Systematic review and network meta-analysis of restorative therapy and adhesive strategies in root caries lesions

AIM

This systematic review and network meta-analysis (NMA) aimed to establish a clinically relevant hierarchy of the different adhesive and/or restorative approaches to restore cavitated root caries lesions through the synthesis of available evidence.

MATERIALS AND METHODS

A systematic search was conducted in Medline/Web of Science/Embase/ Cochrane Library/Scopus/grey literature. RCTs investigating ≥2 restorative strategies (restorative /adhesive materials) for root caries lesions in adult patients were included. Risk of bias within studies was assessed (Cochrane_RoB-2) and the primary outcome was survival rate of restorations at different follow-up times (6-/12-/24-months). Network meta-analyses were conducted using a random effects model stratified by follow-up times. I2-statistics assessed the ratio of true to total variance in the observed effects. All available combinations of adhesives (1-SE: one-step self-etch; 2-3ER: two-/three-step etch-and-rinse) and restorative materials (conventional composite (CC) as well as conventional and resin-modified glass ionomer cements (GIC, RMGIC)) were included. Risk of bias across studies and confidence in NMA (CINeMA) were assessed.

RESULTS

547 studies were identified and nine were eligible for the NMA. In total, 1263 root caries lesions have been restored in 473 patients in the included clinical trials. Patients involved were either healthy (n = 6 trials), living in nursing homes (n = 1 trial) or received head-and-neck radiotherapy (n = 2 trials). There was statistically weak evidence to favour either of material/material combination regarding the survival rate. A tendency for higher survival rate (24-months) was observed for 2-3ER/CC (OR24mths 2.65; 95%CI=1.45/4.84) as well as RMGIC (OR24mths 2.05; 95%CI=1.17/3.61) compared to GIC. These findings were though not statistically significant and confidence of the NMA was low.

CONCLUSION

An evidence-based choice of restorative strategy for managing cavitated root caries lesions is currently impossible. There is a clear need for more standardised, well-designed RCTs evaluating the retention rate of root caries restoration approaches.

Performance of self-etching adhesives on caries-affected primary dentin treated with glutaraldehyde or silver diamine fluoride

OBJECTIVES

to evaluate the quality and stability of adhesive interfaces established by self-etching adhesives on caries-affected primary dentin (CAD) treated with glutaraldehyde (GA) or silver diamine fluoride (SDF).

METHODS

42 primary molars were exposed to a microbiological caries-inducing protocol and divided into 6 groups according to the adhesive system (Clearfil SE - CL or FL Bond II - FL) and pretreatment (water, GA or SDF) applied on CAD. One tooth from each group was analyzed for surface modification using infrared spectroscopy. Crowns were restored with resin composite (n = 36) and cut into beams and slices. The beams were subjected to microtensile testing, Raman spectroscopy and SEM after 24 h and 6 months of storage. The slices were analyzed using Micro-Raman spectroscopy to determine the diffusion zone thickness (DZ) in each period. Data were analyzed by ANOVA and Tukey or Kruskal-Wallis and Dunn tests (α = 0.05%).

RESULTS

SDF reduced the immediate bond strength for both adhesives. The control groups showed a decrease in BS after 6 months in artificial saliva. GA increased immediate DZ for FL, while SDF had the opposite effect on CL. GA decreased the DZ for FL at 6 months. There was a predominance of adhesive failures with areas of cohesive dentin fractures within control groups.

SIGNIFICANCE

Modifications caused by dentin surface treatments may directly affect the performance of adhesive systems and the quality and stability of adhesive restorations.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Are polywave light-emitting diodes more effective than monowave ones in the photoactivation of resin-based materials containing alternative photoinitiators? A systematic review

OBJECTIVE

This systematic review aimed to analyze if using polywave light-emitting diodes (LED) to photoactivate resin-based materials (resin composites, adhesive systems, and resin cements) containing alternative photoinitiators provide better physicochemical properties than monowave ones.

MATERIAL AND METHODS

Inclusion criteria were in vitro studies that evaluated the degree of conversion, microhardness and flexural strength in resin-based materials containing alternative photoinitiators and light-activated with mono and polywave LEDs. Exclusion criteria were studies that evaluated the physicochemical properties of composites through any material interposed between the LED and the resin composite and studies that exclusively compared different modes and/or light activation times. Selection of studies, data extraction, and risk-of-bias analysis was performed. Data from selected studies were qualitatively analyzed. A systematic search was performed in June 2021 using PubMed/Medline, Embase, Scopus, and ISI Web of Science databases and grey literature without language restriction.

RESULTS

A total of 18 studies were included in the qualitative analysis. Nine studies used diphenyl (2,4,6-trimethylbenzoyl) phosphine oxide (TPO) as an alternative photoinitiator for resin composite. Polywave LED improved the degree of conversion of resin composite compared to monowave in 9 of the included studies. Polywave LED improved the microhardness of resin composite compared to monowave in 7 of the included studies. Polywave LED improved the degree of conversion for 11 studies and microhardness of resin composite compared to monowave for 7 included studies. No differences in the flexural strength medium between poly and monowave LEDs were observed. The evidence was graded as low quality due to the high risk of bias for 11 studies.

CONCLUSION

The existing studies, with their limitations, revealed that the polywave light-emitting diode maximizes activation, resulting in a higher degree of double-bond conversion and microhardness of resin composites containing alternative photoinitiators. However, the flexural strength of these materials is not influenced by the type of light activation device.

Survival rates of mandibular fixed retainers: comparison of a tube-type retainer and conventional multistrand retainers : A prospective randomized clinical trial

OBJECTIVE

The purposes of this study were to evaluate the survival rate of a tube-type mandibular fixed retainer and compare it to conventional multistrand retainers.

MATERIALS AND METHODS

In all, 66 patients who had completed their orthodontic treatment were enrolled in this study. They were allocated randomly to a tube-type retainer group or a 0.020 multistrand fixed retainer group. In case of the tube-type retainer, a thermoactive 0.012 NiTi was placed into 6 mini-tubes passively bonded to the anterior teeth. The patients were recalled at 1, 3, 6, 12, and 24 months after retainer placement. During the 2‑year follow-up period, any first-time failure of retainers was recorded. Kaplan-Meier survival analysis and log-rank tests were used to compare the failure rates between the two types of retainers.

RESULTS

Of the 34 patients, 14 (41.2%) showed failure in the multistrand retainer group, whereas only 2 of 32 (6.3%) reported failure in the tube-type retainer group. There was a statistically significant difference in failure between the multistrand retainer and the tube-type retainer (log-rank test, P = 0.001). The hazard ratio was 11.937 (95% confidence interval 2.708-52.620; P = 0.005).

