Does Adhesive Layer Thickness and Tag Length Influence Short/Long-Term Bond Strength of Universal Adhesive Systems? An In-Vitro Study

Equivalence study of the resin-dentine interface of internal tunnel restorations when using an enamel infiltrant resin with ethanol-wet dentine bonding

This preregistered ex vivo investigation examined the dentinal hybrid layer formation of a resinous infiltrant (Icon), with reference to both thickness (HLT) and homogeneity when combined with modified tunnel preparation (occlusal cavity only) and internal/external caries infiltration. The adhesives Syntac and Scotchbond MP were used as controls (Groups 1 and 3) or in combination with Icon (Groups 2 and 4). A split-tooth design using healthy third molars from 20 donors resulted in 20 prepared dentine cavities per experimental group. The cavity surfaces (n = 80) were etched (37% H3PO4), rinsed, and air-dried. Rewetting with ethanol was followed by application of the respective primers. After labeling with fluorescent dyes, either Syntac Adhesive/Heliobond or Scotchbond MP Adhesive was used alone or supplemented with Icon. HLT, as evaluated by scanning electron microscopy, did not significantly differ (P > 0.05), and confocal laser scanning microscopy revealed homogeneously mixed/polymerized resin-dentine interdiffusion zones in all groups. Icon can be successfully integrated into an ethanol-wet dentine bonding strategy, and will result in compact and homogeneous hybrid layers of comparable thickness considered equivalent to the non-Icon controls, thus allowing for preservation of the tooth's marginal ridge and interdental space in the case of internal/external infiltration of proximal caries.

Warm Air Delivery in Adhesive Application: Effect on Bonding Performance and Morphological Outcomes

Solvent evaporation within an adhesive layer is a crucial step during a bonding process. The aim of this current research was to test whether the use of different air temperatures (20 °C, 40 °C, and 60 °C) for solvent evaporation improves the performance of four adhesive systems to dentin. Sixty non-carious human molar teeth were randomly prepared for micro-tensile bond strength (μTBS) tests. Four different adhesive systems, Prime&Bond Universal (PBU), OptiBond Universal (OBU), OptiBond FL (OBFL), and Clearfil SE (CSE), were applied following the manufacturer's instructions. Three groups based on the air-drying temperature were used: solvent evaporation was performed with either of warm (40 °C), (60 °C), and cold air as control group (20 °C) for 10 s at a distance of 5 cm. In all bonded surfaces, three resin composite (Reflectys, Itena Clinical, Paris, France) layers of 2 mm thickness were built up. The resin-dentin samples were kept in distilled water at 37 °C for 24 h and 6 months, respectively, before μTBS testing. Failure analysis, scanning electron microscopy of resin-dentin bonded interface, and solvent evaporation rate were tested as secondary variables. All analyses were conducted using a significance level of α = 0.05. Bond strength (BS) values were similar among all the adhesive systems used (p > 0.05). Also, the aging factor did not affect the BS (p > 0.05). Only the factor of temperature used for solvent evaporation resulted in a statistically significant effect (p < 0.05), with the temperature of 60 °C being the highest value (p < 0.05). A failure mode evaluation revealed mostly adhesive or mixed modes of failures in all the different temperatures of air used for the solvent evaporation of each adhesive system. The thickness of the adhesive layer and the creation of resin tags varied amongst the temperatures evaluated. For all adhesive systems tested, the use of 40 °C or 60 °C air for solvent evaporation led to an increased mass loss. Warmer temperatures for solvent evaporation contributed positively to bonding performance, enhancing both the quality of the adhesive layer and its interaction with the dentin tissue. Optimizing solvent evaporation with warmer air temperatures (40 °C and 60 °C) significantly improved µTBS, offering a practical means to enhance the quality and longevity of adhesive restorations in esthetic dentistry.

Tooth-composite bond failure with a universal and an etch-and-rinse adhesive depending on mode and frequency of application

OBJECTIVES

To evaluate the effect of an additional layer of universal adhesive on the interfacial enamel/dentin-composite gap formation in relation to application mode and aging, via spectral domain optical coherence tomography (SD-OCT) and scanning electron microscopy (SEM).

