x 2.0 mm2) were prepared from the bonded samples. These specimens were stored in 37 degrees C water for 24h before tensile loading to failure at a crosshead speed of 1.0 mm/min. Surfaces of fractured specimens, both resin and dentin, were examined under a scanning electron microscope (SEM).

RESULTS

Significantly different tensile bond strengths (TBS) of 10.0+/-7.2 and 28.5+/-5.2MPa were found for #180- and #600-prepared dentin, respectively (p<0.01). The former specimens fractured within the hybridized, relatively coarse smear layer, while the latter demonstrated adhesive failure between the composite resin and an attached PMMA rod, not between the dentin and applied adhesive agent.

SIGNIFICANCE

The presence and quality of a smear layer yields significantly different bond strengths to prepared human dentin, in vitro. However, a TBS of 10+/-7MPa is evidently adequate, since self-etching primers have been well accepted in dental clinics.

Interaction patterns between dentin and adhesive on prepared class V cavities in vitro and in vivo

The interface between dentin and an acetone-based single-component adhesive system (Prime&Bond 2.1, DeTrey Dentsply, Germany) was morphologically investigated by scanning electron microscopy (SEM). Interaction patterns of human teeth were correlated in vivo and in vitro. The SEM examination proved that the formation of a hybrid and an adhesive layer, the peri- and intratubular adhesive penetration, as well as hiatus and nanoleakage formation were no different on vital and nonvital dentin within the limitation of the experimental arrangement of this study.

Resin diffusion through demineralized dentin matrix

This paper has focused on the factors that may affect the permeability of adhesive resins into the demineralized dentin matrix during the development of the bonding process. The effects of surface moisture are discussed respectively to the adhesive systems, and the problems related to incomplete hybrid layer formation presented.

A tensile test to facilitate identification of defects in dentine bonded specimens

OBJECTIVES

To determine the efficacy of a miniaturized dumbbell test procedure designed to more easily identify defect(s) in bonded dentine test specimens.

METHODS

Extracted human dentine substrates were pre-conditioned with 10-3 solution for 10, 30 or 60 s prior to dentine bonding with 4-META/MMA-TBB resin. Miniaturized dumbbell-shaped test specimens were prepared from the resin bonded samples. After 24 h storage in 37 degrees C water, the specimens were tensile-loaded to failure. Fractured surfaces and cross-sections were examined and compared under scanning electron microscopy (SEM) and transmission electron microscopy (TEM).

RESULTS

Cohesive failure within the bonding resin was observed in specimens pre-conditioned for 10 s. The tensile bond strength of these was excellent. Bond strengths of specimens that were pre-conditioned for 30 and 60 s were significantly lower, and defects in these specimens, formerly difficult or impossible to identify, were readily identified under SEM and TEM microscopy.

CONCLUSION

The proposed method of tensile stressing to failure and microscopically examining fractured miniaturized dumbbell-shaped test specimens is a simple and reproducible test procedure. The protocol is capable of clearly elucidating defective resin infiltration of demineralized dentine in bonded interfaces. These defects are difficult to visualize by conventional and/or ISO recommended methods.

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.

A short- and long-term shear bond strength study using acids of varying dilutions on bovine dentine

OBJECTIVES

The purpose of this study was to evaluate the short-(24 h) and long-(180 day) term shear bond strengths of resin to bovine dentine etched with varying dilutions of aqueous solutions of phosphoric and maleic acids.

METHODS

Bovine dentine surfaces were prepared using water irrigated #600 grit SiC paper. The dentine surfaces were etched in groups of 10 teeth using various dilutions of phosphoric or maleic acid. Using the Scotchbond Multipurpose System (SBMP; 3M Co., MN, USA) and a wet technique the etched surfaces were primed and unfilled bonding resin (UBR) was applied to the dentine surface within the confines of a gelatin cylinder. A cylinder of filled resin (Z 100; 3M Co., MN, USA) was then photocured and the specimens were then stored in water for 24 h or 180 days prior to shear bond testing to failure.

RESULTS

The results showed that high bond strengths were recorded using acids which were more dilute than those commercially available. There were also indications that phosphoric acid is not the etching acid of choice for the SBMP system.

