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

Effect of cross-head speed on the bond strength of dental resin to tooth structure - A review and re-analysis

OBJECTIVE

To review the published evidence for the role of cross-head speed on the apparent mechanical properties and bond strength of filled resins to tooth structure in order to identify the causes of inconsistency and contradictory results.

METHOD

The data for all available mechanical test results for studies involving dental resins at more than one strain rate was collected from 22 papers. Statistical reanalysis using linear regression was used to test the hypothesis that cross-head speed was correlated with the outcome, with the implication of causality, in each case.

RESULTS

In many cases the expected trend was found, in others not. However, it was apparent that the quality of data was often less than can be achieved, and that known interferences have not been recognized.

SIGNIFICANCE

Experimental work for the effect of cross-head speed on bond strength and other properties for dental resin-based materials has often failed to reach the standard which is required for useful data and thus better comprehension of behaviour. Other relevant conditions, such as temperature and water saturation, are in need of attention in this context.

Delayed light activation of resin composite affects the bond strength of adhesives under dynamic simulated pulpal pressure

OBJECTIVE

To evaluate the effect of a time delay before the light activation of resin composite on the microtensile bond strength (µTBS) of self-etch adhesives under dynamic simulated pulpal pressure.

MATERIALS AND METHODS

One hundred twenty crown segments were prepared from human third molars. Dentin surfaces were prepared with coarse diamond burs and connected to a dynamic pulpal pressure device. The self-etch adhesives used were Clearfil SE Bond (CSE), G2-Bond Universal (G2B), Clearfil Universal Bond Quick (CBQ), and G-Premio Bond (GPB). Each adhesive was divided into 3 subgroups: immediate light activation of resin composite (T₀), delayed light activation for 150 s (T₁), and 300 s (T₂). The µTBS data were obtained after 24-h water storage. Scanning electron microscopy was used to evaluate the nanoleakage at the resin-dentin surface. The µTBS data were analyzed using two-way ANOVA and Duncan's multiple comparisons.

RESULTS

All adhesives demonstrated a significant reduction in µTBS at T₂, except for CBQ where the bond strength was not affected by the delayed light activation times. The two-step self-etch adhesives (CSE and G2B) demonstrated higher bond strength than the one-step adhesives at all conditions. Nanoleakage was observed in all adhesives at T₂; however, nanoleakage was detected only in CBQ and GPB at T₁.

CONCLUSIONS

Delayed light activation of resin composite adversely affected the dentin bond strength of self-etch adhesives. Two-step self-etch adhesives had better bonding performance than one-step self-etch adhesives.

CLINICAL RELEVANCE

After adhesive application, resin composite should be adapted and cured as soon as possible.

Biodentine or Mineral Trioxide Aggregate as Direct Pulp Capping Material in Mature Permanent Teeth with Carious Exposure? A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the success rate of direct pulp capping (DPC) with Biodentine in mature permanent teeth with carious vital pulp exposure compared to that of DPC with mineral trioxide aggregate (MTA) by means of a systematic review and meta-analysis.

DATA SOURCES

The two authors searched independently the literature published through July 31, 2020, in five electronic databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science Core Collection, the Wiley Online Library, and the SCOPUS database).

STUDY SELECTION

The research protocol was previously registered in the PROSPERO database (CRD42020192511). Clinical studies that met the inclusion criteria were chosen and independently screened by the authors.

DATA EXTRACTION

A custom-designed spreadsheet was used to extract the data. The quality of each study was evaluated by means of the revised Cochrane risk of bias (ROB) tool or the ROB of nonrandomized studies of interventions tool.

DATA SYNTHESIS

Three randomized controlled trials and one retrospective study met the inclusion criteria. Only one study had a high risk of bias. The included studies reported data on a total of 95 participants with an age range of 8-51 years. No significant difference was observed in the overall treatment outcome when comparing Biodentine with MTA (Risk ratio=1.00, 95% confidence interval [0.93-1.07], p=1.00).

CONCLUSIONS

Biodentine had comparable clinical and radiographic success to that of MTA when used as a DPC agent in mature permanent teeth with carious vital pulp exposure. Additional high-quality studies are needed.

Micro-shear bond strength of adhesives with different degrees of acidity: Effect on sound and artificially hypermineralized dentin

This study evaluates the bond strength of four self-etching adhesive systems with different acidity levels in normal and artificially hypermineralized dentin substrate. Healthy human molars were divided into groups: normal dentin-N (n = 36) and artificially hypermineralized dentin-H (n = 36). Self-etching adhesive systems Clearfil S³ Bond (n = 9), Optibond All in One (n = 9), Clearfil SE Bond (n = 9), and Adhese (n = 9) were used for both the N and H groups. Transparent cylindrical matrices were positioned on the treated dentin surfaces, filled with composite resin, and light-cured for 40 s. After the transparent cylindrical matrices were removed, the specimens were stored for 24 hr in a humid environment at 37°C and were subjected to a micro-shear bond strength test. For each group, a specimen was prepared and evaluated in scanning electron microscope for adhesive interface observation. Normality was confirmed and the two-way analysis of variance and Games-Howell post-tests were conducted (α = .05). The data demonstrated an interaction between the adhesive system and type of dentin substrate (p < .01). For normal dentin, all adhesive systems assessed were adequate; however, in the hypermineralized dentin, the Clearfil SE Bond two-step self-etching adhesive system with mild pH presented the highest immediate bond strength. There was a predominance of adhesive failures for all adhesive systems in the different dentin substrates evaluated. It was concluded that the self-etching adhesive systems evaluated were efficient for both substrates, and for the hypermineralized dentin, the Clearfil SE Bond presented a higher bond strength value.

Variable Smear Layer and Adhesive Application: The Pursuit of Clinical Relevance in Bond Strength Testing

The removal or modification of smear layers that cover the dentin is critical to allow the penetration of adhesive molecules and to ensure a strong bond between resin and dentin. Aiming to establish a model for clinically-relevant dentin-bond testing, we evaluated the effects of smear layers created by abrasives having similar coarseness (180-grit SiC paper; fine-grit diamond bur) and application modes (single application; double application) on the microtensile bond strengths (µTBS) of two currently available universal adhesives (G-Premio Bond; Scotchbond Universal Adhesive) and a two-step self-etch adhesive (Clearfil Megabond 2). Sixty extracted human third molars were used for the μTBS test. Data were analyzed by three-way ANOVA and Tukey’s test (α = 0.05). Fracture modes were determined using stereomicroscopy. An additional 24 third molars were prepared for observation of the resin–dentin interface by TEM and adhesive-smear layer interaction by SEM. μTBS was significantly affected by the adhesives and their application modes (p < 0.001), implying that the double application of universal adhesives should be recommended to improve their performance. The effect of smear layers was not significant (p > 0.05), indicating that 180-grit SiC papers could be used to prepare dentin as a substitute for fine-grit diamond burs for dentin-bond testing in laboratory settings.

The Tooth: Its Structure and Properties

This article provides a brief review of recent investigations concerning the structure and properties of the tooth. The last decade has brought a greater emphasis on the durability of the tooth, an improved understanding of the fatigue and fracture behavior of the principal tissues, and their importance to tooth failures. The primary contributions to tooth durability are discussed, including the process of placing a restoration, the impact of aging, and challenges posed by the oral environment. The significance of these findings to the dental community and their importance to the pursuit of lifelong oral health are highlighted.

Clinical guidance and an evidence-based approach for restoration of worn dentition by direct composite resin

This paper aims to provide the dentist with practical guidance on the technique for direct composite restoration of worn teeth. It is based on current evidence and includes practical advice regarding type of composite, enamel and dentine preparation, dentine bonding and stent design. The application of direct composite has the advantage of being additive, conserving as much of the remaining worn tooth as possible, ease of placement and adjustment, low maintenance and reversibility. A pragmatic approach to management is advocated, particularly as many of the cases are older patients with advanced wear. Several cases restored by direct composite build-ups illustrate what can be achieved. The restoration of the worn dentition may be challenging for many dentists. Careful planning and simple treatment strategies, however, can prove to be highly effective and rewarding. By keeping any intervention as simple as possible, problems with high maintenance are avoided and management of future failure is made easier. An additive rather than a subtractive treatment approach is more intuitive for worn down teeth. Traditional approaches of full-mouth rehabilitation with indirect cast or milled restorations may still have their place but complex treatment modalities will inevitably be more time consuming, more costly, possibly require specialist care and still have an unpredictable outcome. Composite resin restorations are a universal restorative material familiar to dentists from early-on in the undergraduate curriculum. This review paper discusses the application of composite to restore the worn dentition.