CONCLUSION

The tube-type retainer can be used with fewer concerns about recurrent retainer detachments during orthodontic retention.

A multi-functional dentine bonding system combining a phosphate monomer with eugenyl methacrylate

OBJECTIVE

The tooth-resin composite interface is frequently associated with failure because of microbial contamination, hydrolytic and collagenolytic degradation. Thus, designing a dentine bonding system (DBS) with an intrinsically antimicrobial polymerisable monomer is of significance especially if it can be used with self-etching primers enabling resistance to degradation of the interface.

METHODS

Experimental adhesives were developed incorporating eugenyl methacrylate (EgMA) at concentrations of 0,10 or 20 wt%, designated as EgMA0, EgMA10 and EgMA20, respectively, for use as a two-step self-etch DBS with the functional monomer bis[2-(methacryloyloxy) ethyl] phosphate (BMEP) in the primer. The curing, thermal and wettability properties of the adhesives were determined, and hybrid layer formation was characterised by confocal laser scanning microscopy, microtensile bond strengths (µTBS) and nanoleakage by back-scattered SEM. In situ zymography was used to assess MMP inhibitory activity of the BMEP-EgMA DBS.

RESULTS

EgMA in the adhesives lowered the polymerisation exotherm and resulted in higher Tg, without negatively affecting degree of conversion. Water sorption and solubility were significantly lower with higher concentrations of EgMA in the adhesive. The formation of a distinct hybrid layer was evident from confocal images with the different adhesives, whilst EgMA20 yielded the highest µTBS post water storage challenges and lowest nanoleakage after 6 months. The experimental DBS exhibited minimal to no MMP activity at 3 months.

SIGNIFICANCE

The hydrophobic nature of EgMA and high cross-link density exerts considerable benefits in lowering water uptake and polymerisation exotherm. The application of EgMA, adhesives in conjunction with BMEP in a multi-functional self-etching DBS can resist MMP activity, hence, enhance longevity of the dentine-resin composite interface.

Dentin adhesives application deviations: Effects on permeability and nanoleakage

The purpose was to evaluate the effect that deviations from the recommended protocol of a two-step etch-and-rinse adhesive system has on permeability and nanoleakage. One hundred and twenty dentin disks were treated with a two-step etch-and-rinse adhesive system, according to the manufacturer's instructions, or using five simulated deviations from the recommended protocol: applying potassium oxalate, reducing the application time of the adhesive, avoiding adhesive drying, aggressively drying the adhesive, and double application of adhesive. Kruskal-Wallis and Tukey's post hoc comparisons were used to evaluate the permeability reduction (α=0.05). Twelve additional dentin disks were prepared for transmission electron microscope (TEM) analysis of nanoleakage. Aggressive drying, adding additional layers of adhesive or using oxalate reduced dentin permeability and yielded a better infiltration of the hybrid layer, whereas reducing the application time or less drying the adhesive did not to reduce dentin permeability, caused extensive nanoleakage, showing immediate compromised dentin sealing.

Probing the mineralized tissue-adhesive interface for tensile nature and bond strength

The mechanical performance of the dentin-adhesive interface contributes significantly to the failure of dental composite restorations. Rational material design can lead to enhanced mechanical performance, but this requires accurate characterization of the mechanical behavior at the dentin-adhesive interface. The mechanical performance of the interface is typically characterized using bond strength tests, such as the micro-tensile test. These tests are plagued by multiple limitations including large variations in the test results. The challenges associated with conventional tensile tests limit our ability to unravel the complex relationships that affect mechanical behavior at the dentin-adhesive interface. This study used the diametral compression test to overcome the challenges inherent in conventional bond strength tests. The bovine femur cortical bone tissue was considered as a surrogate material (the mineralized tissue) for human dentin. Two different adhesive formulations, which differed by means of their self-strengthening properties, were studied. The tensile behavior of the mineralized tissue, the adhesive polymer, and the bond strength of the mineralized tissue - adhesive interface was determined using the diametral compression test. The diametral compression test improved the repeatability for both the tensile and bond strength tests. The rate dependent mechanical behavior was observed for both single material and interfacial material systems. The tensile strength and bond strength of the mineralized tissue-adhesive interface was greater for the self-strengthening formulation as compared to the control.

On the properties of nanosilicate-based filled dental adhesives: Synthesis, characterization, and optimized formulation

OBJECTIVE

In this study, we incorporated hybrid nanoparticles (poly (acrylic acid)-grafted nanoclay/nanosilica, respectively, with platelet and spherical morphologies, abbreviated as PAA-g-NC-Sil) in different concentrations (0, 0.2, 0.5, 1, 2 and 5 wt%) to an experimental dentin bonding system and investigated the physical properties of the filled adhesive and its shear bond strength (μ-SBS) to dentin. We subsequently compared the properties of the adhesives containing PAA-g-NC-Sil with previously studied adhesives containing poly (methacrylic acid)-g-nanoclay (PMA-g-NC) (Solhi et al., 2012a), poly (acrylic acid)-g-nanoclay (PAA-g-NC) (Solhi et al., 2012b), and the hybrid poly (methacrylic acid)-grafted-nanoclay-nanosilica (PMA-g-NC-Sil) (Solhi et al., 2020).

MATERIALS AND METHODS

In a set of previous publications and the present paper, we grafted poly (acrylic acid) (PAA) or poly (methacrylic acid) (PMA) onto the surface of pristine Na-MMT nanoclay (Cloisite® Na⁺) through free radical polymerization of monomer in an aqueous media in the presence or absence of nanosilica particles. We characterized the resulting modified nanoparticles (PMA-g-NC, PAA-g-NC, PMA-g-NC-Sil and PAA-g-NC-Sil) using GPC, FTIR, TGA, and XRD. We then incorporated the modified particles as functionalized fillers to experimental dentin adhesives in different concentrations and studied the stability of modified fillers dispersion by separation analysis. We also studied the properties of the photo-cured adhesive matrices using FTIR, TEM, SEM, EDXA, and XRD. We examined the shear bond strength of the adhesives (containing different contents of each modified filler, separately) to human premolar teeth. The results were analysed and compared statistically.

RESULTS

The results confirmed that the polymers have been grafted onto the surface of nanoclay. An exfoliated structure for the nanoclay platelets in the photo-cured adhesive containing PAA-g-NC-Sil was observed. Addition of 0.5 wt% of PAA-g-NC-Sil to the experimental adhesive increased the shear bond strength and the dispersion stability in comparison to unfilled adhesive. The same trend was also observed for adhesives containing PMA-g-NC, PAA-g-NC, and PMA-g-NC-Sil. The adhesive containing PAA-g-NC-Sil showed the best dispersion stability and subsequently the highest shear bond strength in the optimal concentration among adhesives containing the four available fillers (PMA-g-NC, PAA-g-NC, PMA-g-NC-Sil and PAA-g-NC-Sil).