CONCLUSIONS

The results of this study showed that high bond strengths can be achieved in dentine using etching acids which are more dilute than those commercially available. Maleic acid appears to be the etchant of choice for the SBMP system.

Regional bond strengths of resins to human root dentine

OBJECTIVES

The demand for restoration of root dentine defects such as cervical erosion and root caries has significantly increased recently, but there is limited information on the performance of the adhesive resins to radicular dentine. The purpose of this study was to measure the regional tensile bond strength (TBS) of composite bonded to human root and coronal dentine, and to observe the interface between resin and root dentine by SEM.

METHODS

Human extracted cuspid teeth were used to measure TBS with a new microtensile bond test. Enamel and cementum were removed from the labial tooth surfaces to form a long cavity preparation into dentine from the mid-crown to the apex of the root within the same tooth. All Bond 2 (all etch technique) or Imperva Bond (no etch) was bonded to dentine surfaces and covered with Protect Liner resin composite. The resin-bonded teeth were serially sliced into 16 sections at right angles to the long axis of the tooth, and the bonded surfaces were trimmed to give a bonded surface area of 1 mm2 for TBS testing.

RESULTS

All Bond 2 bond strengths to coronal and apical dentine showed high values (23.5 MPa) but the bond strength was significantly lower on cervical root dentine. Imperva Bond produced a relatively high tensile bond strength to all regional areas. SEM showed that the thickness of the resin-infiltrated layer formed by All Bond 2 in root dentine was less than coronal areas. Resin infiltration with Imperva Bond was always less than 0.5 micron. The results suggest that high TBS values can be obtained with minimal resin infiltration in root dentine.

The influence of absolute humidity on shear bond adhesion

OBJECTIVES

The purpose of this study was to investigate the relationship between dentine shear bond strength, using data from experiments performed according to a standard protocol, and the absolute humidity for a new, fourth generation dentine adhesive system.

METHODS

Results of seven recently performed adhesion experiments using the same protocol and product were analysed. Groups of 10 human molars were each bonded in a humidity chamber. The temperature and relative humidity conditions varied from 23 to 37 degrees C and 30 to 95%. After bonding of the composite resin a shear bond test at a crosshead speed of 2.0 mm/min was performed.

RESULTS

The bond strength levels of the dentine adhesive system were influenced significantly by extreme temperature and humidity differences. Adhesion levels varied from 27.8 (SD 8.5) MPA to 12.8 (SD 1.4) MPA. Isobond strength curves are a good method to gain insight into the humidity sensitivity of adhesive systems.

CONCLUSIONS

Results of in vitro adhesive bonding procedures for a dentine adhesive can be significantly influenced by the absolute humidity levels at which the procedures are performed. Consequently "Materials and Methods" sections of publications should refer to absolute humidity or temperature and relative humidity levels as a relevant parameter.

Bonding to intact dentin

It has been reported that the presence of a smear layer on dentinal substrates can compromise bonding. Typically, smear layers are removed by acidic agents that selectively extract calcium salts from dentin surfaces to leave a collagen-rich substrate. Acid-conditioned dentin (i.e., demineralized) is then primed and an adhesive agent applied. In the present study, we removed smear layers by "polishing" dentin specimens with a hydroxyapatite paste and ultrasonication. Bonding procedures were carried out by means of an aqueous solution of 20% 2-methacryloyloxyethyl phenyl phosphoric acid (phenyl-P) and 30% 2-hydroxyethyl methacrylate, referred to as 2OP-30H, a "self-etching primer". The 20P-30H solution was applied to "intact" dentin (i.e., non-demineralized) for either 30 or 60 s. Control samples received no application (O s) of the self-etching primer. Mean tensile bond strengths (10 MPa) were similar in both the 30-second- and 60-second-primed groups. The widths of formed hybrid layers varied from 0.3 +/- 0.2 micron at O s application (control) to 2.1 +/- 0.3 micron for the 30-second group and 4.1 +/- 0.2 micron for the 60-second group. SEM and TEM observations revealed that the 20P-30H self-etching primer created diffusion channels into "intact" calcium-rich dentin which permitted monomer to infiltrate dentin substrates. Hybrid layers identified under microscopic examination demonstrated resistance to both HCI and NaOCI treatments, suggesting that the hybrid layer was not defective, and that bonding was stable.

