Meta-analytical review of factors involved in dentin adherence

Bond strength of resin-based restorative materials to fast-setting calcium silicate cement using different resin adhesive systems

This study assessed the bond strength of resin-based restorative materials to fast-setting calcium silicate cement (Aarhus Uinversity, Denmark) when treated with each of two one-bottle universal adhesive systems. The cement surface (N = 256) was treated with a self-priming adhesive and a self-etch phosphate monomer-containing adhesive with and without etching of the cement surface. Specimens then received either resin composite or compomer restorative materials (n = 32). The bond strength was measured after 1 day and 1500 thermocycles (n = 16). The failure type was visually inspected. The cement-adhesive-restorative material interface was visualized using scanning electron microscopy (SEM). The data were analyzed using multiple linear regression. Restorative material type, resin adhesive system, and thermocycling had a statistically significant effect on the bond strength. Compomer restorative material and self-etch universal adhesive system demonstrated statistically significantly higher bond strength values to fast-setting calcium silicate cement, predominantly exhibiting cement cohesive failure. Etching the cement surface enhanced the bond strength of the self-priming universal adhesive. Thermocycling significantly reduced the bond strength. SEM showed self-etch universal adhesive seemingly diffused over the etched cement surface compared to other groups. Self-etch phosphate monomer-containing universal adhesive and compomer resulted in the highest bond strength to fast-setting calcium silicate cement.

Factors influencing the bond strength of additively manufactured crown materials in dentistry: A systematic review of in vitro studies

OBJECTIVE

The purpose of this systematic review was to investigate how different interventions can impact the bond strength of additively manufactured crown materials after cementation.

DATA/SOURCES

Four online databases Ovid MEDLINE, Scopus, Web of Science and Google Scholar were searched up to January 2023. Inclusion criteria were English-language publications, full-text, and in vitro studies only. Exclusion criteria were studies that did not assess the bonding of an additively manufactured crown material to cement or did not conduct any bond strength tests. An assessment of risk of bias was done in accordance with a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Each study was analysed and compared based on the interventions and bond strength results.

STUDY SELECTION

Six studies satisfied the inclusion and exclusion criteria, five of which evaluated photopolymerised resin and one that tested zirconia manufacturing via 3D printing. All studies observed a low risk of bias. The interventions applied included the type of surface pretreatments, airborne-particle abrasion pressure, cement type, taper of crown, and artificial aging. Three studies compared the bonding performance to milled materials.

CONCLUSIONS

The bond strength of crown materials additively manufactured from photopolymers presented high values and are comparable to milled materials. The systematic review demonstrated there was no definite superior cement type, but airborne-particle abrasion with alumina was generally recommended. There is a clear gap in the literature regarding the bond strength of additively manufactured crowns. Therefore, further research is necessary to evaluate its clinical applicability for permanent restorations.

CLINICAL SIGNIFICANCE

Factors influencing the bond strength of additively manufactured crown materials should be evaluated so dental professionals can adopt procedures that promote the strongest bond.

The impact of Bis-GMA free and Bis-GMA containing resin composite as posterior restoration on marginal integrity: a randomized controlled clinical trial

BACKGROUND

There have been concerns surrounding the utilization of Bis-GMA, a type of bisphenol A (BPA) derivative, within the dental industry. The aim of this study was to compare the performance of bulk fill Bis-GMA-free resin composite class II restorations in respect of its marginal integrity in comparison to bulk fill Bis-GMA-containing resin composite class II restorations over a 12-month period in a parallel clinical trial utilizing a split-mouth, double-blind, randomized strategy.

METHODS

20 patients participated in this study. Each patient has received one pair of class II posterior restorations, Bis-GMA-free (Admira fusion x-tra), and Bis-GMA containing (x-tra fil) on each side of the mouth (split-mouth strategy), (n = 40). The restorations' marginal integrity was evaluated based on Ryge's criteria (modified USPHS) at baseline (after 1 week), as well as 1 month, 3 months, 6 months, 9 months, and after 12 months of follow-up by two calibrated examiners. The statistical analyses utilizing the Friedman and Wilcoxon tests, the significance level was adjusted to 0.05.

RESULTS

Following the 12-month period, all patients attended the recall visits to evaluate the restorations. The Wilcoxon signed-rank and Friedman tests, revealed that both types of bulk fill had 100% of Alpha (A) scores at baseline and after 1 month with no significant statistical differences. After 3, 6, 9, and 12 months, both tested bulk fill restorations showed Bravo (B) score with Bis-GMA free 10% and 5% for Bis-GMA containing with no statistically significant difference (p ≤ 0.05) for clinical marginal integrity parameter in USPHS criteria.

CONCLUSIONS

Bis-GMA-free resin composites demonstrated satisfactory, marginal integrity compared with Bis-GMA-containing resin composites within 12 months.

TRIAL REGISTRATION

The protocol of the current study was registered at www.

CLINICALTRIALS

gov , with the identification number NCT05480852 on 29/07/2022. All procedures involving human participants were performed in accordance with the ethical standards of the Research Ethics Committee of the Faculty of Dentistry, Minia University, Egypt, under the approval number 419 on 27/06/2020.

In-Vitro Comparison of Fracture Strength of Endocrowns and Overlays in Endodontically Treated Teeth Manufactured with Monolithic Lithium Disilicate and Zirconia

To evaluate the fracture strength and the failure mode of endodontically treated molars restored with monolithic lithium disilicate and zirconia endocrowns and overlays. A total of 48 extracted mandibular molars were endodontically treated, decoronated 2 mm above the cementoenamel junction and divided into four 12-specimen groups. Group ELD: lithium disilicate endocrowns. Group EZ: monolithic zirconia endocrowns. Group OLD: lithium disilicate overlays. Group OZ: monolithic zirconia overlays. Overlays did not extend in the pulp chamber and endocrowns extended in the pulp chamber 2 mm. After adhesive bonding of the restorations, the specimens were subjected to thermocycling (×5000 cycles) and then to fracture resistance testing at lateral static loading (1 mm/min) at a universal testing machine. The failure mode of the specimens was qualitatively evaluated. Differences in means were compared using with t-tests for independent samples or Mann-Whitney test (p < 0.05). Weibull distribution analysis was also performed. Group ELD showed significantly higher fracture strength than all other groups (p = 0.001), and the highest Weibull modulus. Conclusions: Lithium disilicate endocrowns exhibit higher fracture strength and are more reliable compared to the other types of restorations examined. Endocrowns had more catastrophic failures compared to overlays.

Adhesion and Surface Roughness of Apatite-Containing Carbomer and Improved Ionically Bioactive Resin Compared to Glass Ionomers

The surface roughness of different glass-ionomer-based materials and their shear bond strength with a resin composite with and without thermal cycling were evaluated. Ketac Molar (KM, 3M ESPE, St. Paul, MN, USA), Glass Carbomer (GC, GCP Dental, Leiden, The Netherlands), Bioactive (BA, PULPDENT, Corporation, Watertown, MA, USA) and Fuji II LC (FJ, GC, Tokyo, Japan) were used to prepare the specimens and they were kept in distilled water at 37 °C for 24 h. The surface roughness of the specimens was measured with a profilometer (n = 6). A universal adhesive resin was applied on glass-ionomer materials and cylindrical universal composites were applied and polymerized, respectively (n = 16). The specimens were divided into two subgroups. The first subgroup was subjected to thermal cycling. Shear bond strength was investigated for both subgroups (n = 8). Stereomicroscopy and SEM examinations were performed. The roughest surface was obtained in the GC group (p < 0.05). The shear bond strength of the specimens without thermal cycling was higher than that of those with thermal cycling (p < 0.05). The lowest shear bond was measured in the GC group (p < 0.05). Although FJ, KM and BA have been observed to be suitable materials for clinical use, BA, in particular, is evidenced to become the best option among the materials we tested. GC cement's long-term performance needs to be improved.