METHODS

In vitro class V cavities in 114 caries-free premolars were restored by applying one or two layers of a universal adhesive (Scotchbond Universal, SBU) in self-etch (se) and etch-and-rinse (er) mode or the reference adhesive OptiBond FL (OFL-er). The restorations were imaged by SD-OCT (six groups, n = 8) and SEM (n = 3) directly after filling (t1), water storage (t2, 24 h), embedding (t3), and thermo-mechanical loading (t4, TCML). The interfacial gaps were quantified using 26 parameters and analyzed using principal component analysis and linear mixed effect models.

RESULTS

Gap formation at enamel and dentin was significantly influenced by the adhesive, the application mode and number of layers (p < 0.001). This was due to the influence of the SBU-er mode (p < 1e-05), which showed significantly more gap formation and a greater range of variation with double application when compared to SBU-se and OFL. The fewest interfacial gaps occurred with one or two applications of OFL-er and one layer of SBU-er.

SIGNIFICANCE

Adhesive application mode and the number of adhesive layers are relevant factors in the tooth-composite bond failure. Double application worsened the adaptation of SBU to freshly prepared dentin conditioned with phosphoric acid.

Effect of Modified Triple-Layer Application on the Bond Strength of Different Dental Adhesive Systems to Dentin

The goal of this article was to assess the effect of modified triple-layer application (MTLA) in conjunction with the active bonding technique on the bond strength of four adhesive systems to dentinal substrate. The adhesives tested were Prime&Bond Universal (PBU), OptiBond Universal (OBU), OptiBond FL (OBFL), and Clearfil SE (CSE). The adhesives were applied according to the following strategies: single active application (A) and triple adhesive layer application including Active-Passive-Passive (APP); AAP; and AAA. The micro-tensile bond strength test was evaluated following 24 h or 6 months of storage. The composite-dentin interface morphology was investigated using scanning electron microscopy. The data were statistically analyzed with a significance level of α = 0.05. At 24 h of aging, all of the factors tested were not significant (p > 0.05) for CSE. For OBFL, OBU, and PBU, statistically higher values were observed for the A technique (p < 0.05). Plus, there were no significant variances between the APP, AAP, and AAA techniques (p > 0.05) for OBFL and PBU. However, for OBU, there were no significant differences between the A and AAA techniques (p > 0.05). After 6 months of aging, the A technique showed statistically higher values when compared to the other techniques (p < 0.01), except for OBFL, where the A and AAA techniques showed promising outcomes. When comparing the bond strength values of 24 h and 6 months, only for PBU, all of the techniques used resulted in bond strength stability over time (p > 0.05). Thicker adhesive layers were observed when MTLA was applied. Only the OBFL adhesive showed the formation of resin tags in all of the modalities tested. The bonding performances of the different application techniques used were material-dependent.

Effectiveness of Different Application Modalities on the Bond Performance of Four Polymeric Adhesive Systems to Dentin

One of the major goals of adhesive dentistry is to improve the interaction of the already-existing adhesives with different substrates by using different application techniques. Thus, the objective of the present in vitro study was to assess the bond performance of four adhesive systems, Prime&Bond Universal (PBU), Clearfil SE Bond (CSE), OptiBond Universal (OBU), and OptiBond FL (OBFL), to dentin using various application modes: passive application (PA), active application (AA), Compo-Vibes modified application (CVM), and Compo-Vibes application (CV). Eighty extracted human molars were allocated into four groups based on the application modalities tested. The micro-tensile bond strength as well as fracture mode were tested in accordance with ISO/TS 11.405 after 24 h and 6 months of aging. Adhesive contact angle (CA) and scanning electron microscope analysis were also performed (n = 3). Statistical tests were performed with α = 0.05. After 24 h, a significant difference with a higher bond strength value was found for PBU in the AA modality and for CSE in the CVM modality (p < 0.05). However, no significant difference was shown between the techniques used among the other adhesives (OBFL and OBU). Moreover, at 24 h, only the PA demonstrated significant differences between the tested materials (p < 0.05). After 6 months, CSE, PBU, and OBU demonstrated significant differences between the techniques (p < 0.05), with a higher bond strength for CSE in AA and CVM modalities, for PBU in AA modality, and for OBU in AA and PA modalities. No significant differences were found between the techniques used among the OBFL (p > 0.05). In addition, only the CVM technique demonstrated significant differences between the tested materials after 6 months. CV and CVM showed a decreased value after aging for CSE and PBU, respectively. However, all the modalities decreased for OBU and OBFL after aging. All the adhesives showed marked resin infiltration into dentinal tubules in AA among all the modalities tested. Both universal adhesive systems (OBU and PBU) demonstrated statistically lower CA when compared to the other systems (CSE and OBFL) (p < 0.05) when applied in the PA mode. Concerning the AA mode, only CSE and OBFL were tested. The AA demonstrated lower CA values compared to the same adhesives in PA (p < 0.05). It could be concluded that the bond strength could be influenced by both materials and application techniques. It seems that the AA technique could be recommended as a gold standard for the application of an adhesive system to dentin. Plus, the CV and CVM modalities after 6 months of aging were considered stable for PBU and CSE, respectively. Consequently, the performance of these adhesive systems might vary when applied to other modalities. Future studies are needed to test this hypothesis.

