Changes in resin-infiltrated dentin stiffness after water storage

To etch or not to etch, Part III: On the hydrophobic-rich content and fatigue strength of universal adhesives after long-term ageing

OBJECTIVES

To examine whether dentin-etching extension and/or the hydrophobic-rich content of hybrid layers would affect fatigue strengths of a mild universal adhesive after long-term aging.

METHODS

Twin-bonded resin-dentin interfaces were produced by etching sound midcoronal dentin beams with 32 % ortho-phosphoric acid for 15 s (OPA15s), 3 s (OPA3s) or 10 % meta-phosphoric acid for 15 s (MPA15s). Samples were bonded with a mild universal adhesive with or without additional coating using a solvent-free bisGMA-based bonding resin. Self-etch application served as control. Composite buildups were made with a nanofilled composite. Bar-shaped twin-bonded interfaces (0.9 × 0.9 × 12 mm) were aged for two years in artificial saliva at 37 ℃ and tested under 4-point flexure at quasi-static (n = 16) and cyclic loads (n = 35) until failure. The stress-life fatigue behavior was evaluated using the staircase method at 4 Hz. Crack initiation and fracture patterns were evaluated by SEM. Cyclic-loaded data was analyzed by Kruskal-Wallis on Ranks (α = 0.05).

RESULTS

Significantly higher fatigue life distributions and higher endurance limits were observed for less aggressive etch-and-rinse protocols (OPA3s and MPA15s) after long-term ageing. Hydrophobic-rich coating produced 20-32 % higher endurance limits, prevented micrometer-sized porosities at bonded interfaces, reduced etching-associated variability and lowered crack formation. Significance Long-term hydrolysis produces detrimental effects on the fatigue strength of resin-dentin interfaces. The bond-promotion effect of less aggressive etch-and-rinse protocols and the creation of hybrid layers with higher hydrophobic-rich content are critical to extend the durability of mild universal adhesives. Therefore, current oversimplification trends in adhesive dentistry may limit resin-dentin bonding performance.

Concentration effect of DMSO-dry bonding on the stability of etch-and-rinse bonds

OBJECTIVES

To examine whether lower dimethyl sulfoxide (DMSO) concentrations would affect long-term bond stability of simplified or multistep water-based adhesives to dry-etched dentin.

METHODS

H3PO4-etched mid-coronal dentin surfaces from human molars were randomly blot- or air-dried for 30 s and pretreated or not with 5 or 50 % (v/v) ethanolic DMSO solutions. Untreated samples served as control. Samples were bonded with a two-step or a three-step etch-and-rinse adhesive. Restored crown segments (n = 5/group) were stored in distilled water for 24 h and sectioned for microtensile bond strength testing. Resin-dentin beams (0.8 mm2) were tested under tension until fracture (0.5 mm/min) after 24 h and one year of storage in artificial saliva at 37 °C. Nanoleakage evaluation and hybrid layer characterization were performed by SEM. Bond strength data was examined by three-way ANOVA followed by the Tukey test (α = 0.05).

RESULTS

Dry bonding produced significantly lower bond strengths than conventional wet bonding for both water-based adhesive systems (p < 0.05). DMSO-dry bonding restored bond strengths and reduced nanoleakage levels, regardless of adhesive type or DMSO concentration (p < 0.05). Bond strengths of DMSO-dry bonded samples were not significantly affected by long-term ageing regardless of adhesive type or DMSO concentration (p < 0.05).

SIGNIFICANCE

Although bonding methacrylate-based resins to etched dentin is normally performed under wet conditions, hybridization of air-dried collagen can outperform conventional wet bonding by employing water-free DMSO solutions with concentrations as low as 5 %. Reduced moisture-related technique sensitivity, higher bonding performance and improved hybrid layer stability may contribute to extend the service life of resin-dentin bonding.