Dentin bonding: SEM comparison of the resin-dentin interface in primary and permanent teeth

Previous studies have suggested minor differences between primary and permanent teeth in terms of dentin composition and morphology. Other reports indicated lower bond strengths of resin composites to dentin of primary teeth compared with dentin of permanent teeth; however, no information is available regarding differences in the micromorphology of the resin-dentin interface that may explain these lower bond strengths. Therefore, the purpose of the present study was to compare primary and permanent teeth in terms of the thickness of the hybrid layer developed with two bonding systems. Our hypothesis was that bonding differences previously reported between primary and permanent dentin would be reflected in hybrid layer differences observable in SEM analyses. Twenty human extracted and non-carious teeth were divided into 4 groups: 5 primary and 5 permanent teeth restored with All-Bond 2/Bisfil P system; and 5 primary and 5 permanent teeth restored with Scotchbond Multi-Purpose/Z100. The sample area available on each tooth was divided for the two dentin conditioning times (7 and 15 sec). Measurements of hybrid layer thickness were performed by means of SEM at x13,000. The results of this study indicated that the hybrid layer produced is significantly thicker in primary than in permanent teeth (p = 0.0001), suggesting that primary tooth dentin is more reactive to acid conditioning. No difference was observed in the hybrid layers produced by the two adhesive systems (p = 0.7920). The increased thickness of the hybrid layer in primary teeth (25 to 30%) and the subsequent lack of complete penetration of adhesive resin into previously demineralized dentin may contribute to the lower bond strengths to primary dentin reported in the literature. If a narrower hybrid layer more uniformly infused with resin is the goal of dentin bonding, it is concluded that a differentiated protocol for bonding to primary dentin (with shorter time for dentin conditioning) can be used as a means to reproduce the hybrid layer thickness seen in permanent teeth.

Field emission SEM comparison of four postfixation drying techniques for human dentin

Critical-point drying (CPD) is generally considered essential for the preparation of biologic specimens for electron microscopy. Several attempts have been made to introduce alternative techniques. More recently, this problem has arisen in dentistry, because of the new developments in dentin bonding. The present study focuses on three alternative techniques to CPD: hexamethyldisilazane (HMDS) drying, Peldri II drying, and air drying. Twenty-four dentin disks were obtained from noncarious extracted human molars by microtome sectioning parallel to the occlusal surface. The dentin surfaces were etched with polymer-thickened, silica-free, 10% phosphoric acid semigel, fixed, dehydrated, and dried with one of the four techniques. The specimens were observed in two perpendicular planes, showing dentinal tubules in longitudinal view and cross-section, using a field emission scanning electron microscope. The intertubular demineralized dentin zone was composed of three different successive layers, which did not substantially differ between CPD and Peldri II drying, but were more evident in HMDS-dried specimens: first, an upper layer of denatured collagen and residual smear layer particles, with sectioned collagen fibrils and few open intertubular pores; second, an intermediate layer of closely packed cross-sectioned collagen fibers; and third, a deeper layer with unfilled spaces, scattered hydroxyapatite crystals, and few collagen fibers. HMDS drying seemed to preserve better the collagen network and the microporosity of the demineralized dentin surface. Moreover, HMDS drying is easy to perform. The air-drying method caused some artefacts, such as surface collapsing and thickening of the denatured collagen layer.

Evaluation of the bond strength of dentin bonding agents used to seal resected root apices

A number of improved dentin bonding agents have recently become available, but have not been evaluated on apical radicular dentin. The purpose of this study was to compare the tensile bond strengths of four adhesive resins on resected root ends before and after blood contamination. Forty single-rooted human incisors were cleaned and shaped and obturated. The apical 3 mm was then resected at a 45-degree angle, bonded, and tested for tensile bond strengths using an Instron machine. The bonding systems evaluated included Prisma Universal Bond 3, Scotchbond MultiPurpose Dental Adhesive, Amalgambond, and All Bond 2. All bonding systems were then covered with Prisma APH light-cure composite resin. Results indicated that the bond strengths of the blood contaminated groups were significantly less than those of the control groups, except in the case of Amalgambond where no significant difference was noted. When the surface was contaminated with blood, Prisma Universal Bond 3 had significantly lower bond strengths, whereas Amalgambond had significantly higher bond strengths than the other subgroups.