SIGNIFICANCE

Addition of poly (acrylic acid) modified nanoparticles to the experimental dentin adhesives resulted in higher shear bond strength due to the potential interactions between the carboxylic acid functional groups on the surface of the modified particles and the dentin structure. Between the poly (acrylic acid) and poly (methacrylic acid), the former acid with higher PK_a performed better. Addition of the spherical nanosilica particles to the adhesives containing platelet nanoclay helped to better exfoliate the platelets resulting in improved μ-SBS and dispersion stability.

Dataset on the effect of flavonoids on the stabilization of the resin-dentin interface

Data in this article are associated with our research article “Effect of Myricetin on Odontoblast-like Cells and its Potential to Preserve Resin–Dentin Bonds.” Both a poor infiltration of resin monomers into the demineralized dentin matrix and hydrolytic degradation of the adhesive could lead to the instability of the resin–dentin interface. The degradation of collagen is caused by matrix metalloproteinases (MMP) and cysteine cathepsins. These collagenolytic enzymes are contained in their latent form as pro-MMPs in the dentinal structure, and undergo activation during the adhesive process. Given that the integrity of the collagen matrix is essential for the preservation of the dentin bond strength in both the medium and long term, the inhibition of these proteases is necessary to improve the durability of adhesive restorations. Among the different strategies suggested to improve both the behavior of the substrate against enzymatic degradation and the biomechanical behavior of the adhesive interface, the use of protease inhibitors and collagen crosslinking agents has been recommended, such as polyphenols. Research has focused on flavonoids such as proanthocyanidins (PAC), a class of phenolic compounds found in a variety of plants such as blueberry and grape whose chemical structure favors their action as cross-linking agents. However, the focus has recently shifted towards myricetin (MYR) due to its chemical structure: a greater amount of hydroxyl groups at the substitution positions, which form bonds with the carbonyl groups of the side chains of collagen amino acids and generate interfiber bonds. Our previous study has shown the efficacy of MYR both as a cross-linking agent and as a MMP inhibitor without any immediate effects on microtensile bond strength (µTBS) and preserving it for six months after storage, and maintaining the odontoblastic phenotype without affecting cell viability. The objective of this article is to present a dataset on the effect of flavonoids PAC and MYR on the resin–dentin interface. Given that durability of the resin–dentin bond holds great importance for the clinical longevity of adhesive restorations, our data aims to show the effects of these flavonoids on resin–dentin µTBS after 18-month storage. Test groups for the µTBS assay were set as follows: G1 (negative control), conventional adhesion technique; G2 (vehicle control), 100% ethanol (EtOH) for 120 s; G3, 0.2% chlorhexidine (CHX) for 60 s; G4, 1% glutaraldehyde (GA) for 60 s; and G5, 600 µM myricetin (MYR) for 120 s. Datasets were exported to SPSS software, version 21.0 (SPSS, Chicago, IL, USA) for analysis using the Shapiro–Wilk, a two-way analysis of variance including factor interactions (treatment and storage time). Data are presented as mean ± standard deviation (SD). Differences with p-values < 0.05 were considered significant. Our data can be used as a basis for comparison among other natural and synthetic substances that could work as MMP inhibitors and crosslinking agents. These findings could be useful for designing an effective strategy towards the stabilization of the hybrid layer in a relevant clinical protocol.

In vitro performance of 2-step, total etch adhesives modified by thiourethane additives

OBJECTIVES

Thio-urethane oligomeric additives have been shown to improve the mechanical properties of dental composites and resin cements. To try to harness those same properties in dental adhesives, in this study, these oligomers (TU) were added to the matrix and/or as filler functionalization of experimental adhesives, and the effects on conversion and mechanical properties were analyzed.

METHODS

BisGMA and HEMA (60/40 wt%) were used as the monomer matrix, made polymerizable by the addition of 0.2 wt% 2,2-dimethoxy-2- phenylacetophenone. 2,6-di-tert-butyl-4-methylphenol was added at 0.5 wt% as the inhibitor. This material was used as the unfilled control (BH). TU oligomers were added at 20 wt % to the matrix (BH+20%TU, unfilled) and/or used as filler functionalization (TF, 10 wt%). Fillers functionalized with methacrylate (MF, 10 wt%) served as the control. The experimental adhesives groups containing fillers were: BH+10%MF; BH+10%TF; BH+20%TU+10%MF; BH+20%TU+10%TF. Flexural properties were tested in three-point bending (wet and dry). Polymerization kinetics was followed in real-time in near-IR. Water Sorption/Solubility (WS/SL, ISO 4049) and Viscosity (rotational rheometry) were also evaluated. For Microtensile bond strength 40 vol% ethanol was added to adhesives, which was applied onto sound dentin from third human molars. The data were analyzed with one-way ANOVA and Tukey post-hoc test, and test t for the comparison between storage time of the microtensile bond strength test (alpha = 0.05).

RESULTS

There was no significant difference between groups when yield strength (YS) and flexural modulus (FM) were evaluated in dry conditions. After water storage, all the groups containing TU in the matrix showed statistically lower YS/FM values. This was true in spite of the statistically higher conversion for those same groups. The maximum rate of polymerization (Rpmax) was higher for BH+10%TF and no significant difference was found for the groups BH and BH+10% MF. The lowest Rpmax values were found for BH+20%TU+10%TF and BH+20%TU. BH+20%TU+10%TF showed the highest viscosity values followed by BH+20%TU+10%MF and BH+20%TU, with statistically significant difference between them. For the microtensile bond strength test at 24h (p = 0.13) and 6 months (p = 0.11) and WS/SL (p > 0.05), no significant difference was found among groups. The storage time (24 h and 6 months) did not affect the microtensile bond strength results.

CONCLUSION

In spite of improving the conversion, the addition of TU in the matrix reduced the mechanical properties of the adhesives tested after water storage. This did not affect the bond strength at 24 h or 6 months.