Evaluation of the bonding effectiveness of a universal adhesive to the plasma-activated dentin surface

This study aimed to evaluate the effect of non-thermal atmospheric pressure plasma on the bond strength of a universal adhesive used in etch-and-rinse mode. Dentin surfaces were etched with phosphoric acid and samples were divided into groups exposed to either dry bonding, plasma-dried bonding, plasma-dried and rewetted bonding, or wet bonding (n  =  10). Dentin surfaces of the plasma-dried specimens were treated with a plasma jet before the adhesive procedure. After application, composite blocks were built, and specimens were subjected to micro-tensile bond strength testing after 24 h and after 10,000 thermal cycles. The hybrid layer formation was evaluated by micro-Raman spectral analysis; the resin-dentin interface was analyzed by scanning electron microscopy. One-way ANOVA and Tukey's post hoc multiple comparison tests were used to statistically analyze the data. The bond strength values of the plasma-dried bonding groups were statistically higher than the non-plasma-treated groups both before and after aging. After the thermal cycles, bond strength values decreased significantly only in the wet bonding group. Micro-Raman spectral analysis revealed that plasma-drying increased adhesive penetration, especially hydrophobic monomer infiltration. This may increase the mechanical properties and durability of the resin-dentin interface, provide long-term stability, and improve the polymerization rate of the adhesive layer.

Proanthocyanidin encapsulation for sustained bioactivity in dentin bioadhesion: A two-year study

OBJECTIVES

To determine the long-term effect on the stability of dentin-resin interfaces after the addition of polylactide (PLA) capsules containing proanthocyanidin (PAC) to adhesive resin.

METHODS

Sub-micron (SM) and micron (M) size capsules containing PACs were produced using a combination of emulsification and solvent evaporation techniques and characterized. Human dentin surfaces (n = 8) were etched (35% glycolic acid) and primed (15% enriched Vitis vinifera extract solution - VV_e), followed by the application of an experimental adhesive containing 0 (control), 1.5 wt% of SM or M PAC-filled PLA capsules light cured for 40 s. A crown was built using commercial composite. After 24 h-immersion (37 °C) in simulated body fluid, specimens were serially sectioned into resin-dentin beams. Microtensile bond strength (TBS), micro-permeability and fracture pattern were assessed immediately and after 1 and 2 years. Data were statistically analyzed using two-way ANOVA and post-hoc test (α = 0.05).

RESULTS

Polydisperse capsules were manufactured with average diameter of 0.36 µm and 1.08 µm for SM and M, respectively. The addition of capsules did not affect TBS (p = 0.889). After 2 years, TBS significantly decreased in SM (p = 0.006), whereas M showed similar initial values (p = 0.291). Overall, less micro-permeability was found in M than the control and SM group (p < 0.001). After 2 years, fractured surfaces from capsule-containing groups failed within the adhesive layer while control fractured at the bottom of the hybrid layer.

SIGNIFICANCE

The addition of PAC-filled PLA microcapsules in a dental adhesive did not affect the bond strength while increased and sustained the protection against micro-permeability in the interface, likely due to release of PACs.

The effect of ethanol wet bonding technique on postoperative hypersensitivity of Class II composite restorations: A randomized trial

Background

To evaluate the effect of Ethanol Wet Bonding Technique (EWBT) on postoperative hypersensitivity (POH) of composite restorations in premolar teeth.

Materials and Methods

In this randomized trial, 24 patients with at least three proximal carious lesions with similar axial depth and position of gingival floor in their premolars were enrolled. Following cavity preparation, the teeth were randomly assigned to one of three groups: (1) Class II resin-based composite (RBC) restoration using an etch-and-rinse adhesive + wet bonding technique (Control); (2) RBC restoration using EWBT + hydrophobic adhesive; and (3) RBC restoration using EWBT + hydrophilic adhesive. Tooth hypersensitivity was evaluated before and 1, 3, 7, 14 and 30 days after treatment according to the Visual Analog Scale. Data were analyzed statistically with Kruskal-Wallis and Friedman tests (P = 0.05).

Results

All teeth showed similar levels of hypersensitivity after treatment (both P > 0.05). Furthermore, there was no difference between POH levels of the test and control groups at any control period (P < 0.05). Friedman test indicated that the POH significantly reduced within time in all groups (P < 0.05).

Conclusion

Application of ethanol-wet bonding technique, either with hydrophobic or hydrophilic adhesives did not affect the POH of Class II composite restorations in premolars.

