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Kharma K, Hardan L, Kassis C, Dimitriu B, Harouny R, Baba NZ, Bourgi R, Zogheib CM. Can a Novel Device with Pure Dry Air Increase the Shear Bond Strength of Dental Composites to Dentin? An Experimental Study. Dent J (Basel) 2024; 12:160. [PMID: 38920861 PMCID: PMC11203141 DOI: 10.3390/dj12060160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/01/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Modern conservative dentistry is taking the lead in daily clinical practice and is relying on adhesion. Whether it is a simple composite, ceramic inlays, onlays, veneers or crowns, the common factor for a successful outcome is a good bonding of these elements to dental structures. Thus, the purpose of this study was to evaluate the bond strength of resin composite to dentin when using a new device, the DENTIPURE KM™ (KM, Beirut, Lebanon), which provides a pure air flow, free of any contaminants and without humidity, when compared to other dental equipment. One hundred and eighty extracted human molars were equally divided into three groups according to the device used, the DENTIPURE KM™ (KM, Beirut, Lebanon), the KAVO™ (ESTETICA E30/E70/E80 Vision, KAVO, Biberach, Germany), or the ADEC™ (A-dec Performer 200, Newberg, OR, USA). The shear bond strength (SBS) was evaluated after 24 h of storage in distilled water on a universal testing machine. Statistical analysis was set with a level of significance at p ≤ 0.05. The results revealed that significantly different bond strength was imparted by the DENTIPURE KM™ device and the ADEC™ dental unit (p = 0.042). In conclusion, while the DENTIPURE KM™ device shows promise in providing contaminant-free air during bonding, its impact on dentin bond strength compared to devices like the KAVO™ appears minimal. Further research is needed to fully assess its potential in enhancing dentinal adhesion procedures.
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Affiliation(s)
- Khalil Kharma
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (K.K.); (C.K.); (R.H.); (R.B.); (C.M.Z.)
| | - Louis Hardan
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (K.K.); (C.K.); (R.H.); (R.B.); (C.M.Z.)
| | - Cynthia Kassis
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (K.K.); (C.K.); (R.H.); (R.B.); (C.M.Z.)
| | - Bogdan Dimitriu
- Department of Endodontics, Deputy Dean, Faculty of Dental Medicine “Carol Davila” University, 020021 Bucharest, Romania
| | - Ryan Harouny
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (K.K.); (C.K.); (R.H.); (R.B.); (C.M.Z.)
- Craniofacial Research Laboratory, Division of Biomaterials, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon
| | - Nadim Z. Baba
- Advanced Dental Education Program in Implant Dentistry, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA;
| | - Rim Bourgi
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (K.K.); (C.K.); (R.H.); (R.B.); (C.M.Z.)
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
| | - Carina Mehanna Zogheib
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (K.K.); (C.K.); (R.H.); (R.B.); (C.M.Z.)
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Bourgi R, Kharouf N, Cuevas-Suárez CE, Lukomska-Szymanska M, Kharma K, Moussa FH, Metlej M, Haikel Y, Hardan L. Warm Air Delivery in Adhesive Application: Effect on Bonding Performance and Morphological Outcomes. Biomimetics (Basel) 2024; 9:194. [PMID: 38667205 PMCID: PMC11048613 DOI: 10.3390/biomimetics9040194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Rim Bourgi
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (R.B.); (K.K.)
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France; (N.K.); (Y.H.)
| | - Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France; (N.K.); (Y.H.)
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
| | - Carlos Enrique Cuevas-Suárez
- Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State, San Agustín Tlaxiaca 42160, Mexico
| | | | - Khalil Kharma
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (R.B.); (K.K.)
| | - Fabienne Hajj Moussa
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculty of Pharmacy, Saint-Joseph University, Beirut 1107 2180, Lebanon;
| | - Manar Metlej
- Department of Prosthetic Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon;
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France; (N.K.); (Y.H.)
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Louis Hardan
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon; (R.B.); (K.K.)