Dental resin monomers induce early and potent oxidative damage on human odontoblast-like cells

Resin-based dental materials consist of filler particles and different monomers that are light cured in situ to re-establish dental function and aesthetics. Due to the degree of conversion of adhesive polymers, the monomers triethyleneglycol dimethacrylate (TEGDMA) and 2-hydroxyethyl methacrylate (HEMA) are released in relatively high amounts and are susceptible to degradation, acting as bioactive compounds and affecting cell and tissues. This study aimed to assess the effect of HEMA and TEGDMA exposure on metabolic activity, membrane integrity, and cell survival of human odontoblast-like cell (hOLCs). Exposure to resin monomers for 24 h induced major changes in cell membrane integrity, metabolic activity, and survival, which were measured by the calcein method and lactate dehydrogenase release. Increased and early reactive oxygen species (ROS) production was observed leading to degradative oxidation of membrane lipids identified as malondialdehyde production. Severe alteration in mitochondria occurred due to transmembrane mitochondrial potential collapse, possibly inducing activation of apoptotic cell death. hOLCs exposure to resin monomers modified the cell redox potential, with consequences on membrane permeability and integrity, including mitochondrial function. Lipid peroxidation appears to be a key phenomenon for the membrane structures oxidation after HEMA and TEGDMA exposure, leading to cell death and cytotoxicity. hOLCs respond early by differential induction of adaptive mechanisms to maintain cell homeostasis. Modulation of oxidative stress-induced response involves the regulation of genes that encode for antioxidant proteins such as catalase and heme oxygenase-1; regulation that functions as a critical protection mechanism against oxidative cell damage induced by HEMA and TEGDMA. Ascorbic acid as an antioxidant substance mitigates the oxidative damage associated with exposure to monomers.

Cytotoxicity evaluation of eluates from universal adhesives by real-time cell analysis

The aim of this study was to evaluate the cytotoxicity of universal adhesives on L929 mouse fibroblast cell line by using a real-time cell analysis. In order to obtain extract, six different cured dental adhesives were immersed in Dulbecco's Modified Eagle's Medium (DMEM) at 37°C for 24 h. A real-time cell analysis system was used to assess cytotoxicity of the dental adhesives. After seeding 25,000 cells/300 μL/well cell suspensions into the wells of an e-plate, fibroblasts were exposed to extracts of tested adhesives at varying dilutions (1:1, 1:2, and 1:10) and observed at every 30 min intervals for 72 h. Three-way ANOVA one factor repeated measures were used to analyze the results (α=0.05). All tested adhesives induced cell viability loss, cell morphology alteration, and cell death depending on extract concentration and time. Cell viability of L929 cells to between 44 and 10% for 1:1 diluted extracts, at 72 h, when compared to the negative control.

Dual modified nanosilica particles as reinforcing fillers for dental adhesives: Synthesis, characterization, and properties

A facile procedure has been devised to develop a novel dentin bonding system containing poly (acrylic acid)-grafted-silanized fumed silica particles as reinforcing filler, with high stability of nanoparticle dispersion and enhanced bond strength and mechanical properties. In the first step, the silanization of fumed silica nanoparticles was performed in the following conditions: (i) ethanol-water solution with a pH of 5 and (ii) cyclohexane with a pH of 9 using trimethoxysilylpropyl methacrylate (γ-MPS) as a reactive silane coupling agent. FTIR and TGA analyses confirmed the presence of silane in the resultant structure and enhanced dispersion stability of modified particles was proved by a separation analyzer and also zeta potential analyses. In the second step, free radical polymerization of acrylic acid monomers in the presence of silanized nanoparticles was carried out and poly (acrylic acid) -grafted- silanized fumed silica were acquired. The flexural strength and fracture toughness of the adhesive containing 0.2 wt.% of the dual modified filler reached maximum of 70.4 MPa and 1.34 MPa m^1/2, respectively, showing average improvements of 74% and 179%, respectively, in comparison with the adhesive without filler. Flexural modulus values did not significantly change with increasing the filler content except the adhesive containing 5 wt.% having the lowest flexural modulus. The highest microtensile bond strength was also observed at 0.2 wt.% filler content showing the average improvements of 197% as compared with the neat adhesive. Energy dispersive X-ray (EDX) mapping confirmed a homogenous and uniform distribution of the fillers in the adhesive matrix containing 0.2 wt.% and 0.5 wt.% of filler while incorporation of 5 wt.% led to large particle aggregates. SEM images of the fracture surface of the adhesive with different filler contents subjected to fracture toughness test showed rougher surface and longer crack path by increasing filler concentration. The adhesive containing 0.2 wt.% of filler perfectly penetrated into the dentin tubules proved by the SEM micrographs in microtensile bond strength test.

Poly (methacrylic acid) modified spherical and platelet hybrid nanoparticles as reinforcing fillers for dentin bonding systems: Synthesis and properties

OBJECTIVE

In this study the mechanical and adhesion properties of an experimental methacrylate based dentin bonding system containing a combination of spherical and layered platelet nanoparticles were investigated. The nanoparticles were first modified through surface graft polymerization of methacrylic acid in order to make the particles surface compatible with the bonding matrix resin.

MATERIALS AND METHODS

Graft free radical polymerization in aqueous media was performed to attach Poly (methacrylic acid) (PMA) chains onto the surface of Na-MMT nanoclay (Cloisite® Na+) and silica nanoparticles (Aerosil® 200). The hybrid PMA grafted nanoparticles (PMA-g-NC-Sil) were characterized using GPC, FTIR, TGA, and X-ray diffraction (XRD). Dentin adhesives containing different amounts of the hybrid modified nanoparticles were photopolymerized and their characteristics were studied using FTIR, TEM, SEM, EDXA, and XRD techniques. The adhesives containing different amounts of PMA-g-NC-Sil were applied to the conditioned human premolar dentin to bond a dental composite to the teeth. The bond strength was then measured by microshear bond strength testing method. The results were analyzed and compared statistically. The stability of PMA-g-NC-Sil dispersion in the dentin adhesive was investigated using separation analysis (LUMi Reader) techniques.

RESULTS

The grafting of PMA chains onto the surface of nanoclay was confirmed by FTIR and TGA analytical techniques. The intercalated-exfoliated structure for the nanoclay platelets in the photo-cured adhesive was observed using XRD and TEM. The surface modification of the nanoparticles significantly increased the dispersion stability of the fillers in the adhesive solution. The microshear test results indicated that the incorporation of the PMA-g-NC-Sil nanoparticles significantly enhanced the bond strength to dentin with the highest shear bond strength observed at 0.5 wt%.

SIGNIFICANCE

The incorporation of the PMA modified hybrid nanofillers into the dentin adhesive resulted in a dentin bonding agent with enhanced shear bond strength through reinforcing the adhesive matrix and potential interactions between their carboxylic acid groups and the tooth structure. The dispersion stability of the nanoparticles was also dramatically improved by the surface modification of the nanoparticles.

Antibacterial, ester-free monomers: Polymerization kinetics, mechanical properties, biocompatibility and anti-biofilm activity

OBJECTIVES

Quaternary ammonium (QA) methacrylate monomers have been extensively investigated and demonstrate excellent antibacterial properties. However, the presence of ester bonds makes them prone to degradation in the oral cavity. In this study, ester-free QA monomers based on meth-acrylamides were synthesized and screened for polymerization kinetics, mechanical properties and antibacterial effects.