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.

Effect of bacterial resistant zwitterionic derivative incorporation on the physical properties of resin-modified glass ionomer luting cement

Biofilms induce microbial-mediated surface roughening and deterioration of cement. In this study, zwitterionic derivatives (ZD) of sulfobetaine methacrylate (SBMA) and 2-methacryloyloxyethyl phosphorylcholine, were added in concentrations of 0, 1, and 3% to three different types of commercially available resin-modified glass ionomer cement (RMGIC) (RMC-I: RelyX Luting 2, RMC-II: Nexus RMGI, and RMC-III: GC FujiCEM 2). The unmodified RMGICs served as the control group for comparison. The resistance of Streptococcus mutans to ZD-modified RMGIC was evaluated with a monoculture biofilm assay. The following physical properties of the ZD-modified RMGIC were assessed: wettability, film thickness, flexural strength, elastic modulus, shear bond strength, and failure mode. The ZD-modified RMGIC significantly inhibited biofilm formation, with at least a 30% reduction compared to the control group. The addition of ZD improved the wettability of RMGIC; however, only 3% of the SBMA group was statistically different (P < 0.05). The film thickness increased in proportion to the increasing ZD concentrations; there was no statistical difference within the RMC-I (P > 0.05). The experimental groups' flexural strength, elastic modulus, and shear bond strength showed an insignificant decrease from the control group; there was no statistical difference within the RMC-I (P > 0.05). The mode of failure differed slightly in each group, but all groups showed dominance in the adhesive and mixed failure. Thus, the addition of 1 wt.% ZD in RMGIC favorably enhanced the resistance to Streptococcus mutans without any tangible loss in flexural and shear bond strength.

Bond strength between temporary 3D printable resin and conventional resin composite: influence of cleaning methods and air-abrasion parameters

OBJECTIVES

The influence of different cleaning methods, air-abrasion parameters, and aging on shear bond strength (SBS) and tensile bond strength (TBS) of 3D resin luted to composite resin.

MATERIALS AND METHODS

Nine hundred resin substrates were 3D printed (D20II, Rapid Shape) and cleaned with either isopropanol (ISO), butyldiglycol-based solution (BUT), or centrifugation (CEN). After 24-h storage in 37 °C water, specimens were air-abraded (mean particle size 50 µm; n = 60) with either alumina at 0.1 MPa (AL0.1) or 0.4 MPa (AL0.4) and glass pearls at 0.1 MPa (GP0.1) and 0.4 MPa (GP0.4) or conditioned with visio.link (control) and luted with PanaviaV5. Initially (24 h, 37 °C water storage) or after aging (10,000 thermal cycles), SBS and TBS were measured, and fracture types were examined. Surface free energy (SFE) and roughness (Ra) were determined after air-abrasion. Kolmogorov-Smirnov, Kruskal-Wallis H, Mann-Whitney U, chi-square, and partial eta-squared were computed.

RESULTS

SBS measurements presented higher values than TBS (p < 0.001-0.033). Within the pretreatment groups, CEN showed the highest SBS and TBS values compared to cleaning with ISO or BUT (p < 0.001-0.040). Pretreatment with GP0.1 displayed the lowest bond strength values (p < 0.001-0.049), and mostly adhesive fractures occurred. The highest Ra values (p < 0.001) were observed for AL0.4 pretreatment.

CONCLUSIONS

Pretreatment with AL0.4 and the control group mainly presented the highest bond strength values. Thermocycling had a positive effect on the bond strength.

CLINICAL RELEVANCE

According to this study, 3D-printed restorations should be pretreated with AL0.4 or with visio.link before adhesive luting, regardless of their cleaning.

Dislodgement pushout resistance of five bioceramic root-end filling materials

This study evaluated the dislodgement push-out resistance of five bioceramic materials. One hundred single-rooted teeth with one canal had the apical 3 mm and crown resected to create a 14 mm standardized length. The canals were instrumented to an apical size 80 with a 3 mm root-end preparation made with ultrasonic diamonds. The prepared roots were randomly divided into 5 root-end restorative groups (n=20). ProRoot MTA, Biodentine, EndoSequence Root Repair Material, EndoSequence Fast Set Putty, and EndoSequence BC Sealer with each material placed following manufacturer's instructions and stored at 100% humidity for 2 weeks. An apical-to-coronal static testing load with the identified dislodgement force converted into MPa with mean results analyzed with Kruskal-Wallis and Dunn's post hoc tests (α=0.05). ProRoot MTA and Biodentine displayed similar push-out stress resistance and exhibited significantly greater stress resistance than the similar Endosequence materials. However, all materials failed cohesively and were not dislodged from the root canal surface.

A critical analysis of research methods and experimental models to study the load capacity and clinical behavior of the root filled teeth

The prognosis of root‐filled teeth depends not only on a successful root canal treatment but also on the restorative prognosis. This critical review discusses the advantages and limitations of various methodologies used to assess the load capacity or clinical survivability of root‐filled teeth and restorations. These methods include static loading, cyclic loading, finite element analysis and randomized clinical trials. In vitro research is valuable for preclinical screening of new dental materials or restorative modalities. It also can assist investigators or industry to decide whether further clinical trials are justified. It is important that these models present high precision and accuracy, be reproducible, and present adequate outcomes. Although in vitro models can reduce confounding by controlling important variables, the lack of clinical validation (accuracy) is a downside that has not been properly addressed. Most importantly, many in vitro studies did not explore the mechanisms of failure and their results are limited to rank different materials or treatment modalities according to the maximum load capacity. An extensive number of randomized clinical trials have also been published in the last years. These trials have provided valuable insight on the survivability of the root‐filled tooth answering numerous clinical questions. However, trials can also be affected by the selected outcome and by intrinsic and extrinsic biases. For example, selection bias, loss to follow‐up and confounding. In the clinical scenario, hypothesis‐based studies are preferred over observational and retrospective studies. It is recommended that hypothesis‐based studies minimize error and bias during the design phase.

Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength

The aim of this in vitro study was to assess the effect of two different adhesive application methods on shear dentin bond strength (ISO 29022) using three various adhesive systems. A mid-coronal section of 77 intact third human molars with fully developed apices was made to create flat bonding substrates. The materials used in the study were Excite F (Ivoclar Vivadent), Prime&Bond Universal (Dentsply Sirona) and G-Premio Bond (GC). The application of each adhesion system was performed in two different ways. In the first group, the bonding agent was light cured immediately after the application (conventional method), while in the second group the adhesive and composite were cured concurrently (“co-curing” method). A total of 180 specimens were prepared (3 adhesives × 2 method of application × 30 specimens per experimental group), stored at 37 °C in distilled water and fractured in shear mode after 1 week. Statistical analysis was performed using ANOVA and Weibull statistics. The highest bond strength was obtained for Prime&Bond conventional (21.7 MPa), whilst the lowest bond strength was observed when co-curing was used (particularly, Excite F 12.2 MPa). The results showed a significant difference between conventional and co-curing methods in all materials. According to reliability analysis, the co-curing method diminished bond reliability. Different application techniques exhibit different bond strengths to dentin.