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Bourgi R, Hardan L, Cuevas-Suárez CE, Scavello F, Mancino D, Kharouf N, Haikel Y. The Use of Warm Air for Solvent Evaporation in Adhesive Dentistry: A Meta-Analysis of In Vitro Studies. J Funct Biomater 2023; 14:jfb14050285. [PMID: 37233396 DOI: 10.3390/jfb14050285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Any excess solvent from dental adhesive systems must be eliminated prior to material photopolymerization. For this purpose, numerous approaches have been proposed, including the use of a warm air stream. This study aimed to investigate the effect of different temperatures of warm air blowing used for solvent evaporation on the bond strength of resin-based materials to dental and nondental substrates. Two different reviewers screened the literature in diverse electronic databases. In vitro studies recording the effect of warm air blowing to evaporate solvents of adhesive systems on the bond strength of resin-based materials to direct and indirect substrates were included. A total of 6626 articles were retrieved from all databases. From this, 28 articles were included in the qualitative analysis, and 27 remained for the quantitative analysis. The results of the meta-analysis for etch-and-rinse adhesives revealed that the use of warm air for solvent evaporation was statistically significantly higher (p = 0.005). For self-etch adhesives and silane-based materials, this effect was observed too (p < 0.001). The use of a warm air stream for solvent evaporation enhanced the bonding performance of alcohol-/water-based adhesive systems for dentin. This effect seems to be similar when a silane coupling agent is submitted to a heat treatment before the cementation of a glass-based ceramic.
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Affiliation(s)
- Rim Bourgi
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
| | - Louis Hardan
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon
| | - Carlos Enrique Cuevas-Suárez
- Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State, San Agustín Tlaxiaca 42160, Mexico
| | | | - Davide Mancino
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
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Rifane TO, Cordeiro KEM, Silvestre FA, Souza MT, Zanotto ED, Araújo-Neto VG, Giannini M, Sauro S, de Paula DM, Feitosa VP. Impact of silanization of different bioactive glasses in simplified adhesives on degree of conversion, dentin bonding and collagen remineralization. Dent Mater 2023; 39:217-226. [PMID: 36690502 DOI: 10.1016/j.dental.2023.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/29/2022] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze simplified adhesive containing pure or silanized bioglass 45S5 (with calcium) or Sr-45S5 (strontium-substituted) fillers applied on dentin and to evaluate the microtensile bond strength (µTBS), interface nanoleakage, degree of conversion of adhesive, collagen degradation and remineralization. METHODS Ambar Universal adhesive (FGM) was doped with 10 wt% bioactive glasses to form following groups: Control (no bioglass), 45S5 (conventional bioglass 45S5), Sr-45S5 (Sr-substituted bioglass 45S5), Sil-45S5 (silanized bioglass 45S5) and Sil-Sr-45S5 (silanized bioglass Sr-45S5). Adhesives were applied after dentin acid-etching using phosphoric acid at extracted human molars. Resin-dentin sticks were obtained and tested for µTBS, nanoleakage at 24 h or 6 months. Degree of conversion was measured using micro-Raman spectroscopy. Dentin remineralization was assessed by FTIR after 6-month storage in PBS. Hydroxyproline (HYP) release was surveyed by UV-Vis spectroscopy. Statistical analysis was performed using ANOVA and Tukey's test (p < 0.05). RESULTS Regarding µTBS, Sr-45S5 and 45S5 presented higher and stable results (p > 0.05). Control (p = 0.018) and Sil-Sr-45S5 (p < 0.001) showed µTBS reduction after 6-month aging. Sil-Sr-45S5 showed higher HYP release than that obtained in the 45S5 group. Sil-45S5 showed mineral deposition and increase in µTBS (p = 0.028) after 6-months. All experimental adhesives exhibited higher degree of conversion compared to Control group, except for 45S5. All adhesives created gap-free interfaces, with very low silver impregnation, except for Sil-Sr-45S5. SIGNIFICANCE The incorporation of silanized 45S5 bioglass into the universal adhesive was advantageous in terms of dentin remineralization, bonding performance and adhesive polymerization. Conversely, Sil-Sr-45S5 compromised the µTBS, interface nanoleakage and had a negative impact on HYP outcomes.