Influence of dentin thickness on intrapulpal temperature under simulated pulpal pressure during Nd:YAG laser irradiation

The aim of this study was to evaluate the effects of dentin thickness and pulpal pressure simulation (PPS) on the variation of intrapulpal temperature (∆T) when submitted to an adhesive technique using laser irradiation. Sixty sound human molars were sectioned and randomly divided into two groups (n = 30): group 1-1 mm of dentin thickness; group 2-2 mm of dentin thickness. Each group was divided into two subgroups (n = 15): subgroup A-absence of PPS; subgroup P-presence of PPS (15 cm H₂O), sequentially treated with the following: 37 % phosphoric acid, adhesive system (Adper Single Bond), irradiation with Nd:YAG laser (1064 nm, 10 Hz, 60 s) using 60, 80, and 100 mJ/pulse energy parameters and light-curing (10 s). The ∆T was evaluated during the laser irradiation with a digital thermometer. Data were analyzed by three-way ANOVA and Tukey tests (p < 0.05). Three-way ANOVA revealed no significant differences for dentin thickness (p = 0.6512) on ∆T. PPS significantly reduced ∆T (p = 0.0001). The laser energy parameters (p = 0.0027) indicated that 100 mJ presented with significantly greater ∆T when compared to the groups irradiated with 80 and 60 mJ. Dentin thickness did not affect ∆T. The presence of PPS reduced the mean temperature values. The Nd:YAG laser energy parameters had a negative influence on the variation of temperature in the absence of PPS. In the presence of PPS, there was no risk to the pulp, since this study obtained temperature increases below 5.5 °C for all energy parameters, showing the technical viability for in vivo conditions.

Effect of endodontic sealers on bond strength of restorative systems to primary tooth pulp chamber

Background/purpose

Although current literature suggests that root canal sealers affect the bonding ability of restorative systems to pulp chamber dentin of permanent teeth, primary teeth have not been investigated. This study intended to evaluate the microtensile bond strength (μTBS) of three restorative systems to pulp chamber dentin in primary teeth and to determine the effect of two different root canal sealers on the μTBS.

Materials and methods

Ninety primary molars were used in this study. The teeth were randomly divided into three main groups according to canal sealers: (1) control (without sealer); (2) Metapex; and (3) zinc-oxide eugenol. The main groups were further divided into three subgroups depending on the coronal restorative system: (1) compomer (Prime Bond NT + Dyract EXTRA); (2) composite (Clearfil Tri-S Bond + Clearfil Photo Posterior); and (3) resin-modified glass ionomer (Fuji II LC). After restoration, the buccal wall of the pulp chamber was sectioned to obtain sticks (1 mm × 1 mm). The μTBS was then measured. Data were analyzed with two-way analysis of variance, followed by a posthoc test. The interfacial morphology of the bonded space was evaluated using scanning electron microscopy.

Results

In the control group, a significant difference was observed only for the μTBS of the composite (P < 0.05). Compared with the control groups, Metapex and zinc-oxide eugenol significantly reduced the μTBS of restorative systems (P < 0.05).

Conclusion

Composite materials seemed to bond to pulp chamber dentin in primary teeth with a higher strength than compomer and resin-modified glass ionomer. Metapex and zinc-oxide eugenol canal filling materials reduced the bond strength of all three restorative systems.

Effect of experimental silane-based primers with various contents of 2-hydroxyethyl methacrylate on the bond strength of orthodontic adhesives

AIM

To evaluate in vitro the effect of different concentrations of 2-hydroxyethyl methacrylate (HEMA) in experimental silane-based primers on shear bond strength of orthodontic adhesives.

METHODS

Different volume percentages of HEMA were tested in four experimental silane-based primer solutions (additions of HEMA: 0, 5.0 vol%, 25.0 vol% and 50.0 vol%). An experimental silane blend (primer) of 1.0 vol% 3-isocyanatopropyltrimethoxysilane (ICMS) + 0.5% bis-1,2-(triethoxysilyl) ethane (BTSE) was prepared and used. The experimental primers together with the control group were applied onto acid-etched premolars for attachment of orthodontic brackets. After artificial aging by thermocycling the shear-bond strength was measured. The fractured surfaces of all specimens were examined under scanning electron microscopy (SEM) to evaluate the failure mode on the enamel surface.

RESULTS

The experimental primers showed the highest shear-bond strength of 21.15 MPa (SD ± 2.70 MPa) and with 25 vol% showed a highly significant increase (P < 0.05) in bond strength. The SEM images showed full penetration of adhesive agents when using silane-based primers. In addition, the SEM images suggested that the predominant failure type was not necessarily the same as for the failure propagation.

CONCLUSIONS

This preliminary study suggested that nonacidic silane-based primers with HEMA addition might be an alternative to for use as adhesion promoting primers.

Fatigue failure of dentin-composite disks subjected to cyclic diametral compression

OBJECTIVE

Our aim was to establish the relationship between cyclic loading and fatigue life of the dentin-composite interface using the newly developed disk in diametral compression tests. The results were then used to estimate the fatigue life of restored teeth under occlusal loading.

METHODS

Disk specimens (5mm dia.×2mm thick) were prepared using bovine incisors and restored with either a methacrylate-based composite Z100™ with Adper Single Bond Plus (Z100) or silorane-based composite Filtek™ LS with LS System adhesive (LS). The dentin-composite disks were tested under cyclic diametral compression to determine the number of cycles to failure (Nf) at three load levels (n=3 per group). Finite element analysis (FEA) was used to calculate the interfacial stresses (σ) within the specimen, to establish the σ vs. Nf curves, and those within a restored tooth under normal chewing forces (15N maximum). These were then used to estimate the lifetime of the restored tooth for the two restorative systems.

RESULTS

The disks restored with LS had a higher fatigue resistance than those restored with Z100. The maximum interfacial stress in the restored tooth determined by FEA was ∼0.5MPa. Based on the estimate of 300,000 cycles of chewing per year, the predicted lifetime under occlusal loading for teeth restored with LS and Z100 was 33 and 10 years, respectively.

SIGNIFICANCE

The disk in cyclic diametral compression has been used successfully to provide fatigue data which allows the lifetime of composite-restored teeth under occlusal loading to be predicted using numerical simulation.

The influence of experimental silane primers on dentin bond strength and morphology: a laboratory and finite element analysis study

STATEMENT OF PROBLEM

The inconsistency of dentin bonding affects retention and microleakage.

PURPOSE

The purpose of this laboratory and finite element analysis study was to investigate the effects on the formation of a hybrid layer of an experimental silane coupling agent containing primer solutions composed of different percentages of hydroxyethyl methacrylate.

MATERIAL AND METHODS

A total of 125 sound human premolars were restored in vitro. Simple class I cavities were formed on each tooth, followed by the application of different compositions of experimental silane primers (0%, 5%, 25%, and 50% of hydroxyethyl methacrylate), bonding agents, and dental composite resins. Bond strength tests and scanning electron microscopy analyses were performed. The laboratory experimental results were validated with finite element analysis to determine the pattern of stress distribution. Simulations were conducted by placing the restorative composite resin in a premolar tooth by imitating simple class I cavities. The laboratory and finite element analysis data were significantly different from each other, as determined by 1-way ANOVA. A post hoc analysis was conducted on the bond strength data to further clarify the effects of silane primers.

RESULTS

The strongest bond of hybrid layer (16.96 MPa) was found in the primer with 25% hydroxyethyl methacrylate, suggesting a barely visible hybrid layer barrier. The control specimens without the application of the primer and the primer specimens with no hydroxyethyl methacrylate exhibited the lowest strength values (8.30 MPa and 11.78 MPa) with intermittent and low visibility of the hybrid layer. These results were supported by finite element analysis that suggested an evenly distributed stress on the model with 25% hydroxyethyl methacrylate.

CONCLUSIONS

Different compositions of experimental silane primers affected the formation of the hybrid layer and its resulting bond strength.

Restorative materials in the primary dentition of poli-caries patients

BACKGROUND

Despite an overall caries decline in children, still 50-60% of carious primary teeth of 6-year-olds remain untreated, in 3-year-olds 13%. There are an increasing number of poli-caries patients with insufficiently treated primary teeth. Therefore, early treatment is fundamental.

REVIEW

The assessment and indication for the use of restorative materials can be summarized as follows: Glass ionomer cements (GIC) are associated with easy handling and high fluoride release. This makes them attractive especially for Class I cavities in uncooperative children. However, low flexural strength causes high fracture rates in Class II cavities. Further developments (viscous and resin-modified GIC) have improved handling characteristics, but conventional non-resin-modified GIC are still prone to fracture. Compomers exhibit a clear potential as an alternative to amalgam. Long-term results are good even in stress-bearing areas. The compliance of the child should at least last long enough for adhesive application. Resin composites are still the most time-consuming alternative. Under a correct application protocol, resin composites behave in a similar manner to compomers. Therefore, the effort has to be judged individually. Finally, especially in severely decayed teeth and after endodontic treatment, preformed metal crowns should be taken into account as a last and appropriate alternative to direct restorations.