Effect of irradiance and exposure time on the adhesive properties of universal adhesives after 2 years of storage

OBJECTIVE

This study aims to evaluate the effects of exposure time and irradiance on the dentin bonding properties (microtensile bond strength (μTBS) and nanoleakage (NL)) of the Clearfil Universal Bond Quick (CUQ) adhesive and Scotchbond Universal Adhesive (SBU) immediately and after 2 years of water storage.

MATERIAL AND METHODS

Hence, 128 human molars were randomly assigned to 16 groups based on adhesive strategy, irradiance/exposure times, and storage time for each universal adhesive tested. The adhesives were applied using the etch-and-rinse and self-etch strategies and were light-cured using four different irradiance/exposure times: 1400 mW/cm2 for 5 s (1400 × 5), 1400 mW/cm2 for 10 s (1400 × 10), 3200 mW/cm2 for 5 s (3200 × 5), and 3200 mW/cm2 for 10 s (3200 × 10). Then, each sample was restored and sectioned into a resin-dentin bonded stick to be tested for μTBS and NL (immediately and after 2 years of water storage). The mean μTBS and NL of all resin-dentin bonded sticks from the same hemi-tooth (factor time) were statistically analyzed using a three-way ANOVA and Tukey's test (a = 0.05).

RESULTS

Despite a significant decrease in the μTBS values for all groups after 2 years of water storage, the 3200 × 5 group showed higher μTBS values, whereas the 3200 × 10 group showed lower μTBS values for both universal adhesives tested. Although a significant increase in the NL values was observed for all groups after 2 years of water storage, the 3200 × 10 group showed higher NL values than the other groups (p < 0.001).

CONCLUSION

Results indicate that light-curing the adhesive layer with 14-16 J/cm2 led to an improvement in the stability of the resin-dentin adhesive interface. A longer exposure time (10 s) coupled with a higher irradiance (3200 mW/cm2) resulted in a greater degree of degradation of the adhesive interface.

CLINICAL SIGNIFICANCE

To guarantee better stability of the adhesive interface, clinicians could be preferred a light-cured universal adhesive layer with 14-16 J/cm2. Higher irradiances should be avoided.

Special Issue "Recent Advances in Biomaterials and Dental Disease" Part I

Oral cavities provide an entry point for food and nutrients [...].

Which self-etch acidic composition may result in higher dental bonds at the long-term? A network meta-analysis review of in vitro studies

OBJECTIVES

This review evaluated the effects of the acidic composition of self-etch (SE) adhesives at the long-term bond strengths to dentin and enamel.

DATA

The review followed the PRISMA Extension Statement for network meta-analysis. Studies were identified by a systematic search in PubMed, Web of Science, and Scopus databases.

STUDY SELECTION

The inclusion criteria were in vitro studies that evaluated bond strength data of samples analyzed at both immediate and long-term (after aging simulation) periods and that were bonded to sound dentin/enamel using SE adhesives, with at least one group of adhesives being based on 10-MDP (10-methacryloyloxy-decyl-dihydrogen-phosphate; control) and the other group being comprised of alternative acidic monomers. Statistical analyses were conducted using two methods: standard pairwise meta-analysis (SPMA) and Bayesian network meta-analysis (NMA). Heterogeneity was assessed by using the Cochran Q test and I² statistics.

