In vivo versus in vitro microtensile bond strength of axial versus gingival cavity preparation walls in Class II resin-based composite restorations

Influence of minimally invasive endodontic access cavities and bonding status of resin composites on the mechanical property of endodontically-treated teeth: A finite element study

OBJECTIVE

To study the mechanical behavior of endodontically-treated teeth with minimally invasive endodontic access cavities and resin composite restorations under different bonding conditions using finite element analysis (FEA).

METHODS

Four Class-II endodontic access cavities including the mesio-occlusal minimally-invasive (MO-MIE), mesio-occlusal conventional (MO-CONV), disto-occlusal minimally-invasive (DO-MIE), and disto-occlusal conventional (DO-CONV) cavities were prepared in 3D-printed maxillary first molars. Each tooth was subjected to root canal preparation and scanned using micro-CT to provide a 3D structural model which was virtually restored with resin composite. An intact 3D-printed molar was used as control. FEA was conducted under a 250-N vertical load. Three different interfacial bonding conditions between dentin/enamel and resin composite were considered, i.e. fully bonded, partially debonded, and fully debonded. The maximum principal stress of dentin and the normal tensile stress at the interfaces were recorded. The risk factor of failure for each component was then calculated.

RESULTS

In the fully-bonded tooth, the dentin-composite interface showed significantly higher stress and a higher risk factor than dentin, indicating that debonding at the dentin-composite interface would occur prior to dentin fracture. With the dentin-composite interface debonded, the enamel-composite interface exhibited higher stress and a higher risk factor than dentin, indicating that debonding at the enamel-composite interface would occur next, also prior to dentin fracture. With the resin composite fully debonded from the tooth, stress in dentin increased significantly. Irrespective of the bonding status, the CONV groups exhibited higher median stresses in dentin than the MIE groups.

SIGNIFICANCE

Within the limitation of this study, it was shown that debonding of the resin composite restoration increased the stress in dentin and hence the risk of dentin fracture in endodontically-restored teeth. Minimally-invasive access cavities could better safeguard the fracture resistance of interproximally-restored teeth compared to conventional ones.

Ultrastructural Correlates of in vivo/in vitro Bond Degradation in Self-etch Adhesives

The morphologic correlates of bond degradation in self-etching primers have not been fully elucidated. We hypothesized that there is no difference between the mechanism of degradation of self-etching primers in vivo and in vitro. Class I cavities prepared in vivo in 24 caries-free human molars were bonded with Clearfil SE Bond or Clearfil Protect Bond, and restored with resin composites. Eight teeth were extracted after 24 hrs, and the rest after 1 yr. The same protocol was repeated in vitro with extracted molars. Degradation of resin-dentin bonds was assessed by microtensile bond testing and TEM of interfaces after tracer immersion. Both in vivo and in vitro bond strengths decreased with time for SE Bond but not for Protect Bond, with more pronounced water treeing observed in the former adhesive under both aging conditions. There is no difference between the mechanism of degradation of self-etch adhesives in vivo or in vitro.

Effects of Dentin Characteristics on Interfacial Nanoleakage

Water emanating from dentinal tubules during air-drying and light-curing of adhesives leads to entrapment of droplets at the resin-dentin interface and contributes to nanoleakage. This study tested the null hypothesis that characteristics of substrate dentin and type of adhesive used for bonding would not affect the occurrence of nanoleakage. Three self-etch adhesives were used to bond to 4 types of dentin with different characteristics in 12 groups. After silver challenge, nanoleakage percentage was measured within the hybrid layer of each sample. The deep dentin cut perpendicular to tubules always showed a significantly higher nanoleakage percentage compared with that of the other 3 types of dentin. The percentages of nanoleakage within the hybrid layers were not statistically different among adhesives. However, when bonding to deep perpendicular dentin, both all-in-one adhesives revealed more distinct nanoleakage within the adhesive layer compared with that achieved with Clearfil SE Bond, a two-step self-etch adhesive. The results did not support the null hypothesis.