Clinical status of ten dentin adhesive systems

Laboratory testing of dentin adhesive systems still requires corroboration by long-term clinical trials for their ultimate clinical effectiveness to be validated. The objective of this clinical investigation was to evaluate, retrospectively, the clinical effectiveness of earlier-investigated dentin adhesive systems (Scotchbond, Gluma, Clearfil New Bond, Scotchbond 2, Tenure, and Tripton), and to compare their clinical results with those obtained with four modern total-etch adhesive systems (Bayer exp. 1 and 2, Clearfil Liner Bond System, and Scotchbond Multi-Purpose). In total, 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity designs: In Group A, enamel was neither beveled nor intentionally etched, as per ADA guidelines; in Group B, adjacent enamel was beveled and conditioned. Clinical retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems. With regard to adhesion strategy, adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinically better than systems that modified the disorderly layer of smear debris without complete removal. Hybridization by resin interdiffusion into the exposed dentinal collagen layer, combined with attachment of resin tags into the opened dentin tubules, appeared to be essential for reliable dentin bonding but might be insufficient by itself. The additional formation of an elastic bonding area as a polymerization shrinkage absorber and the use of a microfine restorative composite apparently guaranteed an efficient clinical result. The perfect one-year retention recorded for Clearfil Liner Bond System and Scotchbond Multi-Purpose must be confirmed at later recalls.

Correlation of bond strength with surface roughness using a new roughness measurement technique

OBJECTIVES

The correlation between shear bond strength and surface roughness was investigated using new surface measurement methods.

METHODS

Bonding agents and associated resin composites were applied to set amalgam after mechanically roughening its surface. Surface treatments were noe (as set against glass), 80 grit, and 600 grit abrasive paper. Surface roughness (R(a) as measured parallel and perpendicular (+) to the direction of the polishing scratches and true profile length were measured. A knife-edge was applied (rate = 2.54 mm/min) at the bonding agent/amalgam interface of each sample until failure.

RESULTS

Coefficients of determination for mean bond strength vs either roughness (R(a), of profile length were significantly higher for measurements in parallel directions than for those measurements in (+) directions. The shear bond strength to set amalgam for a PENTA-containing adhesives system (L.D. Caulk Division) was not significantly different from that of a PENTA-free adhesive (3M Dental Products Division), even though PENTA has been reported to increase bond strength to nonprecious metals.

SIGNIFICANCE

The shear bond strength of resin composite to amalgam is correlated to surface roughness when it is measured parallel to the polishing scratches. This correlation is significantly lower when surface roughness is measured in the typical manner, perpendicular to the polishing scratches.

The effect of smear layer removal on marginal contraction gaps

The presence of the smear layer prevents direct contact between dentine and a dentine adhesive. The use of agents to remove the smear layer theoretically should improve the bonding of composite resins to dentine. This study examined the effect of smear layer removal on the effectiveness of a dentine bonding agent in reducing marginal contraction gaps. The agent used for smear layer removal in this study was ethylenediamine tetra-acetic acid (EDTA). Eighty cavities measuring 2 mm in diameter and 1.5 mm in depth were prepared in dentine and randomly assigned to two equal groups. The control group was restored with Prisma Universal Bond 2 Adhesive and Prisma Fil Resin. The experimental group was similarly restored after pretreatment of dentine with 0.5% EDTA for 60 s. All specimens were thermocycled and the marginal contraction gaps were assessed using a Nikon Measurescope. The mean contraction gap was expressed as a percentage of the cavity diameter. Results showed that the experimental group registered smaller contraction gaps (mean: 0.021%) than the control group (mean: 0.027%). No penetration of material into dentine was observed. Pretreatment with EDTA did not significantly improve the effectiveness of the dentine bonding agent used in terms of reduction of marginal contraction gaps.