MATERIALS AND METHODS

Tertiary quaternary ammonium acrylamides (AM) and methacrylamides (MAM) with alkyl side chain lengths of 9 and 14 carbons (C9 and C14) were synthesized and incorporated at 10 wt% into experimental composites based on BisGMA:TEGDMA (1:1), camphorquinone/ethyl-4-dimethylaminobenzoate (0.2/0.8 wt%) and 70 wt% barium glass fillers. Analogous methacrylate versions (MA) were used as controls. Degree of conversion (DC) and rate of polymerization (RP) during photoactivation (800 mW/cm2) were followed in real-time with near-IR. Flexural Strength (FS) and Modulus (E) were measured on 2 × 2 × 25 mm bars in 3-point bending after 24 h dry storage and 7-day storage in water at 37 °C. Antimicrobial properties and biofilm adhesion (fouling) were evaluated by bioluminescence (Luciferase Assay) and biofilm removal by water spray microjet impingement test, respectively. Cytotoxicity was assessed by MTT assay on dental pulp stem cells (DPSC). Data were analyzed with one-way ANOVA/Tukey's test (α = 0.05).

RESULTS

DC was similar for all groups tested (∼70%). Both MAMs and C14-AM presented significantly lower RP. Under dry conditions, FS (110-120 MPa) and E (8-9 GPa) were similar for all groups. After water storage, all materials presented FS/E similar to the control, except for C14-AM (for FS) and C14-MAM (for E), which were lower. All C14 versions were strongly antibacterial, decreasing the titer counts of biofilm by more than two orders of magnitude in comparison to the control. C9 monomers did not present significant antibacterial nor antifouling properties. And biofilms had approximately equivalent adhesion on the C9 composites as on the control. Cytotoxicity did not show significant differences between the MA and AM versions and the control group.

CONCLUSIONS

C14-QA monomers based on methacrylates and meth-acrylamides present strong antibacterial properties, and in general, similar conversion/mechanical properties compared to the methacrylate control.

STATEMENT OF SIGNIFICANCE

This work demonstrates the viability of methacrylamides and acrylamides as potential components in dental restorative materials with antimicrobial properties. The use of ester-free polymerizable functionalities has the potential of improving the degradation resistance of these materials long-term. The use of (meth)acrylamides did not interfere with the antimicrobial potential of quaternary ammonium-based materials.

A review of bioceramics-based dental restorative materials

Currently, much has been published related to conventional resin-based composites and adhesives; however, little information is available about bioceramics-based restorative materials. The aim was to structure this topic into its component parts and to highlight the translational research that has been conducted up to the present time. A literature search was done from indexed journals up to September 2017. The main search terms used were based on dental resin-based composites, dental adhesives along with bioactive glass and the calcium phosphate family. The results showed that in 123 articles, amorphous calcium phosphate (39.83%), hydroxyapatite (23.5%), bioactive glass (16.2%), dicalcium phosphate (5.69%), monocalcium phosphate monohydrate (3.25%), and tricalcium phosphate (2.43%) have been used in restorative materials. Moreover, seven studies were found related to a newly developed commercial bioactive composite. The utilization of bioactive materials for tooth restorations can promote remineralization and a durable seal of the tooth-material interface.

An Overview of Dental Adhesive Systems and the Dynamic Tooth-Adhesive Interface

From the conception of resin-enamel adhesion to today's contemporary dental adhesive systems, clinicians are no longer afraid of exploring the many advantages brought by adhesive restorative concepts. To maximize the performance of adhesive-based restorative procedures, practitioners must be familiar with the mechanism of adhesion, clinical indications, proper handling, the inherent limitations of the materials and the biological challenges. This review provides an overview of the current status of restorative dental adhesives, their mechanism of adhesion, mechanisms of degradation of dental adhesive interfaces, how to maximize performance, and future trends in adhesive dentistry.

In-vitro transdentinal diffusion of monomers from adhesives

OBJECTIVES

Biocompatibility of adhesives is important since adhesives may be applied on dentin near the pulp. Accurate knowledge of the quantity of monomers reaching the pulp is important to determine potential side effects. The aim of this study was to assess the transdentinal diffusion of residual monomers from dental adhesive systems using an in-vitro pulp chamber model.

METHODS

Dentin disks with a thickness of 300 μm were produced from human third molars. These disks were fixed between two open glass tubes, representing an in-vitro pulp chamber. The etch-and-rinse adhesive OptiBond FL and the self-etch adhesive Clearfil SE Bond were applied to the dentin side of the disks, while on in the pulpal side, the glass tube was filled with 600 μl water. The transdentinal diffusion of different monomers was quantified using ultra-performance liquid chromatography-tandem mass spectrometry.

RESULTS

The monomers HEMA, CQ, BisGMA, GPDM, 10-MDP and UDMA eluted from the dental materials and were able to diffuse through the dentin disks to a certain extent. Compounds with a lower molecular weight (uncured group: HEMA 7850 nmol and CQ 78.2 nmol) were more likely to elute and diffuse compared to monomers with a higher molecular weight (uncured group: BisGMA 0.42 nmol). When the adhesives were left uncured, diffusion was up to 10 times higher compared to the cured conditions.

CONCLUSIONS

This in-vitro research resulted in the quantification of various monomers able to diffuse through dentin and therefore contributes to a more detailed understanding about the potential exposure of the dental pulp to monomers from dental adhesives.

CLINICAL SIGNIFICANCE

Biocompatibility of adhesives is important since adhesives may be applied on dentin near the pulp, where tubular density and diameter are greatest.

Complete rehabilitation of compromised full dentitions with adhesively bonded all-ceramic single-tooth restorations: Long-term outcome in patients with and without amelogenesis imperfecta

OBJECTIVES

This clinical follow-up evaluated the long-term outcome of full-mouth rehabilitations with adhesively bonded all-ceramic restorations in patients suffering from amelogenesis imperfecta (AI) or affected by extensive tooth wear including a loss of the vertical dimension of occlusion.

MATERIALS AND METHODS

Included for evaluation were all patients treated with adhesively bonded monolithic single-tooth restorations made of silicate or lithium disilicate ceramics; allowing a maximum four missing teeth and a facial feldspathic veneering of LDS anterior crowns. After treatment, patients have been enrolled in a recall program for dental check-ups including quality assessment of the restorations. Patients answered the oral health impact profile (OHIP-14) at their last visit.