Current perspectives on dental adhesion: (1) Dentin adhesion - not there yet

The essential goal of any adhesive restoration is to achieve a tight and long-lasting adaptation of the restorative material to enamel and dentin. The key challenge for new dental adhesives is to be simultaneously effective on two dental substrates of conflicting nature. Some barriers must be overcome to accomplish this objective. While bonding to enamel by micromechanical interlocking of resin tags within the array of microporosities in acid-etched enamel can be reliably achieved and can effectively seal the restoration margins against leakage, bonding effectively and durably to organic and humid dentin is the most puzzling task in adhesive dentistry.

Much of the research and development of dental adhesives has focused on making the clinical procedure more user-friendly by reducing the number of bottles and/or steps. Although clinicians certainly prefer less complicated and more versatile adhesive materials, there is a trade-off between simplification of dental adhesives and clinical outcomes. Likewise, new materials are launched with claims of being novel and having special properties without much supporting evidence.

This review article discusses dental adhesion acknowledging pioneer work in the field, highlights the substrate as a major challenge to obtain durable adhesive restorations, as well as analyzes the three adhesion strategies and their shortcomings. It also reviews the potential of chemical/ionic dental adhesion, discusses the issue of extensively published laboratory research that does not translate to clinical relevance, and leaves a few thoughts in regard to recent research that may have implications for future adhesive materials.

Evaluation of a Collagen-Reactive Monomer with Advanced Bonding Durability

This study evaluated the use of a new collagen-reactive monomer (CRM), isocyanate-terminated urethane methacrylate precursor, which has covalent affinity to dental collagen, in the formation of dentin-resin bonds and compared it with 2 other dental adhesives. Dentin specimens were bonded with either the CRM-based adhesive (CBA), One-Step (OS; Bisco, Inc.), or a negative adhesive (NA) control and subjected to 24-h storage in water, thermocycling to simulate 1-y clinical function, or a matrix metalloproteinase-mediated aging process. We tested the microtensile bond strength (µTBS), characterized the bonding interface with an atomic force microscope, conducted micro-Raman analysis, and performed leakage tests and in situ zymography. CBA and OS exhibited comparable bonding strength after 24 h (P > 0.05); however, there was a sharp decrease in µTBS after aging for all except CBA (P < 0.001). Raman spectra results indicated increased collagen crosslinking and chemical reaction between the adhesive and collagen in the CBA group. CBA achieved high-quality hybridization with collagen, improving mechanical properties and integrity, and decreased the enzyme-mediated degradation of the bonding interface by inhibiting collagenolytic activity. With the promising bonding durability of coapplied CBA, CRM may be the first dental adhesive to provide strong and long-lasting resin-dental collagen bonding without the additional conditioning step. The use of CBA results in high-quality hybrid layers that protect the resin-dentin interface from harmful biological and chemical activities commonly occurring in the oral environment.

Dimeric Proanthocyanidins on the Stability of Dentin and Adhesive Biointerfaces

A dentin biomodification strategy with selective proanthocyanidin (PAC)-enriched extracts reinforces dentin and dentin-resin interfaces. Enrichment of the extracts according to the degree of polymerization allows exploration of bioactive principles of PACs and structure-activity relationships. This study investigated the sustained dentin matrix biomodification and dentin-resin bioadhesion of 2 fractions consisting exclusively of B-type PAC dimers with or without a single galloyl motif (specifically, DIMER_G and DIMER_NG) and their precursor material, enriched grape seed extract (e-GSE; Vitis vinifera). The biomodification potential was determined by long-term evaluation of the apparent modulus of elasticity and collagen solubility (hydroxyproline release). Chemical characterization of the dentin matrix was performed by attenuated total reflectance-Fourier-transform infrared spectroscopy. The bioadhesive properties were assessed by a microtensile bond strength test at different time points, and macro-hybrid layers were produced to verify the degree of conversion of the adhesive resin. Fractions consisting of DIMER_G, DIMER_NG, and their precursor, e-GSE, increased the modulus of elasticity at all time points and reduced collagen degradation. Specimens treated with DIMER_NG remained stable throughout 12 mo of storage, whereas a significant drop in the modulus of elasticity was observed for the DIMER_G and e-GSE groups at 6 mo. The fractions and precursor did not affect the degree of resin conversion at the hybrid layer. Changes in infrared resonances corresponding to collagen cross-links in the dentin matrix occurred for all treatments. Higher bond strength was observed for dentin treated with e-GSE as compared with DIMER_G and DIMER_NG; all biointerfaces remained stable after 12 mo. Nongalloylated PACs mediate stable dentin biomodification, which includes protective activity against collagen degradation and reinforcement of the anchoring dentin matrix. Collectively, PACs with a higher degree of oligomerization offer a robust bioadhesion between the hydrophilic dentin matrix and the hydrophobic adhesive.