Bonding to ground dentin by a phenyl-P self-etching primer

Increasingly higher concentrations of Phenyl-P in 30% HEMA were used as dentin conditioners to improve the bonding of adhesive resins to smear layers. The maximum bond strength (10.4 MPa) was obtained at a concentration of 20% Phenyl-P. Transmission electron microscopy of fractured, lightly smeared, and compactly smeared dentin demonstrated that 20% Phenyl-P in 30% HEMA demineralized the dentin surface by partially dissolving mineral crystals from around collagen. When applied to smear layers, this resin system demineralized the smear layer and incorporated it into the applied resin which penetrated a short distance into the underlying dentin, thereby creating a hybrid layer that contained the original smear layer. This single-step conditioner/primer offers several advantages over previous bonding systems by permitting a single solution to serve as both a conditioner and a primer.

In vitro bond strengths and SEM evaluation of dentin bonding systems to different dentin substrates

In comparison to enamel, bonding to normal dentin is a greater challenge because of its organic constituents, fluid-filed tubules, and variations in intrinsic composition. Bonding to sclerotic dentin is even more difficult. To evaluate the shear bond strengths of four adhesive systems to dentin substrates with different levels of mineralization, 120 extracted human teeth were randomly assigned to three groups (n = 40). After mid-coronal dentin was exposed, groups of specimens were artificially hypermineralized by immersion in a remineralizing solution, demineralized by means of an acetic acid demineralizing solution, or stored in distilled water to model sclerotic, carious, and normal dentin, respectively. Resin composite was bonded to dentin by use of commercial adhesive systems. After the specimens were thermocycled, shear bond strengths were determined in an Instron universal testing machine. Dentin substrates and resin/dentin interfaces were examined by SEM. For each adhesive system, the mean shear bond strength to normal dentin was significantly higher than that to either of the other substrates. Shear bond strengths to hypermineralized dentin were significantly higher than those to demineralized dentin with all adhesives except Prisma Universal Bond 3.

Air humidity: a detrimental factor in dentine adhesion

Successful dentine adhesion may be negatively influenced by intrinsic and extrinsic dentine wetness. Testing the influence of high humidity levels during the application of bonding systems is therefore relevant. It was the aim of this study to investigate in vitro the sensitivity to air humidity of the dentine bond strength for some commercially available bonding systems. Four bonding systems were tested in vitro on human molars at temperature/humidity levels of 25 degrees C and 40% relative humidity (RH) as well as 35 degrees C and 95% RH. Four operators each made two samples of the respective treatment combinations. After shear bond testing a three-way ANOVA was carried out. Only the factors 'material', 'humidity' as well as their interaction were statistically significant. The factor 'operator' did not exert a significant influence on the shear bond strength. For the 'clinically dry' group statistically significant differences were found between all materials (P < 0.001). In the 'high humidity' setting too, significant differences were found between materials (P < 0.001). The shear bond strength values ('high humidity') were very low (< 3 MPa) for Gluma 2000, Denthesive and Syntac, while the mean values for Scotchbond Multi-Purpose were significantly higher (12 MPa; P < 0.001). It was concluded that in general bonding systems are highly sensitive to extrinsic dentine wetness, resulting in very low adhesion values at high humidity.

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.

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

For a wide variety of dentine bonding systems the bond strength before and after thermocycling was determined on dentine with and without hydraulic tubular pressure. The importance of the hydrophilic nature of several bonding systems could be demonstrated. The dentine smear layer could not prevent a negative effect of water in the tubulus on hydrophobic systems. Removal of the smear layer had a positive effect on the durability of the bond. When loaded until fracture, some bonding systems resisted adhesive failure.

Current concepts in dentin bonding: focusing on dentinal adhesion factors

With greater need for treating root surface lesions, dentinal adhesives are more in demand. For successful treatment, all factors--dentin, tooth, patient and materials--must be considered.