British Society of Prosthodontics Debate on the Implications of the Minamata Convention on Mercury to Dental Amalgam--Should our Patients be Worried?

In 2013, the Minamata Convention on Mercury called for a global phase-down of amalgam use, with a view to reduce environmental mercury pollution. This will significantly impact UK dentistry, given the still extensive use of amalgam in U.K. general dental practice. However, until now there has been little national discussion or debate. In Spring 2015, The British Society of Prosthodontics dedicated a significant part of its Annual Conference to debating the implications of this issue. Clinical case examples were discussed with audience interaction and voting facilitated using innovative Audience Response System Technology. A remarkable range of concerns and opinions were given. The debate elicited specific concerns amongst clinicians regarding the suitability of mercury-free alternatives to amalgam; particularly where cavities are large and extend beneath the gingival anatomy. There are also anecdotal reports of Dental Foundation (DF) dentists not being adequately taught the use of dental amalgam in undergraduate dental schools. CPD/CLINICAL RELEVANCE: Many clinicians, especially those treating patients for whom moisture control is challenging, feel that amalgam should remain available for clinicians to choose in certain clinical circumstances for the restoration of posterior teeth, even in the event of a complete phase-down.

Influence of proximal box elevation on bond strength of composite inlays

OBJECTIVES

The objective of the present study was to evaluate the influence of proximal box elevation on microtensile bond strength (mTBS) of composite inlays to the proximal box floor, using either a total-etch or a self-adhesive resin cement.

MATERIALS AND METHODS

Twenty-five human molars were selected, and a class II OM (inlay) cavity preparation was performed in each tooth. Cavities were randomly assigned into four experimental groups, according to the location of the proximal cervical margin (located 1 mm below cementoenamel junction (CEJ), or with proximal box elevation with composite resin) and the resin cement used for luting (a total-etch resin cement RelyX ARC or a self-adhesive resin cement G-Cem). After 1-week water storage, samples were subjected to mTBS test. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests (p < 0.05).

RESULTS

Kruskal-Wallis revealed statistically significant differences among experimental groups (p = 0.007). Both resin cements showed similar bond strength values when cervical margin was located below CEJ. The proximal box elevation improved the bond strength of composite inlays for both resin cements. However, only for G-Cem was this improvement statistically significant.

CONCLUSIONS

The proximal box elevation improved the bond strength attained by G-Cem resin cement. For RelyX ARC, the position of the cervical margin did not affect composite inlays bond strength.

CLINICAL RELEVANCE

Proximal box elevation does not decline bond strength of composite inlays to the proximal floor when a total-etch or a self-adhesive resin cement is used.

Do Laboratory Results Concerning High-Viscosity Glass-Ionomers versus Amalgam for Tooth Restorations Indicate Similar Effect Direction and Magnitude than that of Controlled Clinical Trials? - A Meta-Epidemiological Study

BACKGROUND

A large percentage of evidence concerning dental interventions is based on laboratory research. The apparent wealth of laboratory evidence is sometimes used as basis for clinical inference and recommendations for daily dental practice. In this study two null-hypotheses are tested: whether trial results from laboratory and controlled clinical trials concerning the comparison of high-viscosity glass-ionomer cements (HVGIC) to amalgam for restorations placed in permanent posterior teeth have: (i) similar effect direction and (ii) similar effect magnitude.

METHODS

7 electronic databases were searched, as well as reference lists. Odds ratios (OR) and Standardised Mean Differences (SMD) with 95% Confidence intervals were computed for extracted dichotomous and continuous data, respectively. Pooled effect estimates for laboratory and clinical data were computed to test for effect direction. Odds ratios were converted into SMDs. SMDs from laboratory and clinical data were statistically compared to test for differences in effect magnitude. The analysed results were further investigated within the context of potential influencing or confounding factors using a Directed acyclic graph.