Effect of Dentin Pretreatment with Arginine on Microshear Bond Strength of Etch-and-Rinse or Self-Etch Adhesive Systems

Objective The main purpose of this study was to evaluate the effect of dentin pretreatment with 8% arginine on the immediate and 6-month bond strength (BS) of adhesive systems and surface morphology of dentin.

Materials and Methods Dentin bovine specimens (5 × 5 mm) were allocated into following pretreatments: without pretreatment (conventional technique, C) or exposure to arginine solution (A) for 5 minutes prior to tooth restoration. The adhesive procedure was performed using ( n = 12): 3-step etch-and-rinse adhesive (Scotchbond Multipurpose—SBMP [C+SBMP and A+SBMP]); 2-step etch-and-rinse adhesive (Single Bond 2 - SB [C+SB and A+SB]); or 2-step self-etch adhesive (Clearfil SE Bond - CSEB [C+CSEB and A+CSEB]). After 24 hours, the composite resin restorations were evaluated immediately and after 6 months of water storage using a microshear test and fracture pattern. The dentin surface exposed to A was assessed by scanning electron microscopy (SEM). The immediate BS data were submitted to a two-way analysis of variance and Tukey's test, and the long-term BS results were analyzed using Kruskal–Wallis and Dunn tests (α = 0.05).

Results There was a significant decrease in immediate and 6-month BS for the A+SB and A+CSEB groups, which differed statistically from the C group. The fracture pattern was predominantly adhesive for SB and CSEB adhesive for C and A. The SEM images presented a different conditioning pattern of the dentin exposed to A.

Conclusion The dentin pretreatment with arginine interfered negatively in the immediate and long-term BS of the simplified adhesive system. However, the SBMP adhesive was not affected by arginine pretreatment presenting the most satisfactory results.

Variation in composite degree of conversion and microflexural strength for different curing lights and surface locations

BACKGROUND

Lack of irradiance-beam profile uniformity across the emission area of light-curing units (LCUs) may result in suboptimal properties of composite restorations. The authors' objective for this study was to assess the variation in local cure of 1 composite at 3 different LCU emission area locations cured with 3 different LCUs by means of testing the degree of conversion (DC) and microflexural strength.

METHODS

The authors fabricated dual-photoinitiator composite specimens (n = 5), which were cured using either a quartz-tungsten-halogen, a multiple-emission peak, or a single-emission peak light-emitting diode LCU. The specimen's top surfaces received irradiation from either the center, 1.5 millimeters straight to the left of the center, or 1.5 mm straight to the right of the center of the LCU emission area. The authors measured irradiance and DC on top and bottom specimen surfaces using a spectrometer and attenuated total reflection-Fourier transform infrared spectroscopy, respectively. The authors performed micro 3-point bend tests using a universal mechanical testing machine. They used multifactorial analysis of variance (α = 0.05).

RESULTS

The irradiance ranged from 452 through 946 milliwatts per square centimeter, and DC ranged from 49.7% through 65.8% on top surfaces. Microflexural strength ranged from 313 through 458 megapascals.

CONCLUSIONS

The authors did not find correlations among the LCU irradiance-beam profile of the 3 emission area locations and the investigated material properties, although they found variations in the measured properties.

PRACTICAL IMPLICATIONS

The irradiance-beam profile from the different LCUs explored did not have a major influence on the DC and microflexural strength for the investigated composite.