RESULTS

From 5220 studies identified, 87 met the eligibility criteria and 83 were meta-analyzed. Seventeen adhesives were based on 10-MDP and 44 systems were based on alternative acids. The resin-dentin/enamel bonds were predominantly reduced after aging (∼84% of cases). From the SPMA findings, the following acidic compositions showed lower bond strength values (effect size: mean difference [MD] with 95% confidence interval [95% CI]) than 10-MDP: 4-META (MD -4.99, 95% CI: -7.21, -2.78; p<0.001); sulfonic acids (MD -9.59, 95% CI -12.19, -6.98; p<0.001); unspecified phosphate esters (MD -8.89, 95% CI -17.50, -0.28; p = 0.04); or mixed acids (MD -11.0, 95% CI -13.62, -8.38; p<0.001). The dental bonds were benefited from the presence of 10-MDP upon longer aging (>6 months). From the NMA probabilistic findings, adhesives based on 10-MDP and phosphonic acids ranked as having the best and the worst bonding potential to dentin, respectively. More than one composition (phosphonic acids and mixed acids) ranked similarly to 10-MDP in enamel. The studies scored as having moderate risk of bias (58.6%), followed by low (39.1%) and high (2.3%) risk of bias.

CONCLUSION

10-MDP is an outstanding acidic monomer that contributes to higher bonds to dentin at the long-term. In enamel, there is no evidence that one acidic composition prevails over the other.

CLINICAL SIGNIFICANCE

The acidic composition of SE adhesives affects the resistance of dental bonds after simulated aging, with 10-MDP playing a significant role in the adhesion to dentin but not to the enamel.

REGISTRATION NUMBER

This report is registered at the Open Science Framework (osf.io/urtdf).

Bonding of universal adhesives to bur-cut dentin: Effect of double application and dentin moisture level

This study investigated how the double application of adhesives and dentin moisture level influence the microtensile bond strength (µTBS) of universal adhesives containing different hydrophilic monomers to bur-cut dentin. Four universal adhesives (Scotchbond Universal, Clearfil Universal Bond Quick, Prime&Bond Universal, BeautiBond Universal) were applied to wet and dry bur-cut dentin either in one or two layers. The µTBS test was performed after 25,000 thermal cycles, and scanning electron microscopy was used for the analysis of failure mode and interfacial ultrastructure. Double application significantly improved µTBS on wet dentin (p<0.001), but the effect was not significant on dry dentin (p>0.050). Double application also enhanced the formation of resin tags and limited voids within the adhesive layer of BeautiBond Universal. Dentin moisture had a significant effect on µTBS only if the adhesives were applied in a single layer (p=0.007). Except for Prime&Bond Universal, the tested universal adhesives performed better on dry dentin.

Effect of Intraoral Humidity on Dentin Bond Strength of Two Universal Adhesives: An In Vitro Preliminary Study

This study investigated the effect of intraoral humidity on microtensile bond strength (μTBS) to dentin of two universal adhesives applied in self-etch (SE) mode. Forty extracted human molars were selected for this study. Dentin specimens were allocated into four groups, standardized and then bonded with two commercial multimode adhesives, according to two humidity conditions (50% relative humidity (RH) and 90% RH). Following composite resin build-up and 24 h of water storage, the μTBS of the bonded interface was analyzed. The 50% RH was higher for Scotchbond Universal (SBU) than Prime&Bond Universal (PBU), while for 90% RH, SBU had significantly lower values than PBU. With PBU, the mean bond strength was not significantly different between both humidity settings tested (p > 0.05), while for SBU, the mean bond strength was significantly different between both conditions tested (p < 0.05); μTBS was significantly higher for 50% RH than for the other group. Within the limitation of this in vitro study, it can be concluded that: 1) the bonding performance of adhesives systems depends on the humidity settings; 2) increased RH exerts a detrimental effect on the bond strength of 2-hydroxyethyl methacrylate (HEMA)-containing adhesive tested. However, this phenomenon was not observed for HEMA-free adhesive tested; 3) further research in this area is needed to investigate different adhesive systems, temperatures and humidity settings.