RESULTS

Of the accepted eight laboratory and nine clinical trials, 13 and 21 datasets could be extracted, respectively. The pooled results of the laboratory datasets were highly statistically significant in favor of amalgam. No statistically significant differences, between HVGICs and amalgam, were identified for clinical data. For effect magnitude, statistically significant differences between clinical and laboratory trial results were found. Both null-hypotheses were rejected.

CONCLUSION

Laboratory results concerning high-viscosity glass-ionomers versus amalgam for tooth restorations do not indicate similar effect direction and magnitude than that of controlled clinical trials.

In Vitro Performance of Class I and II Composite Restorations: A Literature review on Nondestructive Laboratory Trials—Part II

A literature review was conducted on adhesive Class I and II restorations and nondestructive in vitro tests using the PubMed/Medline database for the 1995-2010 period. The first part of this review has presented and critically appraised selected literature dealing with the quality and in vitro behavior of adhesive Class II restorations using photoelasticity, finite element analysis, and microleakage study protocols. This second part reviews additional parameters, which are deformation and fracture resistance to cyclic loading, shrinkage stress and tooth deformation following restoration placement, bond strength (microtensile, tensile, and shear tests), and marginal and internal adaptation. In addition, a “relevance score” has been proposed that aims to classify the different study protocols according, firstly, to the resulting quality, quantity, and consistency of the evidence and then, secondly, to their potential clinical relevance, as estimated by their ability to simulate oral and biomechanical strains. The highest clinical relevance was attributed to marginal and internal adaptation studies, following cyclic loading in a moist environement. However, a combination of in vitro protocols will have an even greater predictive potential and has to be considered as a crucial preclinical research approach with which to investigate the numerous restorative configurations that cannot be efficiently and rapidly tested in vivo.

Posterior composite restoration update: focus on factors influencing form and function

Restoring posterior teeth with resin-based composite materials continues to gain popularity among clinicians, and the demand for such aesthetic restorations is increasing. Indeed, the most common aesthetic alternative to dental amalgam is resin composite. Moderate to large posterior composite restorations, however, have higher failure rates, more recurrent caries, and increased frequency of replacement. Investigators across the globe are researching new materials and techniques that will improve the clinical performance, handling characteristics, and mechanical and physical properties of composite resin restorative materials. Despite such attention, large to moderate posterior composite restorations continue to have a clinical lifetime that is approximately one-half that of the dental amalgam. While there are numerous recommendations regarding preparation design, restoration placement, and polymerization technique, current research indicates that restoration longevity depends on several variables that may be difficult for the dentist to control. These variables include the patient’s caries risk, tooth position, patient habits, number of restored surfaces, the quality of the tooth–restoration bond, and the ability of the restorative material to produce a sealed tooth–restoration interface. Although clinicians tend to focus on tooth form when evaluating the success and failure of posterior composite restorations, the emphasis must remain on advancing our understanding of the clinical variables that impact the formation of a durable seal at the restoration–tooth interface. This paper presents an update of existing technology and underscores the mechanisms that negatively impact the durability of posterior composite restorations in permanent teeth.

BisGMA/TEGDMA dental nanocomposites containing glyoxylic acid-modified high-aspect ratio hydroxyapatite nanofibers with enhanced dispersion