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Affiliation(s)
| | | | | | - Marina Trevelin Souza
- Vitreous Materials Laboratory (LAMAV), Department of Materials Engineering, Federal University of São Carlos, São Carlos, Brazil.
| | - Edgar Dutra Zanotto
- Vitreous Materials Laboratory (LAMAV), Department of Materials Engineering, Federal University of São Carlos, São Carlos, Brazil.
| | - Vitaliano Gomes Araújo-Neto
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
| | - Marcelo Giannini
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
| | - Salvatore Sauro
- Department of Biomaterials and Minimally Invasive Dentistry, Cardenal Herreara CEU University, Valencia, Spain.
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Yumitate M, Mine A, Higashi M, Matsumoto M, Hagino R, Ban S, Yamanaka A, Ishida M, Miura J, Meerbeek BVAN, Ishigaki S, Yatani H. Effect of tooth temperature on the dentin bonding durability of a self-curing adhesives: The discrepancy between the laboratory setting and inside the mouth. Dent Mater J 2021; 41:317-322. [PMID: 34980768 DOI: 10.4012/dmj.2021-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A two-bottle self-curing universal adhesive (Tokuyama Universal Bond; Tokuyama Dental) that does not require a long waiting time or light curing after application of the bonding material has been developed. This study aimed to evaluate the influence of tooth and adhesive temperature during the bonding procedure on the effectiveness of dentin bonding. The results showed that the tooth temperature affected the effectiveness of the dentin bonding; therefore, to determine the precise bonding ability in the laboratory, the temperature of the tooth must be raised until it is the same as that of the oral cavity. In addition, the temperature of the material did not affect bonding effectiveness; this result confirms that it does not matter whether the refrigerated product is used soon after its removal from the refrigerator or after it reaches room temperature in the clinic.
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Affiliation(s)
- Masahiro Yumitate
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Atsushi Mine
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Mami Higashi
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Mariko Matsumoto
- Department of Restorative Dentistry, Hokkaido University Graduate School of Dental Medicine.,KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry
| | - Ryosuke Hagino
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Shintaro Ban
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Azusa Yamanaka
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Masaya Ishida
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Jiro Miura
- Division for Interdisciplinary Dentistry, Osaka University Dental Hospital
| | - Bart VAN Meerbeek
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
| | - Hirofumi Yatani
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
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Zimmer R, Leite ML, de Souza Costa CA, Hebling J, Anovazzi G, Klein CA, Hosaka K, Reston ED. Effect of Time and Temperature of Air Jet on the Mechanical and Biological Behavior of a Universal Adhesive System. Oper Dent 2021; 47:87-96. [PMID: 34624102 DOI: 10.2341/20-038-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the influence of heat application on the degree of conversion (DC) of the 3M Single Bond Universal Adhesive System, as well as its transdentinal cytotoxicity and microtensile bond strength to dentin. METHODS Experimental groups were established according to the time and temperature of the air jet: G1: 5 seconds-25°C; G2: 10 seconds-25°C; G3: 20 seconds-25°C; G4: 5 seconds-50°C; G5: 10 seconds-50°C; G6: 20 seconds-50°C. In control group (G7), no treatment was performed. The DC was assessed using the Fourier transform infrared spectroscopy-attenuated total reflectance (FTIR-ATR) technique. For the transdentinal cytotoxicity test, dentin discs fitted in artificial pulp chambers (APC) received the application of the adhesive system and the air jets. For the microtensile bond strength, healthy molars were restored and submitted to the microtensile test after 24 hours and 6 months, respectively. RESULTS Significant reduction in viability of Mouse Dental Papilla Cell-23 (MDPC-23), which exhibited morphological changes, was observed in all experimental groups compared to control (p<0.05). Although all tested protocols resulted in transdentinal diffusion of 2-hydroxyethyl methacrylate (HEMA), the group G6 presented the highest degree of monomeric conversion and the lowest cytotoxic effect, with higher dentin bond strength values in comparison to group G1 (p<0.05). CONCLUSIONS Applying an air blast at 50°C for 20 seconds increases the DC and microtensile bond strength of the 3M Single Bond Universal Adhesive System to dentin, as well as reduces the transdentinal cytotoxicity of the material to pulp cells.