The Effect of Different Condition of Pulpal Pressure on Microtensile Bond Strength of Several Dentin Bonding Agents on Deep and Superficial Dentin

The objective of this study was to examine the effect of different conditions of simulated hydrostatic pulpal pressure on the μTBS of HEMA-based and HEMA-free dentin bonding agents (DBAs). The influence of dentin location (deep and superficial) on μTBS was also evaluated. Flat coronal dentin surfaces of extracted human molars were prepared. Three groups of resin-bonded specimens were exposed to different pulpal pressures. Pulpal pressure was maintained for 20 min for each group. A flowable resin composite was used for coronal build-up. The bonded teeth were sectioned and, after 24 h of water storage, stressed to failure using the microtensile tester (μTBS). Failed samples were analyzed by SEM inspection. HEMA-based DBAs were much more sensitive to pulpal pressure conditions than non-HEMA-containing DBAs. Pulpal pressure had a greater influence in deep dentin. The HEMA-free DBA was insensitive to the presence or absence of pulpal pressure condition. SEM inspection confirmed a relationship between the presence of voids inside the HEMA-based DBAs layer and the lower μTBS results. HEMA-based DBAs are more sensitive to pulpal pressure conditions than HEMA-free DBAs. Interestingly, HEMA-free DBA showed a greater number of water droplets at resin–dentin interface in all tested conditions.

Retention of different CAD/CAM endocrowns bonded to severely damaged endodontically treated teeth: An in vitro study

Aim:

Assess the retention of endocrowns fabricated of different CAD/CAM materials.

Settings and Design:

In vitro - comparative study.

Material and Methods:

Root canal treated mandibular first molars were prepared in a standardized method. Standardized endocrowns were manufactured using four CAD-CAM blocks: resin infiltrated ceramic (Vita Enamic), partially stabilized tetragonal zirconia (Katana), lithium disilicate ceramic (IPS e.max CAD), and polyether-ether-keton (PEEK, BioHPP). After proper surface treatment, the restorations were cemented using a resin cement (Panavia F2.0) and were connected to a special attachment unit and secured to a universal testing machine. The amount of axial load required to dislodge the restoration from the tooth structure was measured (n = 12, α = 0.05). Failures were classified as adhesive debonding from the tooth structure without damaging the supporting tooth structure and cohesive fracture of the supporting tooth structure

Statistical Analysis Used:

One-way analysis of variance,Tukey's post hoc test.

Results:

The retention of Vita Enamic (61 ± 11 N) and IPS e.max CAD (58 ± 9 N) was significantly higher (F = 123, P < 0.01) than Katana (33 ± 13) and Peek restorations (23 ± 11). Vita Enamic and IPS e.max CAD were associated with fractured tooth segments during debonding while Katana and PEEK specimens were adhesively debonded from the remaining tooth structure.

Conclusions:

Within the limitations of this study, using lithium disilicate ceramics and resin infiltrated ceramics as restorative materials to fabricate endocrowns to restore severely damaged endodontically treated teeth, recorded significantly higher retention values. Meanwhile, using yttrium partially stabilized zirconia and polyether ether ketones for the same purpose recorded a favorable mode failure which avoided the possibility of tooth fracture.

Influence of Preparation Design and Restorative Material on Fatigue and Fracture Strength of Restored Maxillary Premolars

STATEMENT OF PROBLEM

Extensive carious lesions and/or large preexisting restorations possibly contribute to crack formation, ultimately resulting in a fracture that may lead to the loss of a tooth cusp. Hence, preparation design strategy in conjunction with the restorative material selected could be influential in the occurrence of a cuspal fracture.

PURPOSE

The purpose of this in vitro study was to evaluate the fatigue behavior and fracture strength of maxillary premolars restored with direct composite and indirect ceramic inlays and overlays, with different preparation depths in the presence or absence of cuspal coverage, and analyze their failure types.

METHODS AND MATERIALS

Sound maxillary premolars (N=90; n=10) were divided into nine groups: group C: control; group DCI3: direct composite inlay 3 mm; group DCI5: direct composite inlay 5 mm; group ICI3: indirect ceramic inlay 3 mm; group ICI5: indirect ceramic inlay 5 mm; group DCO3: direct composite overlay 3 mm; group DCO5: direct composite overlay 5 mm; group ICO3: indirect ceramic overlay 3 mm; group ICO5: indirect ceramic overlay 5 mm. In indirect ceramic, lithium disilicate restoration groups, immediate dentin sealing was applied. After restoration, all specimens were tested in fatigue (1,200,000 cycles, 50 N, 1.7 Hz). Samples were critically appraised, and the specimens without failure were subjected to a load to failure test. Failure types were classified and the data analyzed.

RESULTS

Zero failures were observed in the fatigue testing. The following mean load to failure strengths (N) were recorded: group ICO5: 858 N; group DCI3: 829 N; group ICO3: 816 N; group C: 804 N; group ICI3: 681 N; group DCO5: 635 N; group DCI5: 528 N; group DCO3: 507 N; group ICI5: 482 N. Zero interaction was found between design-depth-material (p=0.468). However, significant interactions were found for the design-depth (p=0.012) and design-material (p=0.006). Within restorations at preparation depth of 3 mm, direct composite overlays obtained a significantly lower fracture strength in comparison to indirect ceramic onlays (p=0.013) and direct composite inlays (p=0.028). In restorations at depth 5 mm, significantly higher fracture load values were observed in indirect ceramic overlays compared with the inlays (p=0.018). Indirect ceramic overlays on 3 mm were significantly stronger than the deep inlays in ceramic (p=0.002) and tended to be stronger than the deep direct composite inlays. Severe, nonreparable fractures were observed with preparation depth of 5 mm within ceramic groups.

CONCLUSIONS

The preparation depth significantly affected the fracture strength of tooth when restored with either composite or ceramic materials. Upon deep cavity preparations, cuspal coverage proved to be beneficial when a glass ceramic was used as the restorative material. Upon shallow cavity preparations, a minimally invasive approach regarding preparation design used in conjunction with a direct composite material was favorable.

The Influence of Blade Type and Feeding Force during Resin Bonded Dentin Specimen Preparation on the Microtensile Bond Strength Test

This paper presents the effect of blade type and feeding force during resin-bonded dentin specimen preparation on the microtensile bond strength (μTBS) test. Forty resin-bonded flat middle dentin specimens were divided into four groups. The specimens of each group were sectioned according to type of blade and feeding force as follows: fine grit/20 N, fine grit/40 N, medium grit/20 N, and medium grit/40 N to obtain resin-dentin sticks with a cross-sectional area of 1.0 mm². Four sticks from the center of each tooth were subjected to the μTBS test. Five remaining sticks of each group were selected for surface topography observation under a scanning electron microscope (SEM). As a result, the bond strength of the medium-grit group was higher than that of the fine-grit group (p < 0.001), whereas the feeding force had no influence on bond strength values (p = 0.648). From the SEM, sticks prepared with the fine-grit blade showed a smoother surface integrity and fewer defects on the specimen edges in comparison with the sticks prepared with the medium-grit blade. The grit type of the blade is one of the considerable factors that may affect the bond strength and the surface integrity of resin-dentin specimens for microtensile testing.

In Vitro Comparison of Porcelain Fused to Metal Crown Retention after Endodontic Access and Subsequent Restoration: Composite, Amalgam, Amalgam with Composite Veneer, and Fiber Post with Composite

INTRODUCTION

The aim of this study was to evaluate the effect of different access opening restorative materials on crown retention.

METHODS

Thirty-eight extracted molars were mounted in resin and prepared for porcelain fused to metal (PFM) crowns. The crowns were fabricated and cemented with zinc phosphate, and the force to displace it was measured with a tensile-testing machine before and after endodontic access preparations. The endodontic access area, crown preparation axial wall, and preparation surface area were measured for comparison. The crowns were then recemented, and access openings were restored with either amalgam or composite before displacement force was remeasured. The restorative material was removed from each access opening; access area was measured and restored again (amalgam with composite or fiber post with composite) for displacement force to be remeasured. Paired t test was used to compare the means of displacement between groups. One-way analysis of variance was used to compare the mean outcome measure within the groups.