CONCLUSION

Based on the high clinical success rates, compomers with self-etch adhesives can be recommended for restorative therapy in anterior and posterior primary teeth.

Effect of the regional variability of dentinal substrate and modes of application of adhesive systems on the mechanical properties of the adhesive layer

Aim:

This study assessed the effect of the dentin depth and the application mode on the hardness and elastic modulus of the adhesive layer.

Materials and Methods:

Occlusal surfaces of 48 caries-free human third molars were removed, at two levels: Superficial and deep dentin. For each type of surface, the test specimens were randomly divided into groups which underwent the application: A conventional two-step adhesive system (Adper™ Single Bond [SB]) and self-etch adhesives system (Adper™ SE Plus [SE] and AdheSE^® [AD]). The adhesives applied were active or passive. Composite build-ups were constructed incrementally. The teeth were sectioned, embedded, and polished. The nanoindentation test was performed in the adhesive layer. The results were analyzed by ANOVA and Tukey tests.

Results:

In the adhesive layer, the higher hardness (0.307 ± 0.006 GPa) and elastic modulus (4.796 ± 0.165 GPa) of SE were obtained in superficial dentin in passive application. The elastic modulus of SE (4.115 ± 0.098 GPa) was lowest in active application in superficial dentin. The active application significantly increased the hardness of the SB in the deep dentin (0.011 ± 0.314 GPa) compared the superficial dentin (0.280 ± 0.010 GPa). For the AD, only the mode of application was statistically significant (P=0.0041) for the hardness, active application (0.289 ± 0.015 GPa) being higher than passive application (0.261 ± 0.013 GPa) (P=0.0042) in deep dentin.

Conclusion:

The experimental results reveal that the mechanical properties were influenced for the application mode of adhesive systems and dentin depth.

Micromorphology of resin-dentin interfaces using one-bottle etch&rinse and self-etching adhesive systems on laser-treated dentin surfaces: a confocal laser scanning microscope analysis

BACKGROUND AND OBJECTIVES

This study evaluated the hybrid layer (HL) morphology created by three adhesive systems (AS) on dentin surfaces treated with Er:YAG laser using two irradiation parameters.

STUDY DESIGN

Occlusal flat dentin surfaces of 36 human third molars were assigned into nine groups (n = 4) according to the following ASs: one bottle etch&rinse Single Bond Plus (3M ESPE), two-step Clearfil Protect Bond (Kuraray), and all-in-one S(3) Bond (Kuraray) self-etching, which were labeled with rhodamine B or fluorescein isothiocyanate-dextran and were applied to dentin surfaces that were irradiated with Er:YAG laser at either 120 (38.7 J/cm(2)) or 200 mJ/pulse (64.5 J/cm(2)), or were applied to untreated dentin surfaces (control group). The ASs were light-activated following MI and the bonded surfaces were restored with resin composite Z250 (3M ESPE). After 24 hours of storage in vegetable oil, the restored teeth were vertically, serially sectioned into 1-mm thick slabs, which had the adhesive interfaces analyzed with confocal laser microscope (CLSM-LSM 510 Meta). CLSM images were recorded in the fluorescent mode from three different regions along each bonded interface.

RESULTS

Non-uniform HL was created on laser-irradiated dentin surfaces regardless of laser irradiation protocol for all AS, while regular and uniform HL was observed in the control groups. "Stretch mark"-like red lines were found within the HL as a result of resin infiltration into dentin microfissures, which were predominantly observed in 200 mJ/pulse groups regardless of AS. Poor resin infiltration into peritubular dentin was observed in most regions of adhesive interfaces created by all ASs on laser-irradiated dentin, resulting in thin resin tags with neither funnel-shaped morphology nor lateral resin projections.

CONCLUSION

Laser irradiation of dentin surfaces at 120 or 200 mJ/pulse resulted in morphological changes in HL and resin tags for all ASs evaluated in the study.

Adhesive/Dentin interface: the weak link in the composite restoration

Results from clinical studies suggest that more than half of the 166 million dental restorations that were placed in the United States in 2005 were replacements for failed restorations. This emphasis on replacement therapy is expected to grow as dentists use composite as opposed to dental amalgam to restore moderate to large posterior lesions. Composite restorations have higher failure rates, more recurrent caries, and increased frequency of replacement as compared to amalgam. Penetration of bacterial enzymes, oral fluids, and bacteria into the crevices between the tooth and composite undermines the restoration and leads to recurrent decay and premature failure. Under in vivo conditions the bond formed at the adhesive/dentin interface can be the first defense against these noxious, damaging substances. The intent of this article is to review structural aspects of the clinical substrate that impact bond formation at the adhesive/dentin interface; to examine physico-chemical factors that affect the integrity and durability of the adhesive/dentin interfacial bond; and to explore how these factors act synergistically with mechanical forces to undermine the composite restoration. The article will examine the various avenues that have been pursued to address these problems and it will explore how alterations in material chemistry could address the detrimental impact of physico-chemical stresses on the bond formed at the adhesive/dentin interface.

Shear bond strength of three different nano-restorative materials to dentin

OBJECTIVES

To evaluate the shear bond strength (SBS) of a nano-composite, a flowable nano-composite and a nano glass ionomer to dentin in vitro.

MATERIALS AND METHODS

Sixty human molars were ground flat, exposing the dentin surfaces, and they were randomly divided into five groups according to the restorative materials and adhesive systems used (n = 12/group). The restoratives were applied to all dentin surfaces according to the manufacturer's instructions, using a special jig (Ultradent) in the following manner: Group 1: a nano-composite (NC) (Filtek Supreme XT-3M ESPE) was applied with a two-step self-etch adhesive (SE) (Adper SE Plus-3M ESPE); Group 2: NC was applied with an etch&rinse adhesive (SB) (Adper Single Bond 2-3M ESPE); Group 3: a flowable nano-composite (FNC, Filtek Supreme XT Flow-3M ESPE) was applied with SE; Group 4: FNC was applied with SB and Group 5: a nanofilled resin-modified glass ionomer (Ketac N100-3M ESPE) was applied with Ketac Nano Primer (3M ESPE). The bonded specimens were stored in distilled water (37 degrees C, 24 hours) and tested for SBS in a universal testing machine (1 mm/minute). Two specimens from each group were subjected to SEM evaluations of the adhesive interfaces. Failure modes were determined using a stereomicroscope. The mean SBS values were calculated and the data were analyzed with the Kruskal Wallis and Mann-Whitney-U tests (p < 0.05).

RESULTS

Mean SBS values (MPa) for the groups were 13.64; 7.83; 11.20; 4.12 and 0.64 for Groups 1, 2, 3, 4 and 5, respectively. Group 1 exhibited a significantly higher value than all the other groups; whereas, Group 5 had the lowest value (p < 0.05). The SE adhesive yielded higher bond values than the SB adhesive with NC and FNC restorative materials. Failure modes in all the groups were primarily adhesive.

CONCLUSION

The results demonstrate the capacity of the current two-step self-etch adhesive to outperform the etch&rinse adhesive in conjunction with the two nano-restoratives tested.

Acid-etch interval and shear bond strength of Er,Cr:YSGG laser-prepared enamel and dentin

The formation of a superficial layer of tiny flakes has been observed on teeth prepared by Erbium lasers. It has been suggested that removing this layer (mechanically or chemically) may increase the bond strength of the resin composite. The purpose of this study is to evaluate the effect of various etching times on bond strength of resin composite to enamel and dentin prepared by Er,Cr:YSGG laser. Sixty previously flattened human molars were irradiated for 10 s by an Er,Cr:YSGG laser. Enamel (E) specimens were etched with 37% H(3)PO(4) for 20, 40 or 60 s and dentin (D) specimens were etched for 15 or 30 s. All specimens were prepared for a standard shear bond strength (SBS) test (1 mm/min). Data were analyzed [ANOVA, Tukey post-hoc, a < 0.05)] and the failure mode was studied under SEM. Mean SBS+/-sd (MPa) for each group was 16.97 +/- 7.77 (E20s), 21.34 +/- 3.55 (E40s), 14.08 +/- 4.77 (E60s), 13.62 +/- 7.28 (D15s) and 13.15 +/- 6.25 (D30s). SBS for E40s was significantly higher than E60s (p = 0.023). No difference was noted between the dentin groups. SEM evaluation showed predominantly cohesive failure. Within the limits of this study, etching time significantly influenced the SBS of composite resin to laser-prepared enamel. SEM showed subsurface cracks, fissures, and deformities leading to predominantly cohesive failure in both enamel and dentin.