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Affiliation(s)
- R Zimmer
- Roberto Zimmer, DDS, MS, Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil (Ulbra), Canoas, Brazil
| | - M L Leite
- Maria Luisa Leite, DDS, MS, PhD, Department of Physiology and Pathology, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil
| | - C A de Souza Costa
- Carlos Alberto de Souza Costa, DDS, MS, PhD, Department of Physiology and Pathology, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil
| | - J Hebling
- Josimeri Hebling, DDS, MS, PhD, Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil
| | - G Anovazzi
- Giovana Anovazzi, DDS, MS, PhD, Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil
| | - C A Klein
- Celso Afonso Klein-Junior, DDS, MS, PhD, Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil (Ulbra), Canoas, Brazil
| | - K Hosaka
- Keiichi Hosaka, DDS, MS, PhD, Department of Cariology and Operative Dentistry,Graduate School of Medical and Dental Sciences,Tokyo Medical and Dental University, Tokyo, Japan
| | - E D Reston
- *Eduardo Galia Reston, DDS, MSD, PhD, Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil (Ulbra), Canoas, Brazil
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Yonekura K, Hosaka K, Tichy A, Taguchi K, Ikeda M, Thanatvarakorn O, Prasansuttiporn T, Nakajima M, Tagami J. Air-blowing strategies for improving the microtensile bond strength of one-step self-etch adhesives to root canal dentin. Dent Mater J 2020; 39:892-899. [PMID: 32448851 DOI: 10.4012/dmj.2019-299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effect of different air-blowing strategies using a prototype of a newly developed clinically applicable warm air-blowing device on the microtensile bond strength (μTBS) of one-step self-etch adhesives (1-SEAs) to human root-canal dentin was evaluated. Post cavities (8 mm depth, 1.5 mm diameter) were prepared and bonded with four 1-SEAs. Air-blowing was performed using normal air (23±1°C) for 10 or 20 s; warm air (60±1°C) for 10 or 20 s; or their combination for 10 s (5 s normal, 5 s warm) or 20 s (10 s normal, 10 s warm). After filling with corresponding core materials and 24-h water storage, μTBS test was performed. For three of the 1-SEAs, combined air-blowing for 20 s significantly increased μTBS compared to other air-blowing strategies (p<0.05). This suggests that the combination of normal and warm air-blowing for 20 s can enhance solvent evaporation from 1-SEAs, thus resulting in their improved bonding performance to root-canal dentin.
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Affiliation(s)
- Kazuhide Yonekura
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Keiichi Hosaka
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Antonin Tichy
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU).,Institute of Dental Medicine, First Faculty of Medicine of the Charles University and General University Hospital in Prague
| | - Keita Taguchi
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Masaomi Ikeda
- Department of Oral Prosthetic Engineering, Graduate School of Medical and Dental Sciences, Medical and Dental Science and Technology, Tokyo Medical and Dental University (TMDU)
| | | | - Taweesak Prasansuttiporn
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, and Center of Excellence in Materials Science and Technology, Chiang Mai University
| | - Masatoshi Nakajima
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Junji Tagami
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
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8
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Chen Y, Yan X, Li K, Zheng S, Sano H, Zhan D, Fu J. Effect of air-blowing temperature and water storage time on the bond strength of five universal adhesive systems to dentin. Dent Mater J 2020; 40:116-122. [PMID: 32863373 DOI: 10.4012/dmj.2019-280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to evaluate the air-blowing temperature and water storage time on the micro-tensile bond strength (μTBS) of five universal adhesive systems to dentin. The bond strength with two different air-blowing temperatures (60±2ºC and 23±2ºC) was measured after water storage at 37ºC for 24 h and 100 days respectively. The fracture surface on dentin side was observed by scanning electron microscope (SEM). Three-way ANOVA revealed a significant effect of universal system (p<0.001) and air-blowing temperature (p<0.001) on bond strength to dentin except water-storage time (p=0.145). The interaction within three factors was significantly different (p<0.001). It could be concluded that the μTBS of universal systems to dentin was material-depended. The higher and more stable bonding performance of universal systems on dentin could be achieved by air-blowing at 60±2ºC temperature. In addition, the quantity of voids in the adhesive layer of aceton-based universal adhesive was significantly reduced by higher temperature.