The purpose of this research was to investigate the influence of the glyoxylic acid (GA) modification of hydroxyapatite (HAP) nanofibers on their dispersion in bisphenol A glycidyl methacrylate (BisGMA)/triethylene glycol dimethacrylate (TEGDMA) dental composites and also to investigate the mechanical properties, water absorption and water solubility of the resulting dental resins and composites. Scanning/transmission electron microscopy images showed that microsized HAP nanofiber bundles could be effectively broken down into individual HAP nanofibers with an average length of ∼15 µm after the surface modification process. Fourier transform infrared spectroscopy, x-ray photoelectron spectroscopy and thermal gravimetric analysis characterization confirmed that GA was chemically grafted on the HAP nanofiber surface, hypothetically by reacting with the amine group on the HAP nanofiber surface. The enhanced dispersion of HAP nanofibers in the dental matrix led to increased biaxial flexural strength (BFS) compared with the corresponding dental resins and composites filled with untreated HAP nanofibers. In addition, impregnation of small mass fractions of the GA-modified HAP nanofibers into the BisGMA/TEGDMA dental resins (5 wt%, 10 wt%) or composites (2 wt%, 3 wt%) could also substantially improve the BFS in comparison with the controls (pure resins or dental composites filled with silica particles alone). Larger mass fractions could not increase the mechanical property further or even degraded the BFS values. Water behavior testing results indicated that the addition of the GA-modified HAP nanofibers resulted in higher water absorption and water solubility values, which are not preferred for clinical application. In summary, well-dispersed HAP nanofibers and their dental composites with enhanced mechanical properties have been successfully fabricated, but the water absorption and water solubility of such dental composites need to be further improved.

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.

Effect of Operator-specific Handling on Tooth-composite Interface and Microleakage Formation

After calibration of the restoration procedure, three operators experienced differences in tooth-composite interface morphology and microleakage formation. These differences reflect technique-sensitivity of the etch-and-rinse adhesive. The lowest microleakage on dentin was related to an enhanced interface integrity. After additional application of an adhesive component, sealing of the enamel and dentin was partially enhanced, but microleakage formation did not decrease. These results are helpful in the comparative evaluation of other bonding systems.

Adhesive analysis of voids in Class II composite resin restorations at the axial and gingival cavity walls restored under in vivo versus in vitro conditions

OBJECTIVES

Adhesive analysis, under the scanning electron microscope of microtensile specimens that failed through the adhesive interface, was conducted to evaluate the amount of voids present at the axial versus gingival cavity walls of class II composite restorations restored under in vivo and in vitro conditions.

METHODS

Five patients received class II resin composite restorations, under in vivo and in vitro conditions. A total of 14 premolar teeth yielded 59 (n=59) microtensile adhesive specimens that fractured through the adhesive interface. The fractured surfaces of all specimens were examined and the % area of voids was measured.

RESULTS

Voids at the adhesive joint were highly predictive of bond strengths. An increase in the number of voids resulted in a decrease in the microtensile bond strength. The area of voids at the adhesive interface was as follows: in vivo axial 13.6+/-25.6% (n=12); in vivo gingival 48.8+/-29.2% (n=12); in vitro axial 0.0+/-0.0% (n=19) and in vitro gingival 11.7+/-17.6% (n=16).

SIGNIFICANCE

Composite resin may bond differently to dentin depending upon the amount of voids and the cavity wall involved. The bond to the gingival wall was not as reliable as the bond to the axial wall. An increase in the amount of surface voids was a major factor for reducing microtensile bond strengths of adhesive to dentin.

In vitro microtensile bond strength of four adhesives tested at the gingival and pulpal walls of Class II restorations

BACKGROUND

The authors compared the microtensile bond strength of teeth restored with four adhesives at the gingival and pulpal cavity walls of Class II resin-based composite restorations.

METHODS

Five pairs of extracted third molars received two Class II preparations/restorations in each tooth. The authors randomly assigned each preparation to one of four adhesive groups: Adper Scotchbond Multipurpose Dental Adhesive (SBMP) (3M ESPE, St. Paul, Minn.), Clearfil SE Bond (CFSE) (Kuraray America, New York City), Prime & Bond NT (PBNT) (Dentsply Caulk, Milford, Del.) and PQ1 (Ultradent, South Jordan, Utah). They restored the teeth and obtained microtensile specimens from each cavity wall. Specimens were tested on a testing machine until they failed.