In vitro microTBS of one-bottle adhesive systems: sound versus artificially-created caries-affected dentin

This in vitro study aimed to evaluate a pH-cycling model for simulation of caries-affected dentin (CAD) surfaces, by comparing the bond strength of etch-and-rinse adhesive systems on sound and artificially-created CAD. Dentin substrates with different mineral contents and morphological patterns were created by submitting buccal bovine dentin to the following treatments: (1) immersion in artificial saliva during the experimental period (sound dentin, SD), or (2) induction to a CAD condition by means of a dynamic pH-cycling model (8 cycles, demineralization for 3 h followed by mineralization for 45 h). The bond strength of Excite or Prime and Bond NT adhesive systems was assessed using the microtensile bond strength (microTBS) test. Dentin microhardness was determined by cross-sectional Knoop evaluations. Resin-dentin morphology after the treatments was examined by scanning electron microscopy. SD produced significantly higher microTBS than CAD for both adhesives evaluated, without differences between materials. CAD exhibited lower microhardness than SD. Morphological analysis showed marked distinctions between SD and CAD bonded interfaces. Under the conditions of this study, differences in morphological pattern and dentin mineral content may help to explain resin-dentin bond strengths. The proposed pH-cycling model may be a suitable method to simulate CAD surfaces for bonding evaluations.

SEM evaluation of the hybrid layer after cavity preparation with Er:YAG laser

This study compared the thickness of the hybrid layer formed using Scotchbond Multi-Purpose Plus, Single Bond 2, Prime & Bond 2.1 and Xeno III on a dentin surface prepared with a diamond bur in a high speed handpiece or prepared with an Er:YAG laser used with two parameters of pulse energy (200 and 400 mJ) and two parameters of frequency (4 and 6 Hz). Flat dentin surfaces obtained from 20 human third molars were treated with the two methods and were then prepared with the dentin adhesive systems according to the manufacturers' instructions. After a layer of composite was applied, the specimens were sectioned, flattened, polished and prepared for Scanning Electronic Microscopy observation. Five different measurements of the hybrid layer thickness were obtained along the bonded surface in each specimen. The results were statistically analyzed using Analysis of Variance and Student-Newman-Keuls tests (p < or = 0.05). When analyzing the hybrid layer thickness and comparing the cavity preparation method, four groups were formed: Group I (diamond bur) > Group II (Laser 200 mJ/4 Hz) = Group III (Laser 200 mJ/6 Hz) > Group IV (Laser 400 mJ/4 Hz) > Group V (Laser 400 mJ/6 Hz). When comparing the dentin adhesive systems, there were no statistically significant differences. These results showed that the four tested dentin adhesive systems produced a 2.90 +/- 1.71 microm hybrid layer in dentin prepared with a diamond bur. This hybrid layer was regular and routinely found. In the laser groups, the dentin adhesive systems produced hybrid layers ranging from 0.41 +/- 1.00 microm to 2.06 +/- 2.49 microm, which were very irregular and not routinely found. It was also concluded that the Er:YAG laser, with the parameters used in this experiment, has a negative influence on the formation of a hybrid layer and cavity preparation methods influence formation of the hybrid layer.

Long-term dentin retention of etch-and-rinse and self-etch adhesives and a resin-modified glass ionomer cement in non-carious cervical lesions

OBJECTIVES

The aim of this study was to evaluate the clinical long-term retention to dentin of seven adhesive systems.

METHODS

A total of 270 Class V restorations of four etch-and-rinse, one self-etch adhesive system and a resin-modified glass ionomer cement were placed in non-carious cervical lesions without intentional enamel involvement. The restorations were evaluated at baseline, 6, 12, 18, and 24 months and then every year during a 13-year follow-up. Dentin bonding efficiency was determined by the percentage of lost restorations.

RESULTS

During the 13 years, 215 restorations could be evaluated. The cumulative loss rate at 13 years was 53.0%, with significant different failures rates for the different systems varying between 35.6 and 86.8%. Four systems fulfilled the ADA 18-month full acceptance retention criteria. Two systems showed at 18 months and earlier high debonding rates. The annual failure rates for the etch-and-rinse systems were Optibond 3.1%, Permagen 13.0%, Scotchbond MP 4.8%, Syntac classic 2.8%; for the self-etch system P&S 4.4%; and the resin-modified glass ionomer cement Vitremer 2.7%.

CONCLUSION

It can be concluded that all systems showed a continuous degradation of the bond with a wide variation, which was independent of the adhesion strategy. Three bonding systems showed a cumulative failure rate after 13 years between 36 and 41% with the best retention for the resin-modified glass ionomer cement and a four-step etch-and-rinse system.

Nd:YAG laser influence on microtensile bond strength of different adhesive systems for human dentin

OBJECTIVE

The purpose of this study was to investigate the influence of Nd:YAG on microtensile bond strength (microTBS) of different adhesive systems for human dentin.

BACKGROUND DATA

Lasers have been widely used in dentistry. New adhesive systems with different chemical compositions are introduced every year, and it is important to investigate the bonding of new adhesive systems to dentin irradiated with laser.

METHODS

The occlusal surfaces of third molars were removed to obtain flat dentin surfaces. The teeth were randomly divided into six groups. Each adhesive system was applied, according to manufacturers' instructions, to surface dentine with and without Nd:YAG laser irradiation (0.9 W, 15 Hz, 60 mJ per pulse). A block of composite resin was built over the adhesive layer. The specimens were sectioned to obtain 0.70 x 0.70 mm of transversal section. Twenty test specimens were selected for each group, and were then submitted to microTBS on a universal testing machine.

RESULTS

According to Student's t-test, for Single Bond, there was no statistically significant difference without (49.32 MPa) and with (47.34 MPa) laser application (p = 0.60). For the Tyrian SPE/One Step Plus, microTBS value with laser (27.09 MPa) was statistically higher than without laser (19.13 MPa), as well as for Adper Prompt L-Pop (22.85 and 13.78 Mpa; p < or = 0.01).

CONCLUSION

The application of Nd:YAG laser to dentin provided an increase in the bond strength values for the Tyrian SPE/One Step Plus and Adper Prompt L-Pop adhesive systems, but did not influence the bond strength values of the Single Bond adhesive system.

Compomers in restorative therapy of children: a literature review

OBJECTIVE

The restoration of carious primary teeth plays an underestimated role in paediatric dentistry. This is astonishing for many reasons, not least because many new materials have been introduced in recent years. New or modified techniques and materials, with better aesthetics and flexural properties, allow minimally invasive treatment. A transfer of techniques between different dentitions, however, may be problematic because of both micromorphological differences and compliance. Therefore, this paper deals with options for restoring primary teeth and the early stages of the mixed dentition using polyacid-modified composites, the so-called compomers.

METHODS

Medline and Embase were scanned from 1990 through 2006. Furthermore, a hand-search of nonlisted but peer-reviewed papers was performed. The search items were compomer*, dent*, primary* and deciduous*, which identified 109 relevant publications.

CONCLUSIONS

Based on high clinical success rates, compomers are now an effective alternative to other materials for restorative therapy in the anterior and posterior primary teeth. A minimum amount of compliance is still mandatory in order to allow for a few minutes of adhesive pretreatment and layering without contamination. If this is not the case, compomers make no sense. Stainless steel crowns are still the most effective from of restoration for severely decayed primary molars.

Histologic evaluation of direct pulp capping with a self-etching adhesive and calcium hydroxide in beagles

OBJECTIVE

To evaluate the pulpal response of beagles following direct pulp capping with Clearfil SE Bond (SB), a self-etching adhesive.

STUDY DESIGN

One hundred thirty sound teeth from 6 male beagles were used. One hundred twenty teeth had their pulp mechanically exposed at the bottom of the class V cavities and were divided into 2 groups. In group 1, teeth were capped with SB; group 2 teeth were capped with calcium hydroxide cement (CH). Ten teeth were kept intact as an untreated control group. After 7, 30, and 90 days, 40 teeth from 2 beagles were extracted and processed for light microscopic examination.

RESULTS

After the 7-day observation period, inflammatory reaction in the SB group was similar to that of the CH group (P > .05). After the 30-day and 90-day observation periods, inflammatory reaction was slight in both groups, but less dentin bridge formation was observed in specimens from the SB group than in those from the CH group (P < .05).

CONCLUSION

SB showed good biocompatibility with pulp, but its ability to induce reparative dentin was lower than that of CH.

Effect of Dentin Conditioning Time on Nanoleakage

Increasing dentin conditioning time did not affect nanoleakage for any of the dentin adhesives used in this study.

Shear bond strength and SEM evaluation of composite bonded to Er:YAG laser-prepared dentin and enamel

OBJECTIVES

The purpose of this study was to evaluate dentin and enamel bond strength to resin composite following high-speed rotary or Er:YAG laser preparation using a total etch adhesive system. The microstructure of resin-tooth interfaces was also investigated.