Effect of Active Bonding Application after Selective Dentin Etching on the Immediate and Long-Term Bond Strength of Two Universal Adhesives to Dentin

The objective was to evaluate the influence of active bonding applications (ABA) for different time intervals after selective dentin etching (SDE) for 3 s on the microtensile bond strength (μTBS) to dentin of two universal adhesive systems (UAs): one containing 2-hydroxyethyl methacrylate (HEMA) (Scotchbond Universal, SBU), and one that was HEMA-free (Prime&Bond Universal, PBU). Dentin bovine specimens were divided into four groups: self-etch as control (SE), SDE + ABA for 15 s (SDE15), SDE + ABA for 20 s (SDE20), and SDE + ABA for 25 s (SDE25). The μTBS test was performed after a water storage of 24 h and 6 months. Scanning electron microscopy (SEM) was used in order to examine the resin−dentin interface. For the PBU, the µTBS was significantly influenced only by the aging factor (p < 0.026). A statistically significant decrease in the µTBS after 6 months of aging was observed only for the SDE15 group. For SBU, µTBS was significantly influenced by the protocol application and the aging time (p ≤ 0.041). The groups SDE15, SDE20, and SDE25 achieved statistically significant higher values (after 24 h and 6 months). No considerable variances were noticed in the homogeneity and continuity of the hybrid layer (HL) among the groups. In conclusion, SDE and ABA improved the µTBS only of a HEMA-containing universal adhesive.

Does Multi-Fiber-Reinforced Composite-Post Influence the Filling Ability and the Bond Strength in Root Canal?

The purpose of the present in vitro study was to investigate the bond strength of root canal dentin and the filling ability of a new multi-fiber-reinforced composite post (mFRC) compared to a conventional single fiber-reinforced-composite post (sFRC). Twenty-eight freshly maxillary first permanent single-rooted premolars were instrumented and divided into groups (n = 14). Group 1: single-fiber-reinforced composite (sFRC), group 2: multi-fiber-reinforced composite (mFRC). Bonding procedures were performed using a dual-cure universal adhesive system and resin cement. All specimens were sectioned so that seven discs of 1 mm of thickness were obtained from each root. An optical microscope was used before the push-out test to measure the total area of the voids and to determine the length of the smaller/bigger circumferences. The push-out bond strength (PBS) test was performed using an Instron universal testing machine. Data were then compared by one-way ANOVA on ranks (α = 0.05). The dentin–cement–post interface was observed using scanning electron microscopy (SEM). At the coronal third, a significantly higher bond strength (p < 0.05) was obtained in the sFRC group (44.7 ± 13.1 MPa) compared to the mFRC group (37.2 ± 9.2 MPa). No significant difference was detected between the groups at the middle third (sFRC group “33.7 ± 12.5 MPa” and mFRC group “32.6 ± 12.4 MPa”) (p > 0.05). Voids were significantly lower in the mFRC compared to those observed in the sFRC group (p < 0.05) at the coronal third. Whereas, no significant difference was found at the middle third (p > 0.05) between the tested groups. Filling ability was overall improved when employing mFRC, although such technique might have characteristic limitations concerning the bond strength to dentin.

Effectiveness of dentin pre-treatment on bond strength of two self-adhesive resin cements compared to an etch-and-rinse system: an in vitro study

Statement of problem

It has been shown that selective etching improves the bond strength of some self-adhesive resin cements to enamel. The same has yet to be determined with dentin pre-treatment.

Purpose

To evaluate the tensile bond strength of two self-adhesive resin cements after two dentin surface pre-treatments, and also to analyze the cement/dentin interface.

Material and Methods

One hundred and twelve human third molars were extracted. The teeth were distributed into seven groups (n = 16). Maxcem Elite Chroma (MAX) (Kerr, Scafati, Italy) and Relyx U200 (RLX) (3M ESPE, Neuss, Germany) were used without pre-treatment or with two dentin pre-treatments (polyacrylic acid or phosphoric acid). A conventional etch-and-rinse (EAR) luting cement, NX3 Nexus (NX3) (Kerr, Scafati, Italy), was used as an external control group. Before testing, all specimens were stored in distilled water for 24 hours. Three specimens from each group were prepared for scanning electron microscopy observation (SEM). A tensile bond strength test (TBS) was performed for the remaining samples. The data were statistically analyzed using the Kruskal–Wallis test and Pairwise comparisons using the Wilcoxon rank sum test.