RESULTS

Statistical analyses showed retention after unfilled access was significantly lower than intact crowns. Amalgam, composite, amalgam + composite, and fiber post + composite increased retention beyond the original value. There was no statistical difference among the different restorative protocols. Qualitative results indicate that the restorative material remains in the crown after displacement regardless of the material used to restore the access.

CONCLUSIONS

The results from this study suggest that an endodontic access cavity decreases retention of a PFM crown. However, subsequent restoration with amalgam, composite, amalgam + composite, or post + composite may increase the original retention of the crown.

Dentin to dentin adhesion using combinations of resin cements and adhesives from different manufacturers - a novel approach

Aims

The aims of this study were to present a novel method to analyse dentin bond strength and to evaluate the bond strength of combining adhesive systems and resin cement from different manufacturers.

Methods

Human wisdom teeth were ground flat to the dentin on parallel surfaces and axially cut into two parts. Dentin cylinders (Ø 3 mm) were drilled from one half of each tooth. The other half from each tooth was embedded in epoxy resin with the dentin surface exposed. The specimens were ground with silicone carbide paper and the dentin cylinders were cemented onto the dentin surface of the other half of the same tooth.

Materials: Resin cement and adhesive systems from three different manufacturers were used in various combinations (n = 8 per group). Cement and adhesive from the same manufacturer served as control. Shear bond strength (SBS) was measured and fracture modes were registered.

Results and conclusions: The highest median SBS value was found in a bonding combination between cement and a non-corresponding adhesive (33.1 MPa) and one of the lowest values was found in one of the controls (15.3 MPa). Cohesive fractures were most frequent. The results indicated that combining adhesive and cement from different manufacturers did not compromise the dentin bonding. The novel test method is recommended for evaluating dentin bonding.

Composite removal by means of erbium, chromium:yttrium-scandium-gallium-garnet laser compared with rotary instruments

BACKGROUND

Complete removal of existing composite restorations without unnecessary removal of tooth structure is challenging. The authors compared the amount of tooth structure removed and composite remaining in Class III preparations when using an erbium laser or a rotary instrument.

METHODS

Mesiolingual and distolingual preparations were prepared in 14 extracted anterior teeth, restored with shade-matched composite, finished, and polished. One restoration was removed with an erbium, chromium:yttrium-scandium-gallium-garnet laser and the other with a rotary instrument (handpiece and carbide burs). Gypsum models made from vinyl polysiloxane impressions of the preparation and removal stages were scanned. The 2 scans were precisely aligned to calculate the amount of tooth structure removed and residual composite, which were statistically compared (t test) between the bur and laser groups.

RESULTS

Rotary instruments removed significantly more tooth structure than the laser in terms of mean depth (P = .0017) but not maximum depth (P = .0762). Although mean depth of tooth loss was smaller in the laser group, the area of tooth loss was significantly larger (P = .0004) because the rotary instrumentation left significantly more composite than the laser in terms of volume (P = .0104), mean depth (P = .0375), maximum depth (P = .0318), and area (P = .0056).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The erbium, chromium:yttrium-scandium-gallium-garnet laser was more selective in removing existing composite restorations than a rotary instrument because it removed less tooth structure and left behind less composite. Unintentional loss of tooth structure and unnoticeable residual composite are inevitable when removing existing composites. Erbium lasers are alternative means of composite removal that may be more selective than a rotary instrument.

The roughness of deciduous dentin surface and shear bond strength of glass ionomers in the treatment with four minimally invasive techniques

The concept of minimally invasive technique in dentistry emphasizes conservative strategies in the management of caries, which results in less destruction of healthy tooth structure. The use of different techniques seems to interfere in the roughness of dentin and the mechanisms of adhesion with the restorative material. This study characterized the roughness of deciduous dentin surface treated with four minimally invasive techniques using profilometry, atomic force microscopy (AFM) and scanning electron microscopy (SEM); moreover, shear bond strength of Vitremer™ glass ionomer was determined. Samples were divided into four groups: G1_CB carbide bur, G2_PB polymer bur, G3_C Carisolv™, and G4_AA air abrasive. No differences were found between groups before and after treatment in the roughness. Samples treated with a carbide bur presented a smear layer; smart bur surface exhibited the remains of the material; G3_C Carisolv™ showed a rough surface, and air abrasive presented particle traces. Concerning the shear bond strength of Vitremer™ glass ionomer were not found differences after treatment (p > 0.05). It is concluded that roughness showed characteristic patterns derived from the technique used and the shear bond strength is not significantly affected after using any minimally invasive method.

The concept of minimally invasive technique in dentistry emphasizes conservative strategies in the management of caries, which results in less destruction of healthy tooth structure.

Ultra-high-speed videography of resin-dentin interface failure dynamics under tensile load

OBJECTIVES

Ultra-high-speed (UHS) videography was used to visualize the fracture phenomena at the resin-dentin interface during micro-tensile bond strength (μTBS) test. We also investigated whether UHS videography is applicable for failure-mode analysis.

METHODS

Ten human mid-coronal dentin surfaces were bonded using Clearfil SE Bond either in self-etching (SE) or etch-and-rinse (ER) mode. After 24-h water storage, the samples were cut into beams for μTBS test and tested at a cross-head speed of 1 mm/min. The fracture phenomena at the bonded interface were captured using a complementary metal-oxide-semiconductor digital UHS camera at 299,166 frames per second. The failure modes were classified using UHS videography, followed by scanning electron microscopy (SEM) analysis. The failure-mode distributions determined by UHS videography and SEM analysis were statistically analyzed using Fisher's exact test with Bonferroni correction.

RESULTS

The crack-propagation speed exceeded 1,500 km/h. No significant difference was found between the SEM and UHS videography failure-mode distributions in the SE mode. A significant difference appeared between them in the ER mode. Significant differences in the incidence of cohesive failures within the adhesive and at the adhesive-composite interface between the SE and ER modes were identified by both SEM and UHS videography.

SIGNIFICANCE

UHS videography enabled visualization of the fracture dynamics at the resin- dentin interfaces under tensile load. However, the resolution at such high frame rate was insufficient to classify the failure mode as precisely as that of SEM. Nevertheless, UHS videography can provide more detailed information about the fracture origin and propagation.

The effect of vitality and dentin depth on resin tags length of resin-dentin interface in dogs' teeth

The aim of this study was to evaluate the effect of pulpal pressure and dentin depth on the quality of hybrid layer of bonded composite. Four healthy dogs, aged between 12 and 18 months, with intact dentitions were used for the experimental work. A total of 24 teeth were available for the study by using the six upper anterior teeth of each of the four dogs used in the study. The 24 teeth included in the study were divided according to presence or absence of pulpal pressure (P) into two groups with 12 teeth in each group. P₁ teeth with positive pulpal pressure and P₂ teeth with no pulpal pressure. Each of these two groups was further divided into two subgroups, according to the cavity depth (D) they received, where in D₁ a class V cavity with depth of 1 mm was performed, while in D₂ a class V cavity with depth of 2 mm was performed. The cavities were restored with micro hybrid composite restorative material and the samples were then left in the dogs’ mouth for 30 days. At the end of the experimental period, the dogs were euthanized by injecting an overdose of thiopental sodium. The anterior part of the upper jaw was sawed out of each dog’s mouth and the teeth were sectioned to evaluate the resin–dentin interface using Environmental Scanning Electronic Microscope. Results of the study showed that the mean resin tag length value was significantly affected by vitality and dentin depth. The presence of pulpal pressure together with depth of dentin could adversely affect the quality of hybridization.