RESULTS

Seventeen patients (mean age = 35 ± 18 years) were observed up to 16.5 years (mean: 6.2 ± 3.8 years). 12 out of 450 restorations failed due to core fracture (n = 7), tooth fracture (n = 2), one secondary caries, one chip-off grade 3, and one fixed dental prosthesis due to discomfort. The overall mean survival rate of the single-tooth restorations was estimated 99.4% at 5 and 91.4% at 10 years. The overall mean success rate was estimated 92.6% at 5 and 81.4% at 10 years, mainly due to chip-offs and crack formation (27 out of 31 relative failures). The mean annual failure rates (AFR) range between 1.5 and 2% over the years, but non-AI patients were affected more frequently by early technical complications in the facial veneering of anteriors, resulting in an AFR ranging between 5.2 and 4%. Quality assessment revealed stable color, form and marginal integrity in all patients up to ten years. The distribution of OHIP values is comparable to the representative sample of healthy patients.

CONCLUSION

Adhesively bonded single-tooth restorations provided a high clinical quality in the long-run. However, while the survival and success were excellent in AI patients, restorations in non-AI patients were affected by a higher complication rate, likely related to a higher risk profile due to a history of bruxism and tooth wear.

A new arginine-based dental adhesive system: formulation, mechanical and anti-caries properties

Secondary caries at the margins of composite restorations has been attributed to adhesive failure and consequent accumulation of cariogenic biofilms.

OBJECTIVES

To develop and evaluate an etch-and-rinse adhesive system containing arginine for sustainable release and recharge without affecting its mechanical properties. Arginine metabolism by oral bacteria generates ammonia, which neutralizes glycolytic acids and creates a neutral environmental pH that is less favorable to the growth of caries pathogens, thus reducing the caries risk at the tooth-composite interface.

METHODS

Experimental adhesives were formulated with methacrylate monomers and arginine at 5%, 7%, and 10% or no arginine (control). Adhesives were tested for: (i) mechanical properties of true stress (FS and UTS), modulus of elasticity (E), degree of conversion (DC), Knoop hardness number (KHN) and dentin microtensile bond strength (μ-TBS), (ii) arginine release and recharge, and (iii) antibacterial activities. Data was analyzed by t-test, one-way ANOVA and Tukey's tests.

RESULTS

FS and UTS results showed no statistically significant differences between the 7% arginine-adhesive and control, while the results for E, DC, KHN and μ-TBS showed no difference among all groups. The 7% arginine-adhesive showed a high release rate of arginine (75.0μmol/cm²) at 2h, and a more sustainable, controlled release rate (up to 0.2μmol/cm²) at 30days.

CONCLUSIONS

Incorporation of 7% arginine did not affect the physical and mechanical properties of the adhesive. Arginine was released from the adhesive at a rate and concentration that exhibited antibacterial effects, regardless of shifts in biofilm conditions such as sugar availability and pH.

CLINICAL SIGNIFICANCE

Secondary caries is recognized as the main reason for failure of dental restorations. The development of an arginine-based adhesive system has the potential to dramatically reduce the incidence and severity of secondary caries in adhesive restorations in a very economical fashion.

One-step partial or complete caries removal and bonding with antibacterial or traditional self-etch adhesives: study protocol for a randomized controlled trial

BACKGROUND

Current concepts in conservative dentistry advocate minimally invasive dentistry and pulp vitality preservation. Moreover, complete removal of carious dentin in deep carious lesions often leads to pulp exposure and root canal treatment, despite the absence of irreversible pulp inflammation. For years, partial caries removal has been performed on primary teeth, but little evidence supports its effectiveness for permanent teeth. Furthermore, the recent development of new antibacterial adhesive systems could be interesting in the treatment of such lesions. The objectives of this study are to compare the effectiveness of partial versus complete carious dentin removal in deep lesions (primary objective) and the use of an antibacterial versus a traditional two-step self-etch adhesive system (main secondary objective).

METHODS/DESIGN

The DEep CAries Treatment (DECAT) study protocol is a multicenter, randomized, controlled superiority trial comparing partial versus complete caries removal followed by adhesive restoration. The minimum sample size required is 464 patients. Two successive randomizations will be performed (allocation ratio 1:1): the first for the type of excavation (partial versus complete) and the second (if no root canal treatment is required) for the type of adhesive (antibacterial versus traditional). For the two objectives, the outcome is the success of the treatment after 1 year, measured according to a composite outcome of five FDI criteria: material fracture and retention, marginal adaptation, radiographic examination (including apical pathologies), postoperative sensitivity and tooth vitality, and carious lesion recurrence.

DISCUSSION

The study will investigate the interest of a conservative approach for the management of deep carious lesions in terms of dentin excavation and bioactive adhesive systems. The results may help practitioners achieve the most efficient restorative procedure to maintain pulp vitality and increase the restoration longevity.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT02286388 . Registered in November 2014.

Influence of light-curing distance on degree of conversion and cytotoxicity of etch-and-rinse and self-etch adhesives

BACKGROUND

The degree of conversion (DC) of resin based materials depends, beside other factors, on the light-intensity applied during light curing. A lower DC might be correlated with an increased cytotoxicity of the respective materials. Therefore, aim of the present study was to investigate the influence of the distance between light-curing tip and adhesives on their cytotoxicity and degree of conversion (DC).

METHODS

For the cytotoxicity assay, a total of 98 bovine dentine samples were prepared, distributed to seven groups (G1-G7; n = 14) and treated as follows: G1: untreated; G2-G4: OptiBond FL; G5-G7: OptiBond All-In-One. Adhesives were light-cured (1200 mW/cm(2)) at 1 mm (G2;G5), 4 mm (G3;G6) or 7 mm (G4;G7) distance. Samples were stored in culture media for 24 h and extracts were added to cell cultures (dental pulp cells and gingival fibroblasts) for a further 24 h. Finally, released lactate dehydrogenase activity (LDH) was photometrically determined, as measure for the cytotoxic effects of the extracts. The cytotoxicity assay was performed three times. Additionally, the DC of the adhesives was determined by FTIR spectroscopy. DC measurements were performed five times.

RESULTS

For both cell types, no significant difference of LDH release was observed between untreated control group (G1) and treated groups G2-G7 (p > 0.05, respectively), between the groups treated with same adhesive and light-cured at different distance (p > 0.05, respectively), as well as between groups treated with different adhesives and light-cured at the same distance (p > 0.05, respectively). Within the respective adhesive, no significant difference in the DC was observed when light-cured at different distance (p > 0.05, respectively), while OptiBond FL showed significantly higher DCs compared to OptiBond All-In-One when light-cured at same distances (p < 0.05, respectively).