Results

MAX without pre-treatment and with phosphoric acid etching attained statistically similar bond strengths to NX3 (P > 0.05). There was a statistical difference (P = 0.00488) between RLX without pre-treatment (5.62 MPa) and NX3 (10.88 MPa). Phosphoric acid pre-treatment increases the bond strength values of RLX to a strength that is comparable to NX3 (P > 0.05). The lowest tensile bond strength (TBS) was attained after the application of polyacrylic acid with MAX (1.98 MPa). No statistical differences were found between the RLX bond strength values after polyacrylic acid treatment and RLX without pre-treatment or NX3 (P > 0.05). SEM observations disclosed an enhanced potential of the self-adhesive cements to infiltrate into dentin tubules and form resin tags when applied after phosphoric acid pre-treatment. The failure mode was dominantly adhesive.

Conclusions

On dentin, the self-adhesive resin cement MAX might be an effective alternative to conventional resin cement. Etching the dentin with phosphoric acid does not have a negative effect on the bond strength of MAX to dentin. On the other hand, phosphoric acid improved the bond strength of RLX when compared to EAR cement.

Influence of TiO2 and ZrO2 Nanoparticles on Adhesive Bond Strength and Viscosity of Dentin Polymer: A Physical and Chemical Evaluation

The present study aimed to formulate an experimental adhesive (EA) and reinforce it with 5 wt.% titanium dioxide (TiO₂) or zirconium oxide (ZrO₂) to yield 5% TiO₂ and 5% ZrO₂ adhesives, respectively, and then analyze the impact of this reinforcement on various mechanical properties of the adhesives. The EA contained a blend of monomers such as bisphenol A glycol dimethacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA), and ethyl 4-dimethylamino benzoate and camphorquinone. The EA included ethyl 4-dimethylamino benzoate and camphorquinone photo-initiators, and diphenyliodonium hexafluorophosphate (DPIHP) was also included to act as an electron initiator. The TiO₂ and ZrO₂ nanoparticles were incorporated into the EA post-synthesis. To characterize the filler nanoparticles, scanning electron microscopy (SEM) and line-energy dispersive X-ray (EDX) spectroscopy were performed. The adhesives were characterized by analyzing their rheological properties, shear-bond strength (SBS), and interfacial failure types. Further, the resin-dentin interface was also analyzed via SEM. The TiO₂ nanoparticles were spherically shaped on the SEM micrographs, while the ZrO₂ nanoparticles were seen as non-uniformly shaped agglomerates. The EDX mapping demonstrated the presence of Ti and oxygen for TiO₂ and Zr and oxygen for the ZrO₂ nanoparticles. Both 5% TiO₂ and 5% ZrO₂ adhesives revealed decreased viscosity as compared with the EA. The 5% TiO₂ adhesive demonstrated higher SBS values for both non-thermocycled (NTC) and thermocycled samples (NTC: 25.35 ± 1.53, TC: 23.89 ± 1.95 MPa), followed by the 5% ZrO₂ adhesive group (NTC: 23.10 ± 2.22, TC: 20.72 ± 1.32 MPa). The bulk of the failures (>70%) were of adhesive type in all groups. The SEM analysis of the resin-dentin interface revealed the development of a hybrid layer and resin tags (of variable depth) for the EA and 5% TiO₂ groups. However, for the 5% ZrO₂ group, the hybrid layer and resin tag establishment appeared compromised. Reinforcement of the EA with TiO₂ or ZrO₂ caused an increase in the adhesive's SBS (with the 5% TiO₂ group demonstrating the highest values) in comparison with the EA (without nanoparticles). However, both nanoparticle-containing adhesives revealed decreased viscosity compared with the EA (without nanoparticles). Further studies investigating the impact of diverse filler concentrations on the properties of adhesives are suggested.