Comparison of Internal Adaptation of Bulk-fill and Increment-fill Resin Composite Materials

Objectives:

To evaluate 1) the internal adaptation of a light-activated incremental-fill and bulk-fill resin-based composite (RBC) materials by measuring the gap between the restorative material and the tooth structure and 2) the aging effect on internal adaptation.

Methods and Materials:

Seventy teeth with class I cavity preparations were randomly distributed into five groups; four groups were restored with bulk-fill RBCs: Tetric EvoCeram Bulk Fill (TEC), SonicFill (SF), QuiXX Posterior Restorative (QX), and X-tra fil (XF); the fifth group was restored with incremental-fill Filtek Supreme Ultra Universal Restorative (FSU). One-half of the specimens of each group were thermocycled. Each tooth was sectioned, digital images were recorded, and the dimensions of any existing gaps were measured. Data were analyzed using analysis of variance (α=0.05).

Results:

FSU had the smallest gap measurement values compared with the bulk-fill materials except QX and TEC (p≤0.008). FSU had the smallest sum of all gap category values compared with the bulk-fill materials, except QX (p≤0.021). The highest gap incidence and size values were found at the composite/adhesive interface. All aged groups had greater gap values in regard to the gap measurement and the sum of all gap categories compared with non-aged groups.

Significance:

The incrementally placed material FSU had the highest internal adaptation to the cavity surface, while the four bulk-fill materials showed varied results. Thermocycling influenced the existing gap area magnitudes. The findings suggest that the incremental-fill technique produces better internal adaptation than the bulk-fill technique.

Analysis of pre-test failures and bond-strengths of seven adhesive systems to bovine dentine: A nine-year novice/beginner operator study

OBJECTIVE

The aims were to evaluate, via multi-year student cohorts: (i) the incidence of pre-test failures and (ii) shear bond strengths of single- and multi-step adhesives to bovine dentin.

METHODS

The experiments were performed by cohorts of dental students (2008-2016). Each year the bond strengths of three dental adhesives to bovine dentin were tested. Four self-etching adhesives (Optibond-All-in-One, [OBAIO]; Optibond XTR [OBXTR]); Xeno V [XV]; Xeno V+ [XV+]; a three-step etch-and-rinse-system (Optibond FL, [OBFL]), a self-etch universal adhesive (Scotchbond Universal [SBU]) and a self-etch/etch-and-rinse adhesive (Xeno Select, [XS]) were included in the study. Composite-cylinders were bonded perpendicularly to prepared bovine dentin surfaces. Shear-tests were performed with a universal-testing-machine.

RESULTS

Both overall, and within years, XV and XV+ showed significantly (p<0.01) higher percentages of pre-test failures versus other adhesive systems tested in the period 2008-2014 (OAIO, OBFL, OBXTR). Fewest pre-test failures were observed for OBFL, OBXTR and SBU. Trends in mean bond strengths and Weibull distributions were noted, per adhesive, with trends in the incidence of pre-test failures. Pre-test-failures and bond strengths depended on the air-drying technique. The adhesive systems showed variable technique sensitivity. Multistep bonding systems (Optibond FL and Optibond XTR) showed minimal pre-test failures and high bond strength applied by relatively inexperienced operators and irrespective of the applied air-drying technique. However, two single-step adhesives (OAIO and SBU) showed comparable results to the multi-step systems.

SIGNIFICANCE

The clinical need for rapid application dentine adhesives can result in varied outcomes with relatively inexperienced operators. These outcomes include both the incidence of pre-test failures as well as the distributions of shear bond strengths achieved, although these measures appear to be related. However, both outcomes are dependent upon the adhesive products utilised and especially upon the applied air pressure (flow rate). Some rapid application systems appear to perform comparably with well-established multi-step adhesives.

Comparative Evaluation of Shear Bond Strength of Newer Resin Cement (RelyX Ultimate and RelyX U200) to Lithium Disilicate and Zirconia Ceramics as Influenced by Thermocycling

Background/Purpose:

The purpose of this study was to compare the shear bond strength of high strength ceramics to cut dentine as influenced by different resin cement types after thermocycling.

Materials and Methods:

Shear bond strength testing was carried out for 56 sound, freshly extracted first permanent molars. Specimens were divided at random into 2 groups (n = 28) Lithium disilicate and Zirconia. Lithium disilicate and Zirconia specimens were further subdivided depending upon luting with Rely X ultimate cement bonded with single bond universal adhesive and Rely X U200 cement. Half of the specimens of each material luted with cements were subjected to thermocycling. Shear bond strength was evaluated using Universal testing machine at a crosshead speed of 5 mm/min. Results were compared and evaluated using t-test at a significance level of 0.05. The nature of bond failure was observed under a stereomicroscope for each sample.

Results:

The mean difference of Lithium disilicate test specimens bonded with Rely X ultimate cement bonded with single bond universal adhesive with and without thermocycling was found to be 42.95+/-17.41MPa and 120.62+/-56.46 MPa respectively. The mean difference of Zirconia test specimens with Rely X ultimate cement bonded with single bond universal adhesive, with and without thermocycling, was found to be 8.74+/-2.90 MPa and 164.28+/-43.78 MPa respectively. The mean difference of Lithium disilicate test specimens bonded with Rely X U200 with and without thermocycling was found to be 2.36+/-0.63 MPa and 36.79.62+/-17.21MPa respectively. The mean difference of Zirconia test specimens bonded with Rely X U200 with and without thermocycling was found to be 5.96+/-3.11MPa and 122.46+/-23.01MPa respectively.

Conclusion:

Zirconia was found to have better shear bond strength than Lithium discilicate. The use of single bond universal adhesive improves bonding to newer higher strength ceramics such as Zirconia. Cohesive failure was predominant at cement dentine interface.

Bonding effectiveness of self-etch adhesives to dentin after 24 h water storage

Purpose:

This study evaluated the immediate bonding effectiveness of five self-etch adhesive systems bonded to dentin.

Materials and Methods:

The microtensile bond strength of five self-etch adhesives systems, including one two-step and four one-step self-etch adhesives to dentin, was measured. Human third molars had their superficial dentin surface exposed, after which a standardized smear layer was produced using a medium-grit diamond bur. The selected adhesives were applied according to their respective manufacturer's instructions for μTBS measurement after storage in water at 37°C for 24 h.

Results:

The μTBS varied from 11.1 to 44.3 MPa; the highest bond strength was obtained with the two-step self-etch adhesive Clearfil SE Bond and the lowest with the one-step self-etch adhesive Adper Prompt L-Pop. Pretesting failures mainly occurring during sectioning with the slow-speed diamond saw were observed only with the one-step self-etch adhesive Adper Prompt L-Pop (4 out of 18).

Conclusions:

When bonded to dentin, the self-etch adhesives with simplified application procedures (one-step self-etch adhesives) still underperform as compared to the two-step self-etch adhesive Clearfil SE Bond.

Bond strength of self-adhesive resin cement to base metal alloys having different surface treatments

Background

This study aimed to assess and compare the shear bond strength of self-etch and self-adhesive resin cement to nickel-chromium-cobalt alloy with different surface treatments.

Materials and Methods

In this in vitro study, a total of 120 disks were fabricated of VeraBond II base metal alloy. Specimens were divided into 15 groups of 8 based on the type of cement and surface treatment. The five surface treatments studied included sandblasting alone, application of Alloy Primer with and without sandblasting, and application of Metal Primer II with and without sandblasting. The three cement tested included Panavia F2.0, RelyX Unicem (RU), and G-Cem (GC). After receiving the respective surface treatments, the specimens were thermocycled for 1500 cycles and underwent shear bond strength testing. Data were analyzed using SPSS 20.0 and three-way analysis of variance. P values of the significant level of 0.05 were reported.