Primum non nocere - The effects of sodium hypochlorite on dentin as used in endodontics

The medical literature is replete with the maxim 'primum non nocere', cautioning health care providers to avoid doing any harm to human subjects in their delivery of medical care. Sodium hypochlorite (NaOCl) is a well-established irrigant for root canal treatment because of its antimicrobial and organic tissue remnant dissolution capability. However, little is known about the deleterious effect of this strong oxidizing agent on the integrity of human mineralized dentin. Iatrogenically-induced loss of dentin integrity may precipitate post-treatment root fracture and has potential medico-legal complications. In the present work, transmission electron microscopy provided evidence for collagen destruction in the surface/subsurface of dentin treated with high NaOCl concentrations and long contact times. Size exclusion chromatography showed that the hypochlorite anion, because of its small size, penetrated the water compartments of apatite-encapsulated collagen fibrils, degraded the collagen molecules and produced a 25-35µm thick, non-uniform "ghost mineral layer" with enlarged, coalesced dentinal tubules and their lateral branches. Fourier transform-infrared spectroscopy identified increases in apatite/collagen ratio in NaOCl-treated dentin. The apatite-rich, collagen-sparse dentin matrix that remained after NaOCl treatment is more brittle, as shown by the reductions in flexural strength. Understanding the deleterious effects of NaOCl on mineralized dentin enables one to balance the risks and benefits in using high NaOCl concentrations for lengthy periods in root canal debridement. Delineating the mechanism responsible for such a phenomenon enables high molecular weight, polymeric antimicrobial and tissue dissolution irrigants to be designed that abides by the maxim of 'primum non nocere' in contemporary medical practices.

STATEMENT OF SIGNIFICANCE

The antimicrobial and tissue-dissolution capacities of NaOCl render it a well-accepted agent for root canal debridement. These highly desirable properties, however, appear to be intertwined with the untoward effect of collagen matrix degradation within mineralized dentin. Because of its small size, the hypochlorite anion is capable of infiltrating mineralized collagen and destroying the collagen fibrils, producing a mineral-rich, collagen sparse ghost mineral matrix with reduced flexural strength. Findings from the present work challenge the biosafety of NaOCl when it is used in high concentrations and for lengthy time periods during root canal treatment, and laid the background work for future biomaterials design in debridement of the canal space.

Biostability of the Proanthocyanidins-Dentin Complex and Adhesion Studies

Oligomeric proanthocyanidins (OPACs) are potent and renewable natural bioactives possible to be refined into chemically standardized mixtures for biological applications. Herein, we found that multiscale interactions of OPACs with the dentin matrix create tight biointerfaces with hydrophobic methacrylate adhesives on wet surfaces. An enriched mixture of OPACs, with a known phytochemical profile, was produced from grape seed crude extract ( Vitis vinifera; enriched grape seed extract [e-GSE]) and applied to dentin matrices to determine changes to the mechanical properties and biodegradability of the dentin matrix and favorable resin adhesion mechanisms. Methods included a 3-point flexural test, quantification of hydroxyproline (collagen solubilization), static and dynamic nanomechanical analyses, resin-dentin microtensile bond strength, and micropermeability at the adhesive interface. The e-GSE-modified dentin matrix exhibited remarkably low collagen solubilization and sustained the bulk elastic properties over 12 mo. Tan δ findings reveal a more elastic-like behavior of the e-GSE-modified dentin matrix, which was not affected by H-bond destabilization by urea. Dentin-methacrylate biointerfaces with robust and stable adhesion were created on e-GSE-primed dentin surfaces, leading to a dramatic decrease of the interfacial permeability. Standardized OPAC mixtures provide a new mechanism of adhesion to type I collagen-rich tissues that does not rely on hydrophilic monomers. The bioadhesion mechanism involves physicochemical modifications to the dentin matrix, reduced tissue biodegradation, and bridging to methacrylate resins.

Dental adhesives and strategies for displacement of water/solvents from collagen fibrils

OBJECTIVES

To evaluate the influence of temperature of evaporation in adhesive systems with different solvents on the apparent modulus of elasticity and mass change of macro-hybrid layers modified by proanthocyanidins (PACs).