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Affiliation(s)
- Yue Chen
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease
| | - Xiaoyuan Yan
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease
| | - Ke Li
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease
| | - Shize Zheng
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease.,School of Stomatology, Jilin University
| | - Hidehiko Sano
- Department of Restorative Dentistry, Division of Oral Health Science, Faculty of Dental Medicine, Hokkaido University
| | - Desong Zhan
- Department of Dental Materials Science, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease
| | - Jiale Fu
- Department of Dental Materials Science, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease
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9
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Hirokane E, Takamizawa T, Kasahara Y, Ishii R, Tsujimoto A, Barkmeier WW, Latta MA, Miyazaki M. Effect of double-layer application on the early enamel bond strength of universal adhesives. Clin Oral Investig 2020; 25:907-921. [PMID: 32474808 DOI: 10.1007/s00784-020-03379-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The present study aimed to investigate the changes in the enamel bond strengths of universal adhesives in the early phase of specimen creation and evaluate the effect of double-layer application on enamel bond effectiveness using different etching modes. METHOD Four universal adhesives, namely Clearfil Universal Bond Quick, G-Premio Bond, Scotchbond Universal, and Tokuyama Universal Bond, were used. Clearfil SE Bond two-step self-etch adhesive system was used as a comparison. Fifteen specimens per group were used for determining the shear bond strength (SBS) to bovine enamel in the etch-and-rinse or self-etch mode. The adhesive was applied to specimens in accordance with the manufacturers' instructions (single-layer application), or the adhesive was applied twice (double-layer application). The bonded specimens were stored in distilled water at 37 °C for 5 min or 1, 6, 12, or 24 h before SBS testing. The flexural properties of the resin composite Clearfil AP-X were measured for the same storage periods. RESULTS All universal adhesives exhibited increased SBS values with prolonged storage periods regardless of the application technique or etching mode used. Double-layer application was associated with higher SBS values than single-layer application for most universal adhesives over the same storage period. CONCLUSION Phosphoric acid pre-etching and double-layer application of universal adhesives resulted in increased enamel bond strength in the early phase of specimen bonding. CLINICAL RELEVANCE Care should be taken when using universal adhesives in the self-etch mode for enamel bonding because the enamel adhesion is sensitive to the duration after filling.
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Affiliation(s)
- Eizo Hirokane
- Department of Operative Dentistry, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Toshiki Takamizawa
- Department of Operative Dentistry, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Yuta Kasahara
- Department of Operative Dentistry, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Ryo Ishii
- Department of Operative Dentistry, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Akimasa Tsujimoto
- Department of Operative Dentistry, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Wayne W Barkmeier
- Department of General Dentistry, Creighton University School of Dentistry, Omaha, NE, USA
| | - Mark A Latta
- Department of General Dentistry, Creighton University School of Dentistry, Omaha, NE, USA
| | - Masashi Miyazaki
- Department of Operative Dentistry, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
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Taguchi K, Hosaka K, Ikeda M, Kishikawa R, Foxton R, Nakajima M, Tagami J. The effect of warm air-blowing on the microtensile bond strength of one-step self-etch adhesives to root canal dentin. J Prosthodont Res 2018; 62:330-336. [PMID: 29397352 DOI: 10.1016/j.jpor.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The use of warm air-blowing to evaporate solvents of one-step self-etch adhesive systems (1-SEAs) has been reported to be a useful method. The purpose of this study was to evaluate the effect of warm air-blowing on root canal dentin. METHODS Four 1-SEAs (Clearfil Bond SE ONE, Unifil Core EM self-etch bond, Estelink, BeautiDualbond EX) were used. Each 1-SEA was applied to root canal dentin according to the manufacturers' instructions. After the adhesives were applied, solvent was evaporated using either normal air (23±1°C) or warm air (80±1°C) for 20s, and resin composite was placed in the post spaces. The air from the dryer, which could be used in normal- or hot-air-mode, was applied at a distance of 5cm above the root canal cavity in the direction of tooth axis. The temperature of the stream of air from the dryer in the hot-air-mode was 80±1°C, and in the normal mode, 23±1°C. After water storage of the specimens for 24h, the μTBS were evaluated at the coronal and apical regions. The μTBSs were statistically analyzed using three-way ANOVA and Student's t-test with Bonferroni correction (α=0.05). RESULTS The warm air-blowing significantly increased the μTBS of all 1-SEAs at the apical regions, and also significantly increased the μTBS of two adhesives (Estelink and BeautiDualBond EX) at coronal regions. CONCLUSIONS The μTBS of 1-SEAs to root canal dentin was improved by using warm air-blowing.