Results

The results exhibited that the mean bond strengths in sandblasted groups were higher than nonsandblasted one. These differences were significantly higher in the sandblasted groups of Panavia F2.0 and RU cement (P < 0.05). The mean bond strength values between GC and Panavia F2.0 were not statistically significant (P > 0.05). The highest bond strength was recorded for Panavia F2.0 with the surface treatment of both sandblasting and Metal Primer II.

Conclusion

Based on the results, sandblasting improves the shear bond strength of self-etch and self-adhesive resin cement to base metal alloys. The best results can be achieved with a combination of sandblasting and metal primers. The performance of resin cement depends on to their chemical composition, not to the type of system.

Shear bond strength and microleakage of a new self-etch adhesive pit and fissure sealant

This study aimed to evaluate the shear bond strength (SBS) and microleakage of a new self-etch adhesive-based fissure sealant (EG) on aprismatic enamel in comparison to conventional fissure sealing with 30 s acid etching (CG). The fissures were sealed according to the manufacturer's instructions. Each group was divided into 3 subgroups: 1-day water storage, 3-month water storage, and 5,000× thermocycling. After measuring SBS using the Ultradent method, failure mode was analyzed. In additional 16 teeth, microleakage was tested using dye penetration method. Pairwise comparisons were analyzed using Mann-Whitney U-Test. Multiple linear regression was performed to assess the factors influencing on SBS. EG had significantly lower mean SBS (4.1 MPa±2.1) than the CG (17.6 MPa±6.4). CG (1.1%) performed significantly better than the EG (12.8%) in microleakage analysis. The tested EG yielded significantly inferior results and its clinical use should be decided after weighing its pros and cons.

Dentin bonding agent with improved bond strength to dentin through incorporation of sepiolite nanoparticles

Background

The study aims to investigate the effect of incorporation of sepiolite nanoparticles on the microtensile bond strength of an experimental dentin bonding to the human dentin.

Material and Methods

The sepiolite nanoparticles were incorporated into an experimental methacrylate-based dentin bonding system in concentrations of 0.0, 0.2, 1.0, 2.0, and 5.0 weight percents. The specimens were then ultrasonicated to finely disperse the nanoparticles in the adhesive matrix. The coronal enamel of 30 intact human premolars was cut to expose dentin. Having etched, rinsed, and blot dried the experimental bonding agents were applied to dentin surface. Adper Single Bond was used as control group according to the manufactor’s instruction. Then all the teeth were built up by composite and sectioned in stick form for microtensile test. The fracture surface was observed using SEM. The data were analyzed by ANOVA and Tukey’s post-Hoc test.

Results

The results indicated that the incorporation of the nanofiller, improved the bond strength to dentin with the highest values obtained at 1 w% sepiolite nanoparticle content.

Conclusions

Sepiolite nanoparticles can be considered as novel fillers to improve the mechanical properties of dentin bonding agents.

Key words:Dentin bonding agent, nanoparticles, bond strength, sepiolite, microtensile test.

Push-Out Bond Strength and Surface Microhardness of Calcium Silicate-Based Biomaterials: An in vitro Study

OBJECTIVE

This was an in vitro evaluation of push-out bond strength and surface microhardness of calcium silicate-based biomaterials in coronal and apical root dentin.

MATERIALS AND METHODS

Ninety sections (2 mm thick) of coronal and apical root dentin were obtained from roots of 60 extracted teeth; the canals were enlarged to a standardized cavity diameter of 1.3 mm. Sections were randomly divided into 6 groups (n = 15 per group), and cavities were filled with Biodentine™, BioAggregate, or ProRoot mineral trioxide aggregate (MTA), according to the manufacturers' instructions. Push-out bond strength values were measured using a universal testing machine under a compressive load at a speed of 1 mm/min. Samples were analyzed under a light microscope to determine the nature of bond failure. Ten samples (2 mm thick) were prepared for all the materials, and Vickers microhardness was determined using a digital hardness tester. Data were analyzed using one-way analysis of variance and Tukey-Kramer multiple comparison tests at a significance level of p < 0.05.

RESULTS

Biodentine (42.02; 39.35 MPa) and ProRoot MTA (21.86; 34.13 MPa) showed significantly higher bond strengths than BioAggregate (6.63; 10.09 MPa) in coronal and apical root dentin, respectively (p < 0.05). Biodentine also differed significantly from ProRoot MTA in coronal dentin. Bond failure was predominantly adhesive in Biodentine and ProRoot MTA, while BioAggregate showed predominantly mixed failure. ProRoot MTA (158.52 HV) showed significantly higher microhardness and BioAggregate (68.79 HV) showed the lowest hardness.

CONCLUSION

Biodentine and ProRoot MTA showed higher bond strength and microhardness compared to BioAggregate.

Hydrolytic Stability of Self-etch Adhesives Bonded to Dentin

Functional monomers chemically interact with hydroxyapatite that remains within submicron hybrid layers produced by mild self-etch adhesives. The functional monomer 10-MDP interacts most intensively with hydroxyapatite, and its calcium salt appeared most hydrolytically stable, as compared with 4-MET and phenyl-P. We investigated the hypothesis that additional chemical interaction of self-etch adhesives improves bond stability. The micro-tensile bond strength (μTBS) of the 10-MDP-based adhesive did not decrease significantly after 100,000 cycles, but did after 50,000 and 30,000 cycles, respectively, for the 4-MET-based and the phenyl-P-based adhesives. Likewise, the interfacial ultrastructure was unchanged after 100,000 thermocycles for the 10-MDP-based adhesive, while that of both the 4-MET- and phenyl-P-based adhesives contained voids and less-defined collagen. The findings of this study support the concept that long-term durability of adhesive-dentin bonds depends on the chemical bonding potential of the functional monomer.

A Critical Review of the Durability of Adhesion to Tooth Tissue: Methods and Results

The immediate bonding effectiveness of contemporary adhesives is quite favorable, regardless of the approach used. In the long term, the bonding effectiveness of some adhesives drops dramatically, whereas the bond strengths of other adhesives are more stable. This review examines the fundamental processes that cause the adhesion of biomaterials to enamel and dentin to degrade with time. Non-carious class V clinical trials remain the ultimate test method for the assessment of bonding effectiveness, but in addition to being high-cost, they are time- and labor-consuming, and they provide little information on the true cause of clinical failure. Therefore, several laboratory protocols were developed to predict bond durability. This paper critically appraises methodologies that focus on chemical degradation patterns of hydrolysis and elution of interface components, as well as mechanically oriented test set-ups, such as fatigue and fracture toughness measurements. A correlation of in vitro and in vivo data revealed that, currently, the most validated method to assess adhesion durability involves aging of micro-specimens of biomaterials bonded to either enamel or dentin. After about 3 months, all classes of adhesives exhibited mechanical and morphological evidence of degradation that resembles in vivo aging effects. A comparison of contemporary adhesives revealed that the three-step etch-and-rinse adhesives remain the ‘gold standard’ in terms of durability. Any kind of simplification in the clinical application procedure results in loss of bonding effectiveness. Only the two-step self-etch adhesives approach the gold standard and do have some additional clinical benefits.

Microshear bond strength to dentin of self-adhesive flowable composite compared with total-etch and all-in-one adhesives

Background/purpose

Because of the lack of data on long-term survival of a flowable self-adhesive composite (SAC) restoration, the purpose of this study was to compare the microshear bond strengths (μSBSs) of flowable resin composites to dentin, either with self-adhesive ability or with the combined use of a total-etch adhesive and all-in-one adhesive, before and after thermocycling.