METHODS

Human dentin and enamel specimens were prepared with a high-speed handpiece (KaVo) or Er:YAG laser (DELight) at manufacturer's recommended settings and etched with either 37% H(3)PO(4), laser etched, or not etched. Composite rods (Z-250, 3M/ESPE) were bonded to specimens with an adhesive (Adper Scotchbond Multi-Purpose, 3M/ESPE). After thermocycling, specimens were tested in shear to failure.

RESULTS

Two-factor ANOVA detected significant differences in the main effects of preparation and etch type, and interaction (p<0.001). Post hoc analyses showed that in both dentin and enamel, only the acid-etched specimens had significantly higher mean bond strengths, with rotary-prepared specimens having significantly higher mean bond strengths versus laser prepared specimens. Within each preparation type, in both dentin and enamel, acid etch was better than laser etch, and laser etch was better than no etch. Scanning electron microscopy of laser-ablated specimens demonstrated significant surface scaling and subsurface fissuring beyond normal resin penetration depth.

SIGNIFICANCE

Adhesion to laser-ablated or laser-etched dentin and enamel was inferior to that of conventional rotary preparation and acid etching.

Effects of cleaning agents on bond strength to dentin

The cleaning of cavity walls aims to improve adhesive restorative procedures and longevity of restorations. This study has compared the effect of three cleaning agents--sodium bicarbonate jet (Profi II, Dabi Atlante, São Paulo, Brazil); pumice paste plus a biologic detergent (Tergestesim, Probem, São Paulo, Brazil); air water spray--on the bond strength between dentin and two different adhesive systems: Clearfil SE Bond (Kuraray, Kioto, Japan) and Scotchbond Multi-Purpose Plus (3M-ESPE, São Paulo, Brazil). Six groups (n: 10) of dental fragments obtained from young adult extracted teeth were prepared, and each one received one of the listed surface cleaning techniques. After the adhesive application, a cone-shaped test body was built with AP-X (Kuraray, Kioto, Japan) or Z100 (3M-ESPE, São Paulo, Brazil) composite resins, using a Teflon matrix. The specimens were tested for tensile bond strength after one-week storage in distilled water at 37 degrees C. Two pairs of fractured specimens of each group were randomly chosen and processed for scanning electron microscopy (SEM) analysis. ANOVA test of the bond strength values showed no statistical differences among the cleaning agents and neither between their interactions with the bonding systems. Upon SEM analysis, most surfaces showed mixed fractures of adhesive and cohesive failures in bonding resin to dentin. Based on statistical and SEM analysis, it was concluded that the cleaning agents studied did not interfere with the bond strength of the adhesive systems used to dentin.

Marginal Leakage in Class V Cavities Pretreated with Different Laser Energy Densities

The purpose of the present study was to evaluate in vitro the degree of marginal leakage in Class V cavities involving the cementoenamel junction. Cavities were 4 mm wide and 2 mm deep. The specimens received dentin pretreatment (37% phosphoric acid) followed by the Single Bond (3M) adhesive system application. The 40 specimens were then divided into four groups: Group 1 (control); Group 2 (Nd:YAG laser at 120 mJ/pulse, frequency of 10 Hz, power of 1.2 W); Group 3 (Nd:YAG laser at 140 mJ/pulse, frequency of 10 Hz, power of 1.4 W); Group 4 (Nd:YAG laser at 160 mJ/pulse, frequency of 10 Hz, power of 1.6 W). The cavities were restored with Z100 composite resin (3M) and light cured at 300-600 mW/cm2 light intensity. Specimens were thermocycled to 500 cycles from 2-50 degrees C. After that, they were dried and sealed with nail varnish, respecting 1 mm around the restorations, and immersed in 0.5% methylene blue solution for 4 h. After this period, the teeth were rinsed, dried, sectioned, and analyzed in a stereoscopic loupe. The highest leakage scores were considered for each specimen. The results were statistically analyzed by the analysis of variance (ANOVA) - Kruskal-Wallis test to the 5% level. For both the enamel and cementum, there was a decrease in marginal leakage with the application of laser energy; no significant differences were observed for Groups 2, 3, and 4. The results also showed a smaller tendency to marginal leakage on the cementum than on the enamel.

Water content and apparent stiffness of non-caries versus caries-affected human dentin

Caries-affected dentin contains less mineral and more water than surrounding normal dentin. Such dentin should be less stiff and should shrink more than normal dentin when dried. The purpose of this study was to test the relationships between the stiffness, shrinkage, and water content of caries-affected versus normal dentin. Extracted human carious third molars were stained with caries-detector dye and the occlusal surfaces ground down until only caries-affected dentin remained, surrounded by normal dentin. Dentin disks were prepared from these crowns placed in a aluminum well positioned under a modified thermal mechanical analyzer. Changes in specimen height and stiffness were measured following drying or static loading in both caries-affected and surrounding normal dentin. Core samples of these two types of dentin were used to gravimetrically measure water content. Two-way ANOVA and regression analysis was used to test the relationship between shrinkage versus water content, stiffness versus water content, and stiffness versus shrinkage. Caries-affected dentin was found to be less stiff and contained more water than normal dentin (p < 0.05). Regression analysis revealed highly significant inverse relationships between stiffness and water content, and stiffness and shrinkage (p < 0.0005).

Investigation into the nature of dentin resin tags: a scanning electron microscopic morphological analysis of demineralized bonded dentin

STATEMENT OF PROBLEM

While the formation of the dentin/adhesive hybrid layer has been generally established, the infiltration and flow of the adhesive resin inside the acid treated dentinal tubules remains controversial.

PURPOSE

The aim of the present study was to investigate and review the current interpretation of resin tags by means of scanning electron microscopic (SEM) observation.

MATERIAL AND METHODS

Eight noncarious, human third molars were cut transversally and then longitudinally to obtain 8 middle-to-deep dentinal surfaces. The dentin was etched with 37% phosphoric acid (H 3 PO 4 ) gel for 10 seconds and then rinsed with water for 20 seconds. The dentin was kept moist by removing the excess water with a damp cotton pellet. The conditioned dentin was treated with a dentin bonding agent (Single Bond) and was light-polymerized for 20 seconds. A 0.2- to 0.5-mm layer of flowable composite (Tetric Flow) was then applied to the bonded dentin followed by 2 layers (2 mm each) of composite (Z 250). Each composite was light-polymerized for 40 seconds. Subsequently, the specimens were cut lengthwise into 2 halves and randomly divided into 4 groups (n=4), according to the surface preparation modality of the sectioned surface: Group EA: ethylenediamine tetraacetic acid, Group PA3: H 3 PO 4, Group PA120: H 3 PO 4 + NaOCl, and Group CA: HCl + NaOCl. Two additional teeth (Group N) were cut lengthwise into 2 halves and served as the control. The sectioned surfaces were treated with HCl and NaOCl. All specimens were processed for SEM observation.

RESULTS

Specimens from Groups EA, PA3, PA120, CA, and N showed filamentous structures that were tens of microns long. Some filaments presented split-ends with hollow structures and very thin walls. Others made sharp hairpin turns indicating they were soft and compliant.

CONCLUSIONS

Conventional SEM techniques, which are currently used to detect resin tags, actually identified filamentous organic structures, supposedly glycosaminoglycans, which were resistant to conventional specimen preparation techniques. The organic component showed a strong resemblance to the lamina limitans contained within the dentinal tubules. Over-reliance on SEM morphology has led to much confusion about the depth of penetration of resin tags.

Resin bonding to cervical sclerotic dentin: a review

Several reports have indicated that resin bond strengths to noncarious sclerotic cervical dentine are lower than bonds made to normal dentine. This is thought to be due to tubule occlusion by mineral salts, preventing resin tag formation. The purpose of this review was to critically examine what is known about the structure of this type of dentine. Recent transmission electron microscopy revealed that in addition to occlusion of the tubules by mineral crystals, many parts of wedge-shaped cervical lesions contain a hypermineralised surface that resists the etching action of both self-etching primers and phosphoric acid. This layer prevents hybridisation of the underlying sclerotic dentine. In addition, bacteria are often detected on top of the hypermineralised layer. Sometimes the bacteria were embedded in a partially mineralised matrix. Acidic conditioners and resins penetrate variable distances into these multilayered structures. Examination of both sides of the failed bonds revealed a wide variation in fracture patterns that involved all of these structures. Microtensile bond strengths to the occlusal, gingival and deepest portions of these wedge-shaped lesions were significantly lower than similar areas artificially prepared in normal teeth. When resin bonds to sclerotic dentine are extended to include peripheral sound dentine, their bond strengths are probably high enough to permit retention of class V restorations by adhesion, without additional retention.