RESULTS

The mean (+/- standard deviation) bond strengths (in megapascals) were as follows: SBMP (pulpal), 36.4 (17.2); SBMP (gingival), 29.7 (15.3); CFSE (pulpal), 50.8 (13.6); CFSE (gingival), 50.2 (14.0); PBNT (pulpal), 38.3 (19.2); PBNT (gingival), 38.9 (17.7); PQ1 (pulpal), 58.7 (8.7); and PQ1 (gingival), 54.5 (18.5). A two-way analysis of variance found an adhesive effect (P < .001) but no location effect (P >.05).

CONCLUSIONS

PQ1 and CFSE performed the best. The results showed no significant difference in microtensile bond strength at the gingival wall versus the pulpal wall.

CLINICAL IMPLICATIONS

Under in vitro conditions, a total-etch ethanol-based adhesive (PQ1) failed cohesively more often than did the other adhesives tested.

Adhesive performance of dentin bonding agents appliedin vivo andin vitro. Effect of intrapulpal pressure and dentin depth

The purpose of this study was to evaluate the influence of intrapulpal pressure and dentin depth on bond strengths of an etch-and-rinse and a self-etching bonding agent to dentin in vitro and in vivo. Twenty-four pairs of premolars were randomly divided into four groups (n = 6) according to the dentin bonding agent, Single Bond and Clearfil SE Bond, and intrapulpal pressure, null or positive. Each tooth of the pair was further designated to be treated in vivo or in vitro. The intrapulpal pressure was controlled in vivo by the delivery of local anesthetics containing or not a vasoconstrictor, while in vitro, it was achieved by keeping the teeth under hydrostatic pressure. Class I cavities were prepared and the dentin bonding agents were applied followed by incremental resin restoration. For the teeth treated in vitro, the same restorative procedures were performed after a 6 month-storage period. Beams with 1 mm(2) cross-sectional area were prepared and microtensile tested. Clearfil SE Bond was not influenced by any of the variables of the study, while bond strengths produced in vitro were significantly higher for Single Bond. Overall, lower bond strengths were produced in deep dentin, which reached statistical significance when Single Bond was applied under physiological or simulated intrapulpal pressure. In conclusion, in vitro bonding may overestimate the immediate adhesive performance of more technique-sensitive dentin bonding systems. The impact of intrapulpal pressure on bond strength seems to be more adhesive dependent than dentin morphological characteristics related to depth.

Comparison of interfacial characteristics of adhesive bonding to superficial versus deep dentine using SEM and staining techniques

OBJECTIVES

A primary reason for premature failure of Class II composite restorations is recurrent decay at the gingival margin. The integrity of the gingival margin depends on the bond formed with dentine. Using scanning electron microscopy (SEM) and histomorphologic technique, the purpose of this study was to characterise the adhesive/dentine (a/d) bond in dentine sections from the dentinoenamel junction (DEJ) and the cementoenamel junction (CEJ) with commercial adhesives of varying hydrophobic/hydrophilic composition.

MATERIALS AND METHODS

The occlusal 1/3 of the crown was removed from 20 human third molars, this exposed the surface used for the DEJ sections. The teeth were sectioned occluso-gingivally into equal halves: one-half representing the DEJ; the remaining half was sectioned 4mm deep to the exposed surface (CEJ). Each half was treated with the same adhesive. The teeth were randomly selected for treatment with Single Bond (SB, 3M) or Dentastic UNO (UNO, Pulpdent) using wet bonding technique as per manufacturers' instructions. Thin (3-5mum) sections of native a/d interfaces were cut and stained with Goldner's trichrome for light microscopic (LM) examination. Companion slabs were polished and acid-bleach treated, then analysed with SEM.

RESULTS

DEJ sections: SB/dentine specimens had approximately 4mum exposed protein at the interface, UNO infiltrated the depth of the demineralised dentine and encapsulated exposed protein. CEJ sections: SB/dentine specimens had highly variable interface structure with localized exposed protein, UNO/dentine exhibited 3-5mum exposed protein at the interface. The quality of the interface was exaggerated and the above differences were not revealed based on SEM characterisation.