Materials and methods

Coronal dentin specimens of 60 extracted sound third human molars were divided into three groups (n = 20) as follows: Group 1, flowable SAC (VF); Group 2, total-etch adhesive + flowable composite (FL); Group 3, all-in-one adhesive + flowable composite (AL). For each adhesive, half of the specimens were subjected to μSBS testing after 24-hour water storage, and the other half of the specimens were subjected to 5000 thermocycles followed by μSBS testing. The morphologies of the adhesive interfaces were evaluated under a scanning electron microscope. Data were analyzed using one-way analysis of variance (ANOVA) and independent t test.

Results

One-way ANOVA showed similar results for both 24-hour water storage and thermocycled groups. The FL group showed the highest μSBS values (P < 0.001). The VF and AL groups were not statistically significantly different. Thermocycling had no effect on μSBS values (P = 0.578). The interfacial observation revealed that VF had a gap at the resin–dentin interface. By contrast, both FL and AL specimens had distinct adhesive layers without any gap formation.

Conclusion

The results from this study indicated that laboratory bonding effectiveness of flowable SAC was approximately that of all-in-one adhesive.

Ceramic Inlays: Effect of Mechanical Cycling and Ceramic Type on Restoration-dentin Bond Strength

This study aimed to evaluate the bond strength between dentin and five different ceramic inlays in permanent maxillary premolars, with and without mechanical cycling. One hundred permanent maxillary premolars were prepared and divided into 10 groups (n=10) according to the ceramic system (IPS e.Max Press; IPS e.Max CAD; Vita PM9; Vita Mark II; and Vita VM7) and the mechanical cycling factor (with and without [100 N, 2 Hz, 1.2×106 cycles]). The inlays were adhesively cemented, and all of the specimens were cut into microbars (1×1 mm, nontrimming method), which were tested under microtensile loading. The failure mode was classified and contact angle, roughness, and microtopographic analyses were performed on each ceramic surface. The mechanical cycling had a significant effect (p=0.0087) on the bond strength between dentin and IPS e.max Press. The Vita Mark II group had the highest bond strength values under both conditions, with mechanical cycling (9.7±1.8 MPa) and without (8.2±1.9 MPa), while IPS e.Max CAD had the lowest values (2.6±1.6 and 2.2±1.4, respectively). The adhesive failure mode at the ceramic/cement interface was the most frequent. Vita Mark II showed the highest value of average roughness. IPS e.max Press and Vita Mark II ceramics presented the lowest contact angles. In conclusion, the composition and manufacturing process of ceramics seem to have an influence on the ceramic surface and resin cement bond strength. Mechanical cycling did not cause significant degradation on the dentin and ceramic bond strength under the configuration used.

Effect of laser preparation on adhesion of a self-adhesive flowable composite resin to primary teeth

The aim of the study was to evaluate the adhesion of a self-adhering flowable composite resin to primary tooth enamel and dentin after silicon carbide paper (SiC) and laser pretreatment. Adhesive properties were evaluated as shear bond strength (SBS) and scanning electron microscopic (SEM) characteristics. A total 120 primary canine teeth were randomly divided into two groups to study enamel and dentin. Each group was divided into 6 subgroups (n = 10) according to type of surface preparation (SiC or Er:YAG laser) of enamel or dentin. Three methods were used to build cylinders of restoration on tooth surface: OptiBond All-In-One + Premise Flowable composite, OptiBond All-In-One + Vertise Flow and Vertise flow. After restoration, samples were tested for SBS and failure mode. Twenty eight samples were examined by SEM. The results of the study showed SBS of Vertise Flow was lower than others in enamel and dentin samples pretreated with SiC and in dentin samples pretreated with laser (P < 0.001). Compared to SiC pretreatment, laser pretreatment led to a significantly higher SBS with Vertise Flow on enamel (P < 0.001). Vertise Flow associated with the adhesive led to a higher SBS in enamel and dentin compared to Vertise Flow alone. Adhesive and mixed failure modes were observed more frequently in Vertise Flow groups. SEM images showed that Vertise Flow led to more irregularities on enamel and more open dentinal tubules after laser ablation compared SiC pretreatment.

Effect of immediate and delayed dentin sealing on the fracture strength, failure type and Weilbull characteristics of lithiumdisilicate laminate veneers

OBJECTIVES

Adhesion on dentin is less reliable than on enamel, which could affect the durability of laminate veneers (LV). Immediate dentin sealing (IDS) is suggested instead of delayed dentin sealing (DDS) to overcome hypersensitivity and prevent debonding from dentin. This study evaluated the effect of IDS and DDS on the durability of Li2Si2O5 laminate veneers in vitro.

METHODS

Window preparations were made on the labial surfaces of sound maxillary central incisors (N=50). They were randomly divided into five groups: Group 1: Enamel only+H3PO4+Adhesive (control); Group 2: <1/4 dentin+H3PO4+DDS (2 weeks later); Group 3: Complete dentin+H3PO4+DDS (2 weeks later); Group 4: <1/4 dentin+H3PO4+IDS; Group 5: Complete dentin+H3PO4+IDS. Li2Si2O5 laminate veneers (e.max Press) were bonded to the labial surfaces of the teeth with adhesive resin cement (Variolink Veneer). IDS layers were silicacoated (CoJet System) and silanized (ESPE-Sil). The teeth with their bonded laminates were thermocycled (10.000× cycles) and then subjected to static loading (1mm/min). Failure type and location after debonding were classified. Data were analyzed using ANOVA and Tukey's post hoc test (α=0.05). Two-parameter Weibull distribution values including the Weibull modulus, scale (m) and shape (0), values were calculated.

RESULTS

Mean fracture strength (N) per group in descending order was as follows: Group 5 (576±254), Group 4 (478±216), Group 1 (473±159), Group 2 (465±186), and Group 3 (314±137). The presence of complete dentin exposure sealed with DDS after 2 weeks on the bonded surface (Group 3) resulted in significantly lower fracture strength results than those in group 5 with IDS (p=0.034). Weibull distribution presented higher shape (0) for Group 1 (3.67), than those of other groups (2.51-2.89). Failure types were predominantly adhesive failure between the cement and the laminate veneer in Groups 1, 2, 4 whereas Group 3 presented more often complete adhesive failures between the cement and dentin. In Group 5, failures showed some IDS and cement with or without ceramic fracture attached on the tooth.

SIGNIFICANCE

When laminate veneers are bonded to a large dentin substrate, application of immediate dentin sealing improves adhesion and thereby, the fracture strength of Li2Si2O5 laminate veneers.

Factors Affecting the Shear Bond Strength of Orthodontic Brackets - a Review of In Vitro Studies

The adhesive material used to bond orthodontic brackets to teeth should neither fail during the treatment period, resulting in treatment delays, untoward expenses or patient inconvenience nor should it damage the enamel on debonding at the end of the treatment. Although the effectiveness of a bonding system and any unfavorable effects on the enamel may be studied by conducting in-vivo studies, it is nearly impossible to independently analyze different variables that influence a specific bonding system in the oral environment. In-vitro studies, on the other hand, may utilize more standardized protocols for testing different bonding systems and materials available. Thus, the present review focused attention on in-vitro studies and made an attempt to discuss material-related, teeth-related (fluorotic vs non-fluorotic teeth) and other miscellaneous factors that influences the shear bond strength of orthodontic brackets. Within the limitations of this review, using conventional acid-etch technique, ceramic brackets and bonding to non-fluorotic teeth was reported to have a positive influence on the shear bond strength of orthodontic brackets, but higher shear bond strength found on using ceramic brackets can be dangerous for the enamel.

Application of the health belief model to improve the understanding of antihypertensive medication adherence among Chinese patients

OBJECTIVES

We aimed to gain insight into antihypertensive medication adherence on the basis of a well-developed behavior theory.