Influence of the mineral content and morphological pattern of artificial root caries lesion on composite resin bond strength

Dentine substrates with different mineral contents and morphological patterns were created by submitting root slabs to the following treatments: (A) immersion in artificial saliva during the experimental period (control), (B) demineralization for 32 h to induce caries lesion (demineralized group), and (C) demineralization for 32 h followed by remineralization for 8 d (remineralized group). The slabs were longitudinally sectioned, the mineral content was determined by cross-sectional microhardness, and the bond strength of an adhesive system/composite resin was assessed using a microtensile bond strength test. The dentine morphology after the treatments as well as the failure pattern of the debonded specimens was examined by scanning electron microscopy. Statistically significant differences were found in mineral content. Morphological analysis showed marked differences between the patterns of demineralized and remineralized substrates. The bond strength mean value of the control A did not differ from the group B, but was statistically higher than the group C. Since no linear relationship was found between dentine mineral content and bond strength values, it could be suggested that the morphological pattern may be more relevant than the mineral content to explain the bond strength of composite resin to dentine.

The influence of the dentin smear layer on adhesion: a self-etching primer vs. a total-etch system

OBJECTIVE

To determine the effect of dentin smear layers created by various abrasives on the adhesion of a self-etching primer (SE) and total-etch (SB) bonding systems.

METHODS

Polished human dentin disks were further abraded with 0.05 micro m alumina slurry, 240-, 320- or 600-grit abrasive papers, # 245 carbide, # 250.9 F diamond or # 250.9 C diamond burs. Shear bond strength (SBS) was evaluated by single-plane lap shear, after bonding with SE or SB and with a restorative composite. Smear layers were characterized by thickness, using SEM; surface roughness using AFM; and reaction to the conditioners, based on the percentage of open tubules, using SEM.

RESULTS

Overall, SBS was lower when SB was used than when SE was used. SBS decreased with increasing coarseness of the abrasive in the SE group. Among burs, the carbide group had the highest SBS, and 320- and 240-grit papers had SBS close to the carbide group. Surface roughness and smear layer thickness varied strongly with coarseness. After conditioning with SE primer, the tubule openness of specimens abraded by carbide bur did not differ from 240- or 320-grit paper, but did differ from the 600-grit.

SIGNIFICANCE

Even though affected by different surface preparation methods, SE yielded higher SBS than SB. The higher SBS and thin smear layer of the carbide bur group, suggests its use when self-etching materials are used in vivo. Overall, the 320-grit abrasive paper surface finish yielded results closer to that of the carbide bur and its use is recommended in vitro as a clinical simulator when using the SE material.

Influence of adhesive polymerization mode on dentin bond strength of direct core foundation systems

This study examined the influence of various adhesive systems on dentin bond strength of direct core foundation resins. Two commercially available direct core foundation resin systems and 2 adhesive polymerization modes were used. Facial bovine dentin surfaces were wet ground on 600-grit SiC paper. Dentin surfaces were treated according to the manufacturers' instructions and were light polymerized (control). Chemical- and light-polymerized adhesive systems were used separately. The resin paste was condensed into a mold and bonded to the dentin surface. Ten specimens per test group were stored in water at 37 degrees C for 24 hours, and a shear test was conducted at a crosshead speed of 1.0 mm/minute using a universal testing machine. Analysis of variance (ANOVA) and Duncan's multiple comparison test were performed (alpha = 0.05). Dual polymerization of resin pastes revealed higher bond strength with the combination of light-polymerized adhesive (22.8-24.3 MPa), but significantly lower bond strength with the combination of a chemical-polymerized adhesive (4.2-5.7 MPa). The present data suggests that dentin bond strengths in direct core foundation systems can be influenced by the combination of adhesive and resin paste.

Influence of dentinal regions on bond strengths of different adhesive systems

This in vitro study assessed comparatively the shear bond strengths of three composite resins, 3M Valux Plus (3MVP), Herculite (H), Clearfil AP-X (CAP-X), a polyacid modified composite resin Dyract (D), and a resin modified glass-ionomer materials Vitremer (V), to cervical and buccal dentine regions of extracted human molar teeth. Four different bonding systems, 3M ScotchBond Multipurpose (SB), Clearfil Liner Bond 2 (LB2), Opti Bond (OB), and Prime & Bond 2.1 (PB 2.1) were used with the manufacturer's respective composite and compomer materials. One hundred freshly extracted mandibular molar teeth were selected for this study. Flat buccal dentine surfaces were created on 50 teeth and cylindrical rods of the five materials were bonded to the dentine surfaces. For assessment of cervical bond strengths, the materials were bonded to mesial and distal enamel bordered occlusal dentinal surfaces of the remaining 50 teeth. The five groups of restorative procedures were applied as follows; Group 1: SB + 3MVP, Group 2: LB2 + CAP-X, Group 3: OB + H, Group 4: PB2.1 + D, Group 5: Vitremer primer (VP) VP + V. Each restorative procedure thus had 20 specimens (10 buccal + 10 cervical). After 24 h of water storage (37 degrees C), the specimens were tested on a Universal Testing machine in shear with a cross head speed of 0.5 mm min-1. The bond strength values were calculated in MPa and the results were evaluated statistically using Kruskal-Wallis one-way/anova and Mann-Whitney U-tests. It was found that the bond strengths of SB + 3MVP, LB2 + CAP-X and VP + V to buccal dentine surfaces were significantly stronger (P < 0.05) than those to the occluso-cervical dentine floors. When the bond strengths to the occluso-cervical dentine and buccal dentine surface were compared, there was no significant difference between the materials (P > 0.05). Vitremer was found the least successful adhesive material in terms of shear bond strength on both buccal and occluso-cervical dentine surfaces.

Effect of surface conditioning and restorative material on the shear bond strength and resin-dentin interface of a new one-bottle nanofilled adhesive

OBJECTIVES

To determine the effect of different combinations of surface conditioning (DeTrey Conditioner 36, NRC, no etching) and restorative materials (Dyract AP, Spectrum TPH) on the shear bond strength of Prime and Bond NT to enamel and dentin, and to characterize the resin-dentin interface produced by these combinations.

METHODS

Shear bond strength was tested on 30 enamel and 30 dentin flat labial surfaces of extracted bovine teeth. The enamel and dentin specimens were randomly assigned to six groups of five teeth each and treated using different combinations of surface conditioners and restorative materials with Prime and Bond NT. Scanning electron microscope (SEM) observation of argon-ion-etched specimens was done to evaluate the resin-dentin interface.

RESULTS

The type of surface conditioning and restorative material had significant effects on dentin bond strengths. Etching the dentin prior to application of Prime and Bond NT significantly increased bond strength and caused formation of a hybrid layer for Spectrum TPH. For Dyract AP, dentin etching generally did not improve bond strength despite the formation of a hybrid layer. On enamel, Prime and Bond NT had consistently high bond strengths on etched specimens.

SIGNIFICANCE

The results showed that Dyract AP and Spectrum TPH, when used with Prime and Bond NT have different bonding mechanisms and the effect of surface conditioning on their shear bond strength differs. Clinicians should be aware of these effects in order to optimize bonding.

Effect of fluoride application on tensile bond strength of self-etching adhesive systems to demineralized dentin

STATEMENT OF PROBLEM

It has been reported that the bond strength of composite to demineralized dentin is lower than that to sound dentin. This can be a problem in the success of so-called sealed restorations.

PURPOSE

The aim of this study was to evaluate the effect of fluoride application on the tensile bond strength of self-etching adhesive systems to demineralized dentin.

MATERIAL AND METHODS

One hundred twenty extracted bovine incisors were ground flat with 600-grit silicone carbide paper. Ninety teeth were then immersed in acetate buffer (pH 4.0) to form demineralized dentin. These teeth were randomly divided into 3 groups of 30 each: surfaces treated with fluoride solution (Group NF), surfaces treated with fluoride solution followed by a water rinse (Group RF), and control surfaces with no pretreatment (Group C). The remaining 30 teeth comprised a group with normal dentin surfaces (Group S). Each group was further divided into 3 subgroups of 10 each to test the bond strength test of Clearfil SE Bond, Unifil Bond, and Mac-Bond II. Tensile bond strengths (in MPa) were measured with a universal testing machine at a crosshead speed of 0.5 mm/min. Mean bond strengths were analyzed by 2-way analysis of variance and Fisher's PLSD (P =.05). SEM observations of the surfaces before and after priming and at resin-dentin interfaces in each group were performed. Elemental analysis of the dentin surfaces before priming was also carried out.