METHODS

Adhesive resin beams (A) from Single Bond Plus (SB), Excite (EX) and One Step Plus (OS) were prepared after solvent evaporation at 23°C or 40°C (n=12). Macro-hybrid layers (M) (n=12) were prepared using demineralized dentin beams sectioned from extracted human third molars. The demineralized dentin specimens were infiltrated with each one of the three adhesive systems at 23°C or 40°C; with or without prior dentin treatment with PACs for 10min. The apparent modulus of elasticity (E) and mass change (Wmc, %) of adhesives beams and resin-infiltrated specimens were assessed in dry and wet conditions after immersion in water (24h, 1, 3 and 6 months). The E was statistically analyzed by Tukey-Kramer test and the Wmc, % by Kruskal Wallis, and Dunn (α=0.05).

RESULTS

Solvent evaporation at 40°C resulted in higher E values for adhesive resin beams at all storage conditions, regardless of the adhesive system (p<0.05). Increased mass loss (3 months: -0.01%; 6 months: -0.05%) was observed in One Step resin beams (p≤0.05). In the macro-hybrid layer models the pretreatment with PACs along with solvent evaporation at 40°C increased E and decreased the Wmc, % (3 months: -2.5; 6 months: 2.75%) for adhesives evaluated over time (p<0.05). No significant differences in ratio (resin/dentin) were found for the macro-hybrid layers (p>0.05).

SIGNIFICANCE

Improved solvent evaporation at higher temperature, and increased collagen cross-linking induced by PACs, enhanced the mechanical properties resulting in highly stable macro-hybrid layers over 6 months storage.

Polymerization- and solvent-induced phase separation in hydrophilic-rich dentin adhesive mimic

Current dental resin undergoes phase separation into hydrophobic-rich and hydrophilic-rich phases during infiltration of the over-wet demineralized collagen matrix. Such phase separation undermines the integrity and durability of the bond at the composite/tooth interface. This study marks the first time that the polymerization kinetics of model hydrophilic-rich phase of dental adhesive has been determined. Samples were prepared by adding varying water content to neat resins made from 95 and 99 wt.% hydroxyethylmethacrylate and 5 and 1 wt.% (2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl1]-propane prior to light curing. Viscosity of the formulations decreased with increased water content. The photopolymerization kinetics study was carried out with a time-resolved Fourier transform infrared spectrometer. All of the samples exhibited two-stage polymerization behavior which has not been reported previously for dental resin formulation. The lowest secondary rate maxima were observed for water contents of 10-30 wt.%. Differential scanning calorimetry (DSC) showed two glass transition temperatures for the hydrophilic-rich phase of dental adhesive. The DSC results indicate that the heterogeneity within the final polymer structure decreased with increasing water content. The results suggest a reaction mechanism involving both polymerization-induced phase separation and solvent-induced phase separation for the model hydrophilic-rich phase of dental resin.

Viscoelastic properties of collagen-adhesive composites under water-saturated and dry conditions

To investigate the time- and rate-dependent mechanical properties of collagen-adhesive composites, creep and monotonic experiments are performed under dry and wet conditions. The composites are prepared by infiltration of dentin adhesive into a demineralized bovine dentin. Experimental results show that for small stress level under dry conditions, both the composite and the neat adhesive have similar behavior. On the other hand, in wet conditions, the composites are significantly soft and weak compared to the neat adhesives. The behavior in the wet condition is found to be affected by the hydrophilicity of both the adhesive and the collagen. As the adhesive-collagen composites are a part of the complex construct that forms the adhesive-dentin interface, their presence will affect the overall performance of the restoration. We find that Kelvin-Voigt model with at least four elements is required to fit the creep compliance data, indicating that the adhesive-collagen composites are complex polymers with several characteristic time scales whose mechanical behavior will be significantly affected by loading rates and frequencies. Such mechanical properties have not been investigated widely for these types of materials. The derived model provides an additional advantage that it can be exploited to extract other viscoelastic properties which are, generally, time consuming to obtain experimentally. The calibrated model is utilized to obtain stress relaxation function, frequency-dependent storage and loss modulus, and rate-dependent elastic modulus.