CONCLUSIONS

The distance between light-curing tip and adhesive surface does not significantly influence either the cytotoxicity or the DC of the tested adhesives.

Effect of diphenyliodonium hexafluorophosphate on the physical and chemical properties of ethanolic solvated resins containing camphorquinone and 1-phenyl-1,2-propanedione sensitizers as initiators

OBJECTIVES

To evaluate the effects of the diphenyliodonium hexafluorophosphate (DPI) on the physical and mechanical properties of solvated dental adhesive resins containing camphorquinone (CQ) and/or 1-phenyl-1,2-propanedione (PPD) as initiators.

METHODS

Model solvated resins containing bisphenol glycidyl methacrylate (BisGMA); triethyleneglycol dimethacrylate (TEGDMA); 1,3-glycerol dimethacrylate (GDMA); 2-hydroxyethyl methacrylate (HEMA); dimethylaminoethyl amine benzoate (EDAB) and ethanol were prepared. The resins were divided in 24 test groups according to the incorporated initiator systems (CQ-0.5 or 1mol%; PPD-0.5 or 1mol%; CQ+PPD-0.5 or 1mol%) as well the presence of DPI (0, 0.5 or 1mol%). Degree of conversion (using Fourier-transformed near infra-red spectroscopy), flexural strength and modulus by three point bending, cohesive strength and water sorption and solubility were measured. Data were statistically analyzed by one and two way ANOVA and Tukey's test (α=0.05).

RESULTS

DPI increased the degree of conversion of all materials tested. Camphorquinone promoted higher degree of conversion than resins containing only PPD or CQ+PPD. Generally, the resins containing PPD+CQ with DPI presented higher flexural strength and modulus, cohesive strength, as well lower water sorption and solubility.

SIGNIFICANCE

The use of PPD combined with CQ can increase the physical properties of the solvated resins. DPI improved the monomer conversion of all experimental materials and can positively modulate most of the physical properties of the solvated resins.

The use of micro-CT with image segmentation to quantify leakage in dental restorations

OBJECTIVE

To develop a method for quantifying leakage in composite resin restorations after curing, using non-destructive X-ray micro-computed tomography (micro-CT) and image segmentation.

METHODS

Class-I cavity preparations were made in 20 human third molars, which were divided into 2 groups. Group I was restored with Z100 and Group II with Filtek LS. Micro-CT scans were taken for both groups before and after they were submerged in silver nitrate solution (AgNO3 50%) to reveal any interfacial gap and leakage at the tooth restoration interface. Image segmentation was carried out by first performing image correlation to align the before- and after-treatment images and then by image subtraction to isolate the silver nitrate penetrant for precise volume calculation. Two-tailed Student's t-test was used to analyze the results, with the level of significance set at p<0.05.

RESULTS

All samples from Group I showed silver nitrate penetration with a mean volume of 1.3 ± 0.7mm(3). In Group II, only 2 out of the 10 restorations displayed infiltration along the interface, giving a mean volume of 0.3 ± 0.3mm(3). The difference between the two groups was statistically significant (p<0.05). The infiltration showed non-uniform patterns within the interface.

SIGNIFICANCE

We have developed a method to quantify the volume of leakage using non-destructive micro-CT, silver nitrate infiltration and image segmentation. Our results confirmed that substantial leakage could occur in composite restorations that have imperfections in the adhesive layer or interfacial debonding through polymerization shrinkage. For the restorative systems investigated in this study, this occurred mostly at the interface between the adhesive system and the tooth structure.

An invitro evaluation of antibacterial properties of self etching dental adhesive systems

BACKGROUND AND OBJECTIVES

The microbial flora of the oral cavity is extremely diverse. Residual bacteria in the oral cavity may remain at the tooth restoration interface and increase the risk of developing recurrent caries. The aim of this study is to evaluate the immediate and long term antibacterial effect of polymerised self etching adhesive systems.

MATERIALS AND METHODS

Streptococcus mutans were used as a test organism. The self etching dental adhesives that were used are Adper Easy One, G-Bond, Clearfil S3 bond and Xeno V. Agar diffusion test (ADT) was performed on agar plates, in which four holes that were 4mm in diameter were punched. Then 200 μL of freshly grown S.mutans spread evenly. The four holes were immediately filled with the four tested materials and light polymerised them using a light curing unit. The agar plates were incubated for 72h at 37°C. For the direct contact test (DCT), the bonding agents were placed on the side walls of microtiter plate wells and light polymerized according to the manufacturer's instructions. A 10μL bacterial suspension was placed on the tested material samples. Bacteria were allowed to directly contact the polymerized dental adhesives for 1h at 37(o)C. Fresh Brain heart infusion broth was then added. The bacterial growth was then spectrophotometrically measured in the wells every 30 min for 16h for 1,2, 7 and 14 days.

RESULTS

In the ADT, inhibitory halos were found around all the bonding agents, with greater inhibition halo seen around Xeno V after incubating for 72 h at 37°C. The readings obtained through DCT were subjected to ANOVA and Tukey's multiple comparisons tests, which showed no bacterial growth on fresh samples and after aging for one day in PBS with self etching adhesives. RESULTS of DCT after aging for 2 days, 7 days and 14 days showed bacterial growth in all the bonding agents used with no significant difference from the control group.(p<0.001) CONCLUSION: All the dental adhesives showed antibacterial properties immediately and one day after polymerization but none of the self-etching adhesives had long-lasting antibacterial properties.

Thirty-year follow-up of a TMD case treated based on the neuromuscular concept

AIM

Occlusal therapy is employed to alleviate the symptoms of a temporomandibular disorder (TMD) at times. However, the long-term effect of occlusal therapy in the masticatory system is not well understood. This case study aims to present a 30-year follow-up of a TMD case.

METHODOLOGY

The patient developed TMD with intermittent closed lock of the left temporomandibular joint (TMJ). Chief complaints included trismus, pain, and noise of the left TMJ during function. The patient's occlusal disharmony was assessed with use of electronic instruments and corrected based on the neuromuscular concept. A minimum-invasive and reversible approach using adhesive occlusal restorations was used.

RESULTS

The jaw movement and masticatory muscle activity assessed at the 7- and 23-year follow-ups revealed that the established occlusion was well adapted, and re-established the patient's functional occlusion system. The patient has been free from TMD symptoms with the corrected occlusion for 30 years.

CONCLUSIONS

Occlusal reconstruction based on the neuromuscular concept can be stably integrated into the patient's functional occlusion system.

Impact of erosive conditions on tooth-colored restorative materials

OBJECTIVES

To give an overview of the impact of erosive conditions on the behavior of tooth-colored restoratives and performance of dental adhesives.