RESULTS

The bond strengths of the adhesives to demineralized dentin in Groups NF, RF, and C were significantly lower than that of the normal dentin in Group S (P <.05). The mean bond strengths of the 3 adhesives in Group NF were higher than those in Groups RF and C, but a significant difference was observed only when Clearfil SE Bond was used (P <.05). In SEM images the open dentinal tubules on the surface and the resin tag formation at the resin-dentin interface were apparent in Group NF but were not observed in Groups RF and C. On elemental analysis, considerable amounts of fluoride and calcium were detected in the surfaces of Group NF.

CONCLUSION

Within the limitations of this study, the surface treatment with fluoride solution supported the resin tag formation at the resin-dentin interface and slightly improved the bond strength of the self-etching adhesive systems tested to demineralized dentin. This result indicated that the fluoride treatment to demineralized dentin might contribute to the success of the sealed restoration.

The use of flowable composites as filled adhesives

OBJECTIVE

The effect of filled adhesives on bonding resin composites to dentin has not been fully understood. Due to their filler content, filled adhesives may act as stress breakers. The aim of this in vitro study was to evaluate the use of flowable composites of different viscosities on bonding to enamel and dentin without the use of an intermediate bonding resin.

MATERIALS AND METHODS

Enamel and dentin bond strengths of OptiBond FL, Syntac Classic, and EBS Multi combined either with their proprietary bonding agent or a flowable resin composite (Ultraseal XT Plus or Revolution) were measured. The tests were carried out with a microtensile device at a crosshead speed of 1mm/min after 24h of storage at 37 degrees C in water. Mean bond strengths were analyzed using the Wilcoxon test and multiple comparisons according to the Mann-Whitney U-test. The micro-morphology of corresponding resin-dentin interfaces of the same teeth were analyzed using SEM and TEM.

RESULTS

The control groups with adhesive systems used as per manufacturers' protocol showed bond strengths of 38.9-41.1 MPa to enamel and 28.8-33.4 MPa to dentin. With respect to bond strength to etched enamel, only Ultraseal XT Plus as bonding resin reached the level of the control groups. When used as bonding agents on dentin, both flowable composites produced lower microtensile bond strengths to etched and primed dentin than did the control groups. Micro-morphological analysis using SEM and TEM resulted in hybrid layer formation for both control and experimental groups. However, many areas of the resin-dentin interface showed insufficient penetration of the flowable composites at the top of the hybrid layer as well as numerous tubules obstructed by filler particles.

CONCLUSIONS

The flowable composites tested in this study should not be used to replace bonding agents. Flowable composites of thinner viscosity, such as Ultraseal XT Plus, may bond to enamel adequately without the requirement of an intermediate bonding resin.

"No-bottle" vs "multi-bottle" dentin adhesives--a microtensile bond strength and morphological study

PURPOSE

To compare the adhesive capability of the new adhesive Prompt L-Pop (ESPE) with that of two total-etch adhesive systems-EBS Multi (ESPE) and Prime&Bond NT (Dentsply).

METHODS

Extracted human molars were bonded and prepared for microtensile dentin bond strength (microTBS) testing using Prompt L-Pop, EBS Multi, and Prime&Bond NT combined with Pertac II (composite) or Hytac Aplitip (compomer). Prompt L-Pop was applied using five different protocols: (1) as an "all-in-one" self-conditioning adhesive, as per manufacturer's instructions (LP); (2) as a self-etching primer combined with a separate bonding resin (LP/self-etch 2-step); (3) as a classical primer used upon etching dentin with phosphoric acid, followed by a bonding resin (LP/total-etch 3-step); (4) as a multi-application "all-in-one" self-conditioning adhesive (LP/multi-coat) to leave a visibly glossy dentin surface; and (5) as a filled adhesive, upon adding quartz fillers to its composition (LP/filled). After 24h of storage in water at 37 degrees C the microTBS were measured in an Instron machine. Corresponding interfaces of the same specimens were micromorphologically analyzed using SEM and TEM.

RESULTS

When used with a composite resin, LP/filled and LP/multi-coat resulted in significantly higher microTBS than LP. The addition of an extra adhesive bonding resin (LP/self-etch 2-step) had no effect on bond strength. The use of Prompt L-Pop as a primer of a fourth-generation adhesive (LP/total-etch 3-step) replacing the EBS Multi primer, resulted in lower bond strengths than those of the original EBS Multi. LP/multi-coat showed similar microTBS to Prime&Bond NT (P&BNT). When used with a compomer, LP exhibited higher bond strengths than when used with the resin composite and was as effective as the experimental groups LP/filled and LP/multi-coat and the control group P&BNT. The SEM evaluation showed an inconsistent hybrid layer for the LP specimens, whereas in both the LP/filled and LP/multi-coat specimens a hybrid layer was clearly evident. Under the TEM all groups displayed dentin hybridization with dissolved smear plugs in the specimens that had been conditioned with Prompt L-Pop without a separate etching step. In many tubules of specimens conditioned with LP (as per manufacturer's instructions), fillers of the resin composite were present within the dentinal tubules.

CONCLUSIONS

When combined with a resin composite, Prompt L-Pop resulted in statistically lower bond strengths when applied in one layer than when applied in multiple layers. Prompt L-Pop also resulted in higher bond strengths when used with a polyacid-modified composite resin than with a composite resin. When applied in multiple coats, Prompt L-Pop results in bond strengths that are not statistically different from those of Prime&Bond NT, a total-etch adhesive.

Meta-analytical review of factors involved in dentin adherence

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

Bond strength of dual-cured resin cements to human teeth

PURPOSE

This study evaluated the bond strength of four commercial resin luting cements to enamel and superficial dentin, using a second-generation laboratory composite.

MATERIALS AND METHODS

Forty teeth were embedded in acrylic: 20 had superficial dentin exposed; 20 had enamel exposed. Each group was divided into four subgroups (n = 5) to be bonded with Variolink II, Dual Cement, 2-bond-2, and Permalute System, using an inverted, truncated cone of pre-cured Artglass that was placed over the resin cement with a load of 2 N for 2 seconds. Specimens were stored at 37 degrees C in 100% relative humidity for 24 hours before being tested for tensile bond strength (MPa). Data were analyzed using a two-way analysis of variance. Tukey-Kramer intervals for comparisons among resin cements and bonding substrates were calculated at a .05 significance level.

RESULTS

Significant differences were found among resin cements. Variolink II had statistically higher bond strength values for both substrates than the rest of the cements evaluated. When bonding was to enamel, all failures were cohesive in the composite, and when bonding was to dentin, some adhesive failures occurred at the resin cement-dentin interface. Permalute System had higher bond strengths than 2-bond-2 and Dual Cement when bonded to enamel.

CONCLUSIONS

Variolink II and Permalute had statistically different bond strengths to enamel and dentin. Variolink II showed statistically higher values for dentin bonding than the other cements. Use of Variolink II and Permalute resulted in statistically higher bond strengths than the other two cements.

Nd:YAG laser influence on sound dentin bond strength

OBJECTIVE

In the present study, the authors evaluated tensile bond strength of composite resin to dentin treated with Nd:YAG laser before and after bonding procedures.

SUMMARY BACKGROUND DATA

Lasers have been widely used in dentistry and have contributed to the development of new technologies. Adhesive systems have been indicated for most dental procedures and have produced good results. Studies concerned with the combined use of this adhesive system was the subject of this study.

METHODS

Thirty noncarious human anterior teeth, freshly extracted, for periodontal reasons, were used. After grinding the buccal dentinal surface until its exposition, specimens were separated into three groups and received the following treatments: (group 1) control--acid etching plus primer plus bond; (group 2) laser plus acid etching plus primer plus bond; (group 3) acid etching plus primer plus bond plus laser. Specimens of composite resin (Z100, 3M, Saint Paul, MN) were constructed on an inverted truncated 3-mm diameter cone mold. Tensile bond strength was performed using Inströn Universal machine, at 0.5 mm/min speed.

RESULTS

Analysis of variance (ANOVA) (p < 0.05) determined that the type of dentinal treatments used had an influence on tensile bond strength. Tukey's test, however, showed that group 1 (15.46) and 3 (15.67) had similar results both of which were higher than group 2 (4.57).

CONCLUSIONS

Based on the results obtained, one can conclude that group 1 (without laser) and group 3 (laser after bonding) had similar results, both higher than those observed for group 2 (laser before bonding). These results indicate that more research is needed about how a hybrid layer is formed when laser radiation is used.

Shear bond strengths of three resin cements to dentine over 3 years in vitro

OBJECTIVES

This study was conducted to evaluate the bond durability of three resin cements bonded to bovine dentine over a period of 3 years.

METHODS

Ten bovine dentine specimens were tested for shear bond strengths with each of the following materials: Panavia 21, BISTITE resin cement, and MASA Bond (experimental resin cement) at 1 day, 6 months, 1 and 3 years after cementation of a composite rod. All specimens were stressed in shear at a crosshead speed of 1mm min(-1) until failure. The means of the bond strengths were compared statistically by two-way ANOVA and Fisher's PLSD test (P<0.05). The mode of failure was classified after fracture of the bonds by SEM observation. Results for the mode of fracture were analyzed using the Mann-Whitney U-test.