A characterization of the mechanical behavior of resin-infiltrated dentin using nanoscopic Dynamic Mechanical Analysis

This study explored the spatial variations in mechanical behavior of resin-infiltrated dentin using nanoscopic Dynamic Mechanical Analysis (DMA).

OBJECTIVE

The objectives were to: (1) evaluate the mechanical behavior of resin-infiltrated dentin using a scanning-based approach to nanoindentation, (2) identify contributions of the collagen matrix to time-dependent deformation of the hybrid layer, and (3) assess the importance of specimen hydration on the nanoDMA response.

METHODS

Specimens of completely demineralized dentin infiltrated with commercial resin adhesive and control samples of resin adhesive were evaluated using a nanoindenter in scanning mode. The load and displacement responses were used to perform DMA and to estimate the complex (E*), storage (E') and loss (E″) moduli over selected regions of evaluation. The importance of hydration on the mechanical behavior was also examined from a comparison of responses in the hydrated and dehydrated conditions.

RESULTS

In the hydrated state the apparent complex, storage and loss moduli for the resin-infiltrated dentin samples were 3.5±0.3GPa, 3.4±0.2GPa and 0.9±0.3GPa, respectively. Those values for the resin adhesive control were 2.7±0.3GPa, 2.7±0.3GPa and 0.2±0.02GPa, respectively. Viscoelastic deformation of the resin-infiltrated collagen exceeded that occurring in regions of uniform resin adhesive. Though dehydration resulted in a significant increase in both the complex and storage moduli of the macro hybrid layer, the largest changes occurred to the resin adhesive.

SIGNIFICANCE

The microstructure and hydration play critical roles on the mechanical behavior of the hybrid layer and nanoDMA provides a potent measurement tool for identifying the spatial variations.

Dentin adhesion and MMPs: a comprehensive review

This review examines the fundamental processes responsible for the aging mechanisms involved in the degradation of resin-bonded interfaces, as well as some potential approaches to prevent and counteract this degradation. Current research in several research centers aims at increasing the resin-dentin bond durability. The hydrophilic and acidic characteristics of current dentin adhesives have made hybrid layers highly prone to water sorption. This, in turn, causes polymer degradation and results in decreased resin-dentin bond strength over time. These unstable polymers inside the hybrid layer may result in denuded collagen fibers, which become vulnerable to mechanical and hydrolytical fatigue, as well as degradation by host-derived proteases with collagenolytic activity. These enzymes, such as matrix metalloproteinases and cysteine cathepsins, have a crucial role in the degradation of type I collagen, the organic component of the hybrid layer. This review will also describe several methods that have been recently advocated to silent the activity of these endogenous proteases.

Effects of calcium silicate-based materials on the flexural properties of dentin

INTRODUCTION

Prolonged exposure of root dentin to calcium hydroxide alters the fracture resistance of dentin. Calcium silicate-based materials (CSMs) used in endodontics release calcium hydroxide on setting. This study examined whether prolonged contact of dentin with CSMs adversely affects its mechanical properties.

METHODS

Dentin beams prepared from extracted human molars (7 × 3 × 0.3 mm) were divided into 3 groups on the basis of the material to which dentin was exposed (Biodentine, MTA Plus, and untreated control beams). Three-point flexure to failure was performed for each beam at designated exposure times (24 hours, 1, 2, and 3 months; n = 10). Data were analyzed with 2-factor repeated-measures analyses of variance to determine the effects of material and aging time on flexural modulus, flexural strength, and modulus of toughness (α = 0.05).

RESULTS

For flexural modulus, there was no significant difference for material (P = .947) or aging time (P = .064) when compared with baseline control. For flexural strength, significant differences were associated with aging time (P < .001) but not with material (P = .349). Flexural strength of dentin exposed to Biodentine decreased significantly after 2 and 3 months, whereas that exposed to MTA Plus decreased significantly after 3 months of aging (P < .05). For modulus of toughness, significant declines were observed for both material (P < .004) and aging time (P < .001).