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Affiliation(s)
- Keita Taguchi
- Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Hosaka
- Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Masaomi Ikeda
- Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuzo Kishikawa
- Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Richard Foxton
- King's College London Dental Institute at Guy's, King's and St Thomas' Hospitals, King's College London, London, UK
| | - Masatoshi Nakajima
- Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junji Tagami
- Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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11
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Fujiwara S, Takamizawa T, Barkmeier WW, Tsujimoto A, Imai A, Watanabe H, Erickson RL, Latta MA, Nakatsuka T, Miyazaki M. Effect of double-layer application on bond quality of adhesive systems. J Mech Behav Biomed Mater 2018; 77:501-509. [DOI: 10.1016/j.jmbbm.2017.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/26/2017] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
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12
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Sutil BGDS, Susin AH. Dentin pretreatment and adhesive temperature as affecting factors on bond strength of a universal adhesive system. J Appl Oral Sci 2017; 25:533-540. [PMID: 29069151 PMCID: PMC5804390 DOI: 10.1590/1678-7757-2016-0500] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/27/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives: To evaluate the effects of dentin pretreatment and temperature on the bond strength of a universal adhesive system to dentin. Material and Methods: Ninety-six extracted non-carious human third molars were randomly divided into 12 groups (n=8) according to Scotchbond Universal Adhesive (SbU) applied in self-etch (SE) and etch-and-rinse (ER) mode, adhesive temperature (20°C or 37°C) and sodium bicarbonate or aluminum oxide air abrasion. After composite build up, bonded sticks with cross-sectional area of 1 mm2 were obtained to evaluate the microtensile bond strength (μTBS). The specimens were tested at a crosshead speed of 0.5 mm/min on a testing machine until failure. Fractured specimens were analyzed under stereomicroscope to determine the failure patterns in adhesive, cohesive (dentin or resin) and mixed fractures. The microtensile bond strength data was analyzed using two-way ANOVA and Tukey's test (α=5%). Results: Interaction between treatment and temperature was statistically significant for SbU applied in self-etch technique. Both dentin treatments showed higher bond strength for ER mode, regardless of adhesive temperature. When compared to control group, sodium bicarbonate increased bond strength of SbU in SE technique. Adhesive temperature did not significantly affect the μTBS of tested groups. Predominantly, adhesive failure was observed for all groups. Conclusions: Dentin surface treatment with sodium bicarbonate air abrasion improves bond strength of SbU, irrespective of adhesive application mode, which makes this approach an alternative to increase adhesive performance of Scotchbond Universal Adhesive to dentin.