RESULTS

The shear bond strengths (MPa+/-SD) for different times (1 day, 6 months, 1 and 3 years) were: Panavia 21 (15.2+/-3.6, 9.3+/-3.2, 8.5+/-2.1, 6.8+/-2.4), BISTITE (15.6+/-2.8, 11.0+/-1.4, 10.4+/-2.2, 9.0+/-2.7) and MASA Bond (29.6+/-9.5, 17.5+/-4.6, 19.6+/-4.5, 16.1+/-5.4). Panavia 21 and BISTITE strengths were significantly lower (P<0.05) at all times compared with MASA Bond, and 1 day strengths for all three materials were significantly higher (P<0.05) than 3 year strengths. Regarding the fracture modes after bond testing, there were statistical differences between the 1 day and the 1 year results for all cements (P<0.05). Although no Panavia 21 specimen showed complete cohesive failure in the demineralized dentine during the experiment, several BISTITE and MASA Bond specimens showed cohesive fracture in the demineralized dentine. For BISTITE, partially or complete demineralized dentine cohesive failures increased over time.

CONCLUSIONS

The type of resin cement seemed to have an influence on the long-term durability of bonding to dentine.

An ultrastructural study of the application of dentine adhesives to acid-conditioned sclerotic dentine

OBJECTIVE

This in vitro study examined the ultrastructure of resin-infiltrated sclerotic dentine following the application of a self-etching primer, with or without the adjunctive use of phosphoric acid pre-conditioning.

MATERIALS AND METHODS

Non-carious, natural cervical sclerotic lesions were hand-cleaned with a slurry of pumice and chlorhexidine and bonded without further cavity preparation. One group was bonded using Clearfil Liner Bond 2V (Kuraray Co. Ltd, Osaka, Japan) alone. Specimens from the other group were pre-conditioned with K-etchant (40% phosphoric acid gel, Kuraray) prior to the application of the same self-etching primer. Artificially prepared wedge-shaped lesions were also made in sound bicuspids, bonded using the two methods, and used as controls for the two groups. For SEM examination, each specimen was cryofractured into two halves through a pre-formed slit made on the lingual surface, after the respective conditioning treatment. Different locations within the lesions were examined after rinsing of the phosphoric acid/self-etching primer and specimen dehydration. For TEM investigation, specimens were bonded with the adhesive. Both demineralised and undemineralised ultrathin sections were prepared from the occlusal, gingival and deepest part of the wedge-shaped bonded lesions following specimen fixation, dehydration and resin embedding.

RESULTS

A hypermineralised surface layer was present on the surface of etched sclerotic dentine. This layer was thicker in the deepest part of the natural lesions, where bacterial colonisation of the lesion surface was also apparent. Both treatment protocols were unable to effectively dissolve sclerotic casts that occluded the dentinal tubules. Depending upon the thickness of the surface layers at different locations in the natural lesion, self-etching primer treatment alone resulted in reduction of the thickness of the authentic hybrid layer (i.e. hybridised intertubular dentine). This was also true of phosphoric acid pre-conditioning along the deepest part of the natural lesions. Within this region, intertubular dentine completely devoid of an authentic hybrid layer could be seen in both treatment groups. Resin tags were also sparsely observed in such regions.

CONCLUSIONS

Adhesive strategies that rely mostly on micromechanical retention alone may be compromised by the sporadic absence of the hybrid layer and resin tags in sclerotic dentine. Based on the ultrastructural features presented, it is further speculated that adaptive strategies such as removal of the surface layers and extended etching time may not be completely effective in improving bonding efficacy in highly sclerotic dentine. Interdisciplinary research should be continued to develop alternative procedures for bonding resins equally well to sound and sclerotic dentine.

Differences in bonding to acid-etched or Er:YAG-laser-treated enamel and dentin surfaces

STATEMENT OF PROBLEM

Er:YAG (erbium-doped yttrium aluminium garnet) lasers have been effective in the removal of dental tissues. It has been suggested that they are also useful for preparing dental surfaces for adhesion, but results to date have been controversial.

PURPOSE

This study compared the tensile strength of bracket-tooth bonds obtained after preparation of the surface for adhesion (dentin or enamel) by conventional acid-etching or by Er:YAG laser etching and investigated microstructure of resin-tooth interfaces using the 2 procedures.

MATERIAL AND METHODS

Eighty healthy human premolars were used. Brackets were cemented to acid-etched enamel, laser-etched enamel, acid-etched dentin, or laser-etched dentin (20 teeth per group). Dentin was previously exposed using a high-speed handpiece. Acid-etching was with 37% orthophosphoric acid (15 seconds for enamel, 5 seconds for dentin). Laser etching was with Er:YAG laser (four 200 mJ pulses per second for enamel; four 160 mJ pulses per second for dentin). Brackets were bonded with autocuring resin paste, having first applied a primer (dentin only) and then light-cured bonding resin. Tensile strength was determined with a universal testing machine. Data were analyzed with 2-way ANOVA and subsequent t test with Bonferroni correction. Fracture patterns were compared by the Wilcoxon test with Bonferroni correction. For SEM studies of the resin-tooth interface, a total of 12 premolars were used (3 for each tissue per treatment combination).

RESULTS

Mean tensile bond strength for acid-etched enamel (14.05 +/- 5.03 MPa) was significantly higher (P<.05) than for laser-etched enamel (8.45 +/- 3.07 MPa), and significantly higher (P<.05) for acid-etched dentin (4.70 +/- 2.50 MPa) than laser-etched dentin (2.48 +/- 1.94 MPa). Bond failure after laser etching was due to microcohesive fracture of tooth tissue. SEM studies of both resin-enamel and resin-dentin interfaces indicated extensive subsurface fissuring after laser etching.

CONCLUSION

Adhesion to dental hard tissues after Er:YAG laser etching is inferior to that obtained after conventional acid etching. Enamel and dentin surfaces prepared by Er:YAG laser etching show extensive subsurface fissuring that is unfavorable to adhesion.

New method for the in vitro evaluation of dental alloy bonding systems

STATEMENT OF PROBLEM

Bonding systems are used in some fixed prosthetic devices with base alloys. However, different studies of the same dental alloy bonding agents, under similar circumstances, have yielded disparate results in bond strength testing.

PURPOSE

This study compared directly 2 dental alloy bonding systems through a "duel" type of confrontation, which basically is a 2-way tensile force test.

MATERIAL AND METHODS

Ninety Wiron 88 base alloy cylinders (diameter of 8 mm length 15 mm) were sandblasted on both sides with Al(2)0(3) powder (particle size 50 microm) during 10 seconds at an approximate distance of 5 mm, at an air pressure of 60 psi determined before sandblasting procedures. The surface of each cylinder was cleaned from Al(2)0(3) powder with a strong burst of oil-free air from a chairside air syringe. Thirty cylinders were randomly assigned to 1 of 3 groups for direct bond strength comparison: (1) Panavia 21 to Panavia EX, (2) Panavia 21 to Metabond, or (3) Panavia 21 to a combination of a resin bonding agent plus Panavia 21. Each group was composed of 10 specimens that used 3 cylinders for each specimen. Each side of the sample cylinder received the same quantity of cement and 1 cylinder at a time was bonded to it. Cylinder alignment was verified with a Boley gauge during luting procedures. The bonded 3-piece block was held together for 24 hours under a compressive force of 2 kg/cm(2) using a hydraulic press. Excess cement was removed with a brush, and the pertinent air sealant was applied to allow for autocuring of the cement. Specimens were later stored in water at room temperature for 48 hours before thermocycling procedures. Each specimen was thermocycled for 100 cycles with a 5-minute dwelling time in water at 4 degrees C and 60 degrees C. Specimens were subject to tensile force testing until debonding in 1 of the cylinders.

RESULTS

The opposing pull duel test (OPDT) showed that the Panavia EX failed (40. 3 MPa) 10 of 10 duels against Panavia 21, whereas Panavia 21 failed (49.7 MPa) 9 of 10 duels against Metabond, and Panavia 1 failed (50. 1 MPa) 10 of 10 duels against Photobond+Panavia 21. ANOVA revealed significant differences (P <.05) between PAN-EX group and MET and PHB+P21 groups. However, no significant differences were found between MET and PHB+P21 groups.

CONCLUSION

The opposing pull duel test was a valid method to directly compare bond strengths of 2 bonding systems to dental base alloys. There was a small dispersion of the values even though cement mixing and thickness variables were difficult to control. Duel tensile testing provides meaningful information on the superiority of one bonding system over another in this controlled environment.