The Bond Strength and Antibacterial Activity of the Universal Dentin Bonding System: A Systematic Review and Meta-Analysis

Streptococcus mutans (S. mutans) is a group of viridans mostly located in oral flora among the wide and biodiverse biofilm. It plays a significant role not only in caries formation but also triggering intracerebral haemorrhage. The durable and stable bond interface, besides bacteria elimination, is one of the crucial factors influencing the resin composite restoration performance. This study aimed to evaluate universal adhesives (UAs) with regard to in vitro bond strength to dentin, and the inhibition of the S. mutans growth and compare them with UAs modified with antimicrobial agents through a systematic review and meta-analysis. Two reviewers performed a literature search up to April 2021 in 5 electronic databases: PubMed MedLine, Scielo, ISI Web of Science, Scopus, and EMBASE. Only in vitro studies reporting the effect of modifying UAs with antimicrobial agents on the bond strength to dentin and/or on the inhibition of the S. mutans were included. Analyses were carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The methodological quality of each in vitro study was evaluated following the parameters of a previous systematic review. A total of 1716 potentially relevant publications were recognized. After reviewing the title and abstract, 16 studies remained in the systematic review. From these, a total of 3 studies were included in the meta-analysis. Since data from the studies included in the antimicrobial outcome included zero values, they could not be meta-analysed. Including 0 values in the analysis will lead to several biases in the analysis, so these data were discarded. The antibacterial effect against S. mutans of UAs modified with antimicrobial agents was higher than the non-modified adhesive systems. Within the limitations of the present study, the bond strength of UAs to dentin could be improved by using antimicrobial agents. The UAs modified with antibacterial agents showed a decrease in the viability of S. mutans biofilm, among the adhesives tested. However, there are not enough valid data on antibacterial properties of modified UAs; therefore, more well-designed research on these materials is needed.

Antibacterial and Bonding Properties of Universal Adhesive Dental Polymers Doped with Pyrogallol

This study investigated the antibacterial activity, bond strength to dentin (SBS), and ultra-morphology of the polymer-dentin interface of experimental adhesive systems doped with pyrogallol (PY), which is a ubiquitous phenolic moiety that is present in flavonoids and polyphenols. A universal adhesive containing 4-META and 10-MDP was used in this study. PY behaves as an antioxidant and anti-cancerogenic agent and it was incorporated into the adhesive at different concentrations (0.5 and 1 wt.%). The antibacterial activity and SBS were analyzed and the results were statistically analyzed. The ultra-morphology of the polymer-dentin interface was assessed using scanning electron microscopy (SEM). At 24 h, a lower antibacterial activity was observed for the control adhesive compared to those with 0.5% and 1% PY. No difference was seen in SBS between the three groups at 24 h. After 6 months, the SBS of the 0.5% PY adhesive was significantly lower than the other tested adhesives. The specimens created with 1% PY adhesive presented a higher bond strength at six months compared with that found at 24 h. No morphological differences were found at the polymer-dentin interfaces of the tested adhesives. Pyrogallol may be incorporated into modern universal adhesive systems to preserve the polymer-dentin bonding interface and confer a certain degree of antibacterial activity.

One-Year Clinical Aging of Low Stress Bulk-Fill Flowable Composite in Class II Restorations: A Case Report and Literature Review

Bulk-fill flowable composites provide functional and aesthetic restorations while eliminating incremental composite layering and saving time. The degradation of the adhesive interface with subsequent gap formation is a concern when adhesively luted restorations are placed. Moreover, the number of adhesive interface failures increases when they are exposed to long-term water storage. The aim of the present study was to evaluate the morphological characteristics of the tooth-composite interface in class II cavities restored with a low stress bulk-fill flowable composite after aging in an oral environment. We describe a case of a patient with class II cavities in four premolars restored with a low stress bulk-fill flowable composite Surefil SDR (Dentsply DeTrey GmbH, Konstanz, Germany). The occlusal part was restored with nano-hybrid resin composite Ceram X Mono (Dentsply DeTrey GmbH). After one year of clinical function, the teeth were extracted and examined in a scanning electron microscope (SEM). It can be concluded that the application of bulk-fill covered with conventional composite seems to provide the homogeneous and stable bond to tooth structure after one year of aging in an oral environment. However, some defects within the dentin-resin composite interface were observed.