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Affiliation(s)
| | - Alexandre Henrique Susin
- Universidade Federal de Santa Maria, Departamento de Odontologia Restauradora, Santa Maria, RS, Brasil
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13
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Niem T, Schmidt A, Wöstmann B. Bonding resin thixotropy and viscosity influence on dentine bond strength. J Dent 2016; 51:21-8. [PMID: 27234437 DOI: 10.1016/j.jdent.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/04/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To investigate the influence of bonding resin thixotropy and viscosity on dentine tubule penetration, blister formation and consequently on dentine bond strength as a function of air-blowing pressure (air-bp) intensity. METHODS Two HEMA-free, acetone-based, one-bottle self-etch adhesives with similar composition except disparate silica filler contents and different bonding resin viscosities were investigated. The high-filler-containing adhesive (G-Bond) featured a lower viscous bonding resin with inherent thixotropic resin (TR) properties compared to the low-filler-containing adhesive (iBond) exhibiting a higher viscous bonding resin with non-thixotropic resin (NTR) properties. Shear bond strength tests for each adhesive with low (1.5bar; 0.15MPa; n=16) and high (3.0bar; 0.30MPa; n=16) air-bp application were performed after specimen storage in distilled water (24h; 37.0±1.0°C). Results were analysed using a Student's t-test to identify statistically significant differences (p<0.05). Fracture surfaces of TR adhesive specimens were morphologically characterised by SEM. RESULTS Statistically significant bond strength differences were obtained for the thixotropic resin adhesive (high-pressure: 24.6MPa, low-pressure: 9.6MPa). While high air-bp specimens provided SEM images revealing resin-plugged dentine tubules, resin tags and only marginally blister structures, low air-bp left copious droplets and open dentine tubules. In contrast, the non-thixotropic resin adhesive showed no significant bond strength differences (high-pressure: 9.3MPa, low-pressure: 7.6MPa). CONCLUSIONS A pressure-dependent distinct influence of bonding resin thixotropy and viscosity on dentine bond strength has been demonstrated. Stronger adhesion with high air-bp application is explained by improved resin fluidity and facilitated resin penetration into dentine tubules. CLINICAL SIGNIFICANCE Filler particles used in adhesive systems may induce thixotropic effects in bonding resin layers, accounting for improved free-flowing resin properties. In combination with high air-bp this effect allows an easy plugging of dentine tubules and elimination of blister structures, both resulting in superior dentine bond strength.
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Affiliation(s)
- Thomas Niem
- Department of Prosthodontics, Justus-Liebig University, Schlangenzahl 14, D-35392 Giessen, Germany.
| | - Alexander Schmidt
- Department of Prosthodontics, Justus-Liebig University, Schlangenzahl 14, D-35392 Giessen, Germany.
| | - Bernd Wöstmann
- Department of Prosthodontics, Justus-Liebig University, Schlangenzahl 14, D-35392 Giessen, Germany.
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14
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Matuda LSDA, Marchi GM, Aguiar TR, Leme AA, Ambrosano GMB, Bedran-Russo AK. Dental adhesives and strategies for displacement of water/solvents from collagen fibrils. Dent Mater 2016; 32:723-31. [PMID: 27068741 DOI: 10.1016/j.dental.2016.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/26/2015] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Larissa Sgarbosa de Araújo Matuda
- Department of Restorative Dentistry Piracicaba Dental School, University of Campinas, 13414-903 Campinas, São Paulo, Brazil; Department of Restorative Dentistry, University of Illinois at Chicago, 60612 Chicago, IL, USA.