METHODS

A cross-sectional study of Chinese hypertensive patients was conducted using the health belief model as a theoretical framework.

RESULTS

The HBM explained 48.8% of the variance in antihypertensive medication adherence with an overall prediction accuracy was 82.8%. After adjusting for controlling factors, the HBM explained 50.5% of the variance in antihypertensive medication adherence with an overall prediction accuracy of 86.2%. Higher levels of perceived susceptibility (p = 0.017), cues to action (p=0.034), and self-efficacy (p = 0.002) and a lower level of perceived barriers (p < 0.001) were significantly associated with better antihypertensive medication adherence. The risk factors of older age (p = 0.037), longer duration of HTN (p = 0.003), longer duration of drug use (p = 0.001), and taking a combination of antiplatelet agents (p < 0.001) were significantly associated with better antihypertensive medication adherence and influenced different HBM constructs.

CONCLUSION

The HBM is reliable in predicting medication adherence among Chinese hypertensive patients. Intervention programs in clinical practice could be guided by the relationship between risk factors and HBM constructs and antihypertensive medication adherence.

PRACTICE IMPLICATIONS

This study provides a structured understanding of the relationships between risk factors and HBM constructs and antihypertensive medication adherence.

New methodology to evaluate bond strength of root-end filling materials

This study evaluated the bond strength of root-end filling materials to root-end cavities using a new methodology. Twenty maxillary central incisors were subjected to biomechanical preparation (#80 hand file) and sectioned transversally 2 mm short of the apex and 4 mm coronally to this point. The root cylinders were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. Two groups (n=10) were formed according to the root-end filling material: MTA and Super EBA. A gutta-percha cone (#80) was tug-backed at the limit between the canal and the root-end cavity. The cavity was filled and the gutta-percha cone was removed after complete setting of the sealer. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and run at a crosshead speed of 1.0 mm/min for pushing out the root-end filling material. Data were analyzed by ANOVA (α=5%). Super EBA (6.03±1.31) presented higher bond strength (MPa) than MTA (1.81±0.45) (p>0.05). There was a predominance of cohesive failures for Super EBA and mixed for MTA. The protocol of specimen preparation is effective and introduces a specific methodology for assessing bond strength of root-end filling materials to dentin. Among the materials, Super EBA presented the highest bond strength.

Longitudinal Evaluation of Bond Strength to Enamel of Dental Adhesive Systems Associated with Nd:YAG Laser

OBJECTIVES

This study evaluated the durability of bond strength to enamel using total-etch (Single Bond/SB) and self-etch (Clearfil SE Bond/CSEB) adhesives associated with neodymium:yttrium-aluminu-garnet (Nd:YAG) laser irradiation through the uncured adhesives.

METHODS

Bovine incisors were worn to expose an area of enamel and were divided into four groups: group 1 (control) SB + polymerization; group 2 (control) CSEB + polymerization; group 3 (laser) - SB + Nd:YAG laser (174.16 J/cm(2)) + polymerization; and group 4 (laser) CSEB + Nd:YAG (174.16 J/cm(2)) + polymerization. Blocks of composite were fabricated and stored for 24 hours or 12 months, sectioned into beams, and submitted to microtensile tests. Results were analyzed by three-way analysis of variance (ANOVA) (adhesive, technique, and storage time) and Tukey tests.

RESULTS

ANOVA revealed significant differences for adhesive × technique and technique × storage time (p<0.05). The mean values (MPa) for interaction adhesive × technique (standard deviation) were as follows: SB/control = 35.78 (6.04)a; SB/laser = 26.40 (7.25)b, CSEB/control = 26.32 (5.71)b, CSEB/laser = 23.90 (7.49)b. For interaction technique × storage time the mean values were as follows: control/24 hours = 32.58 (6.49)a; control/12 months = 29.52 (8.38)a; laser/24 hours = 29.37 (5.71)a; laser/12 months = 20.92 (6.5)b. Groups with the same letters showed no statistically significant differences.

CONCLUSION

Scanning electron microscope analysis showed evident areas of micromorphological alterations in lased samples after 12 months of water storage. Nd:YAG laser irradiation of enamel through unpolymerized total-etch adhesive significantly reduced bond strength compared with the control. Bond strength decreased when enamel samples irradiated with Nd:YAG laser through unpolymerized adhesives were stored in water for 12 months.

Bond strength tests of dental adhesive systems and their correlation with clinical results - A meta-analysis

OBJECTIVE

To evaluate the variability of bond strength test results of adhesive systems (AS) and to correlate the results with clinical parameters of clinical studies investigating cervical restorations.

MATERIALS AND METHODS

Regarding the clinical studies, the internal database which had previously been used for a meta-analysis on cervical restorations was updated with clinical studies published between 2008 and 2012 by searching the PubMed and SCOPUS databases. PubMed and the International Association for Dental Research abstracts online were searched for laboratory studies on microtensile, macrotensile and macroshear bond strength tests. The inclusion criteria were (1) dentin, (2) testing of at least four adhesive systems, (3) same diameter of composite and (4) 24h of water storage prior to testing. The clinical outcome variables were retention loss, marginal discoloration, detectable margins, and a clinical index comprising the three parameters by weighing them. Linear mixed models which included a random study effect were calculated for both, the laboratory and the clinical studies. The variability was assessed by calculating a ratio of variances, dividing the variance among the estimated bonding effects obtained in the linear mixed models by the sum of all variance components estimated in these models.

RESULTS

Thirty-two laboratory studies fulfilled the inclusion criteria comprising 183 experiments. Of those, 86 used the microtensile test evaluating 22 adhesive systems (AS). Twenty-seven used the macrotensile test with 17 AS, and 70 used the macroshear test with 24 AS. For 28 AS the results from clinical studies were available. Microtensile and macrotensile (Spearman rho=0.66, p=0.007) were moderately correlated and also microtensile and macroshear (Spearman rho=0.51, p=0.03) but not macroshear and macrotensile (Spearman rho=0.34, p=0.22). The effect of the adhesive system was significant for microtensile and macroshear (p < 0.001) but not for macrotensile. The effect of the adhesive system could explain 36% of the variability of the microtensile test, 27% of the macrotensile and 33% of the macroshear test. For the clinical trials, about 49% of the variability of retained restorations could be explained by the adhesive system. With respect to the correlation between bond strength tests and clinical parameters, only a moderate correlation between micro- and macrotensile test results and marginal discoloration was demonstrated. However, no correlation between these tests and a retention loss or marginal integrity was shown. The correlation improved when more studies were included compared to assessing only one study.

SIGNIFICANCE

The high variability of bond strength test results highlights the need to establish individual acceptance levels for a given test institute. The weak correlation of bond-strength test results with clinical parameters leads to the conclusion that one should not rely solely on bond strength tests to predict the clinical performance of an adhesive system but one should conduct other laboratory tests like tests on the marginal adaptation of fillings in extracted teeth and the retention loss of restorations in non-retentive cavities after artificial aging.

Validity of bond strength tests: A critical review: Part I

Adhesive systems are selected based on their bond strengths achieved while testing in laboratories. These bond strengths can predict the longevity of a restoration to some extent. There were several discrepancies in the reported bond strengths. To critically review the reliability of macro-bond strength tests used to evaluate resin-tooth interface. Relevant literature published between January 1983 and May 2013 was collected from PubMed database, Google scholar, and hand-searched journals of Conservative Dentistry, Endodontics and Dental materials. Variables that influence the test outcome are categorized into substrate-related factors, factors related to specimen properties, preparation of specimens, and test methodology. Impact of these variables on the test outcome is critically analyzed. There is lack of a standard format for reporting the bond strength tests, which could lead to misinterpretation of the data and bonding abilities of adhesives.