Noncarious cervical lesions: the decision to ignore or restore

A variety of unusual noncarious cervical lesions (NCL) are depicted that appear to negate W.D. Miller's toothbrush/dentifrice abrasion theory and demonstrate that other factors may be involved in their etiology. Confusion exists in the designation of NCL ever since G.V. Black stated in 1908 that toothbrush/dentifrice abrasion is an erosive effect. Since abrasion and erosion are two distinct activities, it is suggested that dentistry adopt the same terminology as chemical engineering in order to foster improved communication between the sciences. The term "abfraction" has been used to supplant erosion because it seems more appropriate when describing the loss of tooth substance attributable to effects of occlusal loading forces as well as the physiochemical breaking that occurs during stress corrosion. Numerous reasons, based on accepted engineering principles, indicate that NCL should be restored. It is incumbent on dentists to become cognizant of these reasons, since this would help them inform patients of the benefits to be gained by restoring such deficient areas.

Shear bond strengths of ten dentin adhesive systems

This in vitro study tested the shear bond strengths of nine third-generation dentin bonding systems. All of these systems had higher bond strengths than the control, a second-generation agent. Amalgambond and All-Bond had the strongest bonds to dentin, 23.3 +/- 5.7 and 19.3 +/- 5.6 MPa, respectively. Clearfil Photo Bond and Prisma Universal Bond 3 had intermediate bond strengths (approximately 13 MPa). Gluma, PowerBond, Scotchbond 2, Tenure, and XR-Bond all had mean shear bond strengths of less than 8 MPa.

Morphological aspects of the resin-dentin interdiffusion zone with different dentin adhesive systems

Cross-sections of resin-dentin interfaces were etched with an argon-ion beam to make their substructure detectable by scanning electron microscopy. The dentin adhesive systems were categorized morphologically into three groups, and an attempt was made to clarify their adhesive mechanism. The first group of products removed the smear layer. The argon-ion bombardment clearly disclosed a hybrid or resin-impregnated dentin layer. It is hypothesized that conditioning with acidic or chelating agents demineralized the dentin surface-layer to a certain depth, leaving behind a collagen-rich mesh-work. Hydrophilic monomers are then believed to alter this collagen-fiber arrangement in a way that facilitates penetration of the adhesive resin, resulting in a mechanical, intermingled link between collagen and the adhesive resin. The second group preserved the smear layer. In this case, the dentinal tubules were obliterated with globular particles at their orifices and remained patent underneath these smear plugs. This type of adhesive system aims at the incorporation of the smear layer into the hydrophilic monomers, which have an affinity for the organic and/or inorganic components of the underlying dentin. Finally, a third, small group only partly dissolved the smear layer, creating a thin resin-impregnated dentin layer and a resin-impregnated smear plug. This study clearly showed that the application of recent adhesive systems induced structural changes in the dentin surface morphology, creating a retentive interface, called the inter-diffusion zone, between the deep, untouched dentin layers and the composite filling material. This resin-dentin interdiffusion zone offers bonding sites for copolymerization with the resin composite and, concurrently, might have protective potential for the pulp tissues.

Clinical correlations of dentin structure and function

Dentin, a porous, fluid-filled mineralized tissue, may provide critical mechanical support to overlying enamel. Once the enamel or cementum surface seals are lost by disease or trauma, the same organization that provided critical mechanical support then becomes a liability, offering millions of fluid-filled diffusion channels from the periphery directly to the pulp. If restorative materials placed in cavities do not seal the dentin, there is a fluid-filled continuum from the cavosurface margins, around gaps between the restorative material and the tooth, to dentin surfaces, then through dentin via its tubules to the pulp. Under most conditions these channels permit bidirectional diffusion of exogenous and endogenous substances across dentin. Occasionally, hydrodynamic stimuli will produce transient, rapid movement of dentinal fluid that will induce pain. The tubules are sometimes so close together in deep dentin that their intrinsic wetness interferes with the bonding of adhesive resins. This permits the formation of gaps, microleakage, dentin sensitivity, and, occasionally, pulpal irritation. Many clinical problems such as poor dentin bonding, microleakage, dentin sensitivity, and pulpal irritation have a common denominator in the structure and function of dentin.