| | - Giselle Maria Marchi
- Department of Restorative Dentistry Piracicaba Dental School, University of Campinas, 13414-903 Campinas, São Paulo, Brazil
| | | | - Ariene Arcas Leme
- Department of Restorative Dentistry, University of Illinois at Chicago, 60612 Chicago, IL, USA
| | - Gláucia M B Ambrosano
- Department of Community Dentistry Piracicaba Dental School, University of Campinas, 13414-903 Campinas, São Paulo, Brazil
| | - Ana Karina Bedran-Russo
- Department of Restorative Dentistry, University of Illinois at Chicago, 60612 Chicago, IL, USA
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15
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CARVALHO MPM, ROCHA RDO, KREJCI I, BORTOLOTTO T, BISOGNO FE, SUSIN AH. Influence of a heating device and adhesive temperature on bond strength of a simplified ethanol-based adhesive system. REVISTA DE ODONTOLOGIA DA UNESP 2016. [DOI: 10.1590/1807-2577.07315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Increased adhesive temperature has been reported to promote solvent evaporation, reduce viscosity, and improve monomeric permeation into dentin. Objective The aim of this study was to determine the influence of different heating methods on the microtensile bond strength of an etch-and-rinse adhesive to dentin. Material and method Twenty-four caries-free extracted human third molars were transversally sectioned to expose a flat dentinal surface. The samples were etched with 37% phosphoric acid gel and divided into three groups (n = 8): 1) Control - the adhesive system (Adper Single Bond 2; 3M ESPE) was applied at room temperature; 2) Warming device - the adhesive was warmed to 37°C in a custom device before application; and 3) Warm air - the adhesive was warmed to 50°C with an air jet after application on dentin. The specimens were restored with a composite resin (Filtek Z250 A2, 3M ESPE) and prepared for microtensile bond strength testing, after 24 h in water storage. The data were subjected to one-way ANOVA and Tukey's test (p < 0.05). Result There was no significant difference among the groups (p > 0.05). The mean bond strength values in the control, the warming device, and the warm air groups were 48.5 (± 5.2), 40.35 (± 4.9), and 47.2 (± 5.3) MPa, respectively (p = 0.05). Conclusion The different heating methods had no significant influence on the immediate microtensile bond strength of an etch-and-rinse ethanol-based adhesive to dentin.
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Miyazaki M, Tsujimoto A, Tsubota K, Takamizawa T, Kurokawa H, Platt JA. Important compositional characteristics in the clinical use of adhesive systems. J Oral Sci 2016; 56:1-9. [PMID: 24739701 DOI: 10.2334/josnusd.56.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Improvements in dentin bonding systems have influenced modern restorative dentistry. The desire for minimal invasiveness has resulted in more-conservative cavity design, which basically relies on the effectiveness of current dentin bonding systems. Interaction of adhesives with enamel and dentin is based on two systems, commonly described as etch-and-rinse and self-etch. Priming and bonding agents can be separate or combined, resulting in two- or three-step systems for etch-and-rinse adhesives and one- or two-step systems for self-etch adhesives. Self-etch systems use acidic functional monomers that simultaneously demineralize and impregnate tooth structures. Etch-and-rinse and self-etch systems have advantages and disadvantages, which are primarily related to the simplified bonding procedures required under clinical conditions. Knowledge of the composition, characteristics, and mechanisms of adhesion for each adhesive system is critical in selecting the ideal adhesive materials for clinical use.
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Affiliation(s)
- Masashi Miyazaki
- Department of Operative Dentistry, Nihon University School of Dentistry
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Moosavi H, Forghani M, Managhebi E. Effect of different air-drying time on the microleakage of single-step self-etch adhesives. Restor Dent Endod 2013; 38:73-8. [PMID: 23741709 PMCID: PMC3670980 DOI: 10.5395/rde.2013.38.2.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/21/2013] [Accepted: 04/27/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives This study evaluated the effect of three different air-drying times on microleakage of three self-etch adhesive systems. Materials and Methods Class I cavities were prepared for 108 extracted sound human premolars. The teeth were divided into three main groups based on three different adhesives: Opti Bond All in One (OBAO), Clearfil S3 Bond (CSB), Bond Force (BF). Each main group divided into three subgroups regarding the air-drying time: without application of air stream, following the manufacturer's instruction, for 10 sec more than manufacturer's instruction. After completion of restorations, specimens were thermocycled and then connected to a fluid filtration system to evaluate microleakage. The data were statistically analyzed using two-way ANOVA and Tukey-test (α = 0.05). Results The microleakage of all adhesives decreased when the air-drying time increased from 0 sec to manufacturer's instruction (p < 0.001). The microleakage of BF reached its lowest values after increasing the drying time to 10 sec more than the manufacturer's instruction (p < 0.001). Microleakage of OBAO and CSB was significantly lower compared to BF in all three drying time (p < 0.001). Conclusions Increasing in air-drying time of adhesive layer in one-step self-etch adhesives caused reduction of microleakage, but the amount of this reduction may be dependent on the adhesive components of self-etch adhesives.
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Affiliation(s)
- Horieh Moosavi
- Dental Materials Research Center and Department of Operative Dentistry, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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