CONCLUSIONS

Both CSMs alter material toughness more than the strength and stiffness of dentin after aging in 100% relative humidity. Because dentin toughness is attributed to its collagen matrix, the amount of collagen extracted from mineralized dentin and changes in collagen ultrastructure should be further examined after exposure of dentin to CSMs.

Limitations in bonding to dentin and experimental strategies to prevent bond degradation

The limited durability of resin-dentin bonds severely compromises the lifetime of tooth-colored restorations. Bond degradation occurs via hydrolysis of suboptimally polymerized hydrophilic resin components and degradation of water-rich, resin-sparse collagen matrices by matrix metalloproteinases (MMPs) and cysteine cathepsins. This review examined data generated over the past three years on five experimental strategies developed by different research groups for extending the longevity of resin-dentin bonds. They include: (1) increasing the degree of conversion and esterase resistance of hydrophilic adhesives; (2) the use of broad-spectrum inhibitors of collagenolytic enzymes, including novel inhibitor functional groups grafted to methacrylate resins monomers to produce anti-MMP adhesives; (3) the use of cross-linking agents for silencing the activities of MMP and cathepsins that irreversibly alter the 3-D structures of their catalytic/allosteric domains; (4) ethanol wet-bonding with hydrophobic resins to completely replace water from the extrafibrillar and intrafibrillar collagen compartments and immobilize the collagenolytic enzymes; and (5) biomimetic remineralization of the water-filled collagen matrix using analogs of matrix proteins to progressively replace water with intrafibrillar and extrafibrillar apatites to exclude exogenous collagenolytic enzymes and fossilize endogenous collagenolytic enzymes. A combination of several of these strategies should result in overcoming the critical barriers to progress currently encountered in dentin bonding.

Changes in stiffness of resin-infiltrated demineralized dentin after remineralization by a bottom-up biomimetic approach

This study examined changes in elastic modulus, mineral density and ultrastructure of resin-infiltrated dentin after biomimetic remineralization. Sixty demineralized dentin beams were infiltrated with Clearfil Tri-S Bond, One-Step or Prime&Bond NT. They were immersed in simulated body fluid (SBF) for 1 week to maximize water sorption before determining the baseline elastic moduli. For each adhesive (N = 20) half of the beams remained immersed in SBF (control). The rest were immersed in a biomimetic remineralization medium. The elastic moduli were measured weekly for 15 additional weeks. Representative remineralized specimens were evaluated by X-ray microtomography and transmission electron microscopy (TEM). The elastic moduli of control resin-infiltrated dentin remained consistently low, while those immersed in the biomimetic remineralization medium increased by 55-118% after 4 months. X-ray microtomography of the remineralized specimens revealed decreases in mineral density from the beam surface to the beam core that were indicative of external mineral aggregation and internal mineral deposition. Interfibrillar and intrafibrillar remineralization of resin-sparse intertubular dentin were seen under TEM, together with remineralized peritubular dentin. Biomimetic remineralization occurs by diffusion of nanoprecursors and biomimetic analogs in completely demineralized resin-infiltrated dentin and proceeds without the contribution of materials released from a mineralized dentin base.

A review--micromorphological evidence of degradation in resin-dentin bonds and potential preventional solutions

Resin adhesion to dentin was first achieved in 1982 through mechanical hybridization between resin and collagen fibrils using an adhesive resin containing a functional monomer. Over the last 2 decades, newly developed adhesive resins have attempted to improve the bond strength at least in the first 24 h after bonding. Although much is known about the initial bond strength, learned through morphological analysis, the long-term durability of bonds has not yet been established analytically. However, numerous recent studies have shown chemical biodegradation of resin-dentin bonds under various testing regimes. In general, studies have shown that dentin bond strength decreases over time due to degradation of the resin and the collagen fibrils within the bonds. Furthermore, crystal formation around cured bonding resins has been reported in a number of adhesives after long-term water storage. However, the extent and process of degradation or crystallization is adhesive type specific. This review mainly summarizes the most recent and state of the art work in degradation of the bonding of dental restorative compounds with dentin based on micromorphological data of scanning and transmission electron microscopy.