CONCLUSIONS

As a result of adhesive phase separation, SB does not form structurally integrated a/d bonds at the DEJ or CEJ. The increased hydrophilic composition of UNO contributes to the formation of an integrated a/d bond at the DEJ, but structural differences and increased moisture leads to unprotected protein at the a/d interface in the CEJ sections. The inability of the SEM technique to reveal the complexity of the interface could be related to the modifications of the a/d interface caused by polishing and acid-bleach treatment.

Interfacial chemistry of class II composite restoration: structure analysis

The gingival margins of class II composite restorations are particularly vulnerable to marginal leakage and secondary caries. In identifying the factors contributing to caries development, the molecular structure and differences in the structure at the proximal and gingival margins have been largely overlooked. The purpose of this study was to compare the molecular structure at the adhesive/dentin interface of the proximal and gingival walls of class II composite restorations. Class II preparations were cut in 12 unerupted third molars with a water-cooled high-speed dental handpiece. The prepared teeth were randomly selected for treatment with Single Bond (SB) + Z100 (3M). Teeth were restored, per manufacturer's directions, under humidity and temperature characteristic of the oral cavity. Restored teeth were kept in sterile Delbecco's phosphate saline for 48 h. The samples were sectioned occluso-gingivally and micro-Raman spectra were acquired at approximately 1.5-microm spatial resolution across the composite/adhesive/dentin interfaces. Samples were wet throughout spectral acquisition. Raman spectral characteristics at the proximal and gingival margins were distinctly different; the depth of demineralized dentin was 6-7 microm at proximal margin, 12-13 microm at gingival margin. SB adhesive penetrated the depth of demineralized dentin in a gradient at the proximal margin. The "single bottle" adhesive used in this study, gradually penetrated the depth of the demineralized dentin at the proximal margin but failed to infiltrate the depth at the gingival margin, leaving a thick exposed collagen layer.

Single-bottle adhesives behave as permeable membranes after polymerisation. II. Differential permeability reduction with an oxalate desensitiser

OBJECTIVES

This study examined the changes in hydraulic conductance and ultrastructure of dentine bonded with simplified etch-and-rinse adhesives to oxalate desensitiser pre-treated acid-etched dentine.

METHODS

Human dentine disks were acid-etched, treated with an oxalate desensitiser (BisBlock, Bisco), and bonded with One-Step (OS), Single Bond (SB), OptiBond Solo Plus (OB) or Prime and Bond NT (PB). Similar disks from each group were acid-etched, and bonded without oxalate pre-treatment. Hydraulic conductance of the specimens was measured at 20 cm of water pressure and analysed with nonparametric statistical methods. Epoxy resin replicas of the smear layer-covered dentine and bonded dentine were examined with SEM for the extent of fluid transudation. Specimens bonded under perfusion were examined with TEM after tracer immersion.

RESULTS

OB and PB exhibited a highly significant reversal of the reduced hydraulic conductance obtained with BisBlock on unbonded acid-etched dentine. Profuse water transudation across the bonded dentine was observed from the replicas. Adhesive interfaces were covered with spherical globules that interfered with dentine hybridization. Conversely, no significant difference in hydraulic conductance was observed in SB, between Bisblock pre-treated, unbonded and bonded acid-etched dentine. Significantly lower hydraulic conductance was shown on application of OS to Bisblock-treated acid-etched dentine. Water transudation was sparse, interfering surface globular structures were absent, and only angular subsurface crystals were seen in the dentinal tubules.

CONCLUSIONS

Convective water fluxes through dentine may be reduced by applying Bisblock to acid-etched dentine before bonding with One-Step or Single Bond. However, reducing adhesive permeability with the use of oxalate desensitiser is not applicable to low acidity adhesives such as OptiBond Solo Plus and Prime and Bond NT.