METHODS

Acid-induced erosive lesions of enamel and dentin often need restorative procedures for rehabilitation. Nowadays, mostly tooth-colored restoratives (ceramics or resin composites), which are adhesively fixed to the dental substrate are used for this purpose. In some cases it might be necessary to seal the exposed dentin before achieving this goal in order to combat hypersensitivities and to protect those teeth from further erosive and abrasive loss. Moreover, it is conceivable that patients will fall back into their old "erosive behavior" after the application of restoratives. The following overview describes in how far intra-oral erosive conditions might affect the integrity of restorative materials, such as composite resins and ceramics, or of dentin sealants. Additionally, the use of erosively altered enamel and dentin as substrate for adhesive technologies is elucidated.

RESULTS

In the literature, information of the behavior of tooth-colored restoratives under still persisting erosive conditions are limited and mostly based on in vitro-studies. There is information that the adhesion of dental adhesives to eroded dentin is compromised as compared to regular dentin. The impact of erosive conditions relevant for the oral cavity on ceramics and resin composites seems to be rather low, although only few clinical studies are available.

SIGNIFICANCE

The review showed that erosive conditions might have only little impact on behavior of tooth-colored restorative materials, such as composites and ceramics. Dentin sealants also seem to be rather resistant against erosive conditions and might therefore serve as an intermediary treatment option for exposed dentin surfaces. The adhesion of dentin adhesives to eroded dentin might be increased by mechanical pre-treatment of the substrate, but needs further investigation.

Hydroxyapatite induces spontaneous polymerization of model self-etch dental adhesives

The objective of this study is to report for the first time the spontaneous polymerization phenomenon of self-etch dental adhesives induced by hydroxylapatite (HAp). Model self-etch adhesives were prepared by using a monomer mixture of bis[2-(methacryloyloxy)ethyl] phosphate (2MP) with 2-hydroxyethyl methacrylate (HEMA). The initiator system consisted of camphorquinone (CQ, 0.022 mmol/g) and ethyl 4-dimethylaminobenzoate (4E, 0.022-0.088 mmol/g). HAp (2-8 wt.%) was added to the neat model adhesive. In a dark environment, the polymerization was monitored in-situ using ATR/FT-IR, and the mechanical properties of the polymerized adhesives were evaluated using nanoindentation technique. Results indicated that spontaneous polymerization was not observed in the absence of HAp. However, as different amounts of HAp were incorporated into the adhesives, spontaneous polymerization was induced. Higher HAp content led to higher degree of conversion (DC), higher rate of polymerization (RP) and shorter induction period (IP). In addition, higher 4E content also elevated DC and RP and reduced IP of the adhesives. Nanoindentation result suggested that the Young's modulus of the polymerized adhesives showed similar dependence on HAp and 4E contents. In summary, interaction with HAp could induce spontaneous polymerization of the model self-etch adhesives. This result provides important information for understanding the initiation mechanism of the self-etch adhesives, and may be of clinical significance to strengthen the adhesive/dentin interface based on the finding.

Effect of Postoperative Bleaching on Microleakage of Etch-and-Rinse and Self-etch Adhesives

BACKGROUND

Bleaching the discoloured teeth may affect the tooth/composite interface. The aim of this in vitro experimental study was to evaluate the effect of vital tooth bleaching on microleakage of existent class V composite resin restorations bonded with three dental bonding agents.

METHODS

Class V cavities were prepared on buccal surfaces of 72 intact, extracted human anterior teeth with gingival margins in dentin and occlusal margins in enamel, and randomly divided into 3 groups. Cavities in the three groups were treated with Scotch bond Multi-Purpose, a total etch system and Prompt L-Pop and iBond, two self-etch adhesives. All teeth were restored with Z250 resin composite material and thermo-cycled. Each group was equally divided into the control and the bleached subgroups (n = 12). The bleached subgroups were bleached with 15% carbamide peroxide gel for 8 hours a day for 15 days. Microleakage scores were evaluated on the incisal and cervical walls. Data were analyzed using Kruskal-Wallis, Mann-Whitney and Bonferroni post-hoc tests (α = 0.05).

RESULTS

Bleaching with carbamide peroxide gel significantly increased the microleakage of composite restorations in Prompt L-Pop group at dentinal walls (P = 0.001). Bleaching had no effect on microleakage of restorations in the Scotch bond Multi-Purpose and iBond groups.

CONCLUSION

Vital tooth bleaching with carbamide peroxide gel has an adverse effect on marginal seal of dentinal walls of existent composite resin restorations bonded with prompt L-Pop self-etch adhesive.

Permeability of Dental Adhesives - A SEM Assessment

OBJECTIVES

To morphologically evaluate the permeability of different commercial dental adhesives using scanning electron microscopy.

METHODS

SEVEN ADHESIVE SYSTEMS WERE EVALUATED: one three-step system (Scotchbond Multi-Purpose - MP); one two-step self-etching primer system (Clearfil SE Bond - SE); three two-step etch-and-rinse systems (Single Bond 2 - SB; Excite - EX; One-Step - OS); and two single-step self-etching adhesives (Adper Prompt - AP; One-Up Bond F - OU). The mixture of primer and bond agents of the Clearfil SE Bond system (SE-PB) was also tested. The adhesives were poured into a brass mold (5.8 mm x 0.8 mm) and light-cured for 80 s at 650 mW/cm2. After a 24 h desiccation process, the specimens were immersed in a 50% ammoniac silver nitrate solution for tracer permeation. Afterwards, they were sectioned in ultra-fine slices, carbon-coated, and analyzed under backscattered electrons in a scanning electron microscopy.

RESULTS

MP and SE showed slight and superficial tracer permeation. In EX, SB, and OS, permeation extended beyond the inner superficies of the specimens. SE-PB did not mix well, and most of the tracer was precipitated into the primer agent. In AP and OU, "water-trees" were observed all over the specimens.

CONCLUSIONS

Different materials showed distinct permeability in aqueous solution. The extent of tracer permeation varied according to the composition of each material and it was more evident in the more hydrophilic and solvated ones.

Effect of storage time, thermocycling and resin coating on durability of dentin bonding systems

BACKGROUND

Along with development of different dental adhesives, concerns about hydrolytic deg-radation of the adhesive components have arisen. The purpose of this study was to evaluate the in vitro influence of thermocycling, water storage and resin coating on the microshear bond strength of total etch and self etch adhesive systems to dentin.

METHODS

The superficial coronal dentin of eighty intact third molars were exposed and divided into 5 equal groups. Dental adhesives including Scotch Bond Multi Purpose (SBMP), Single Bond (SB), Clearfil SE Bond (CSE), Prompt L-Pop (PLP), and Prompt L-Pop plus Margin bond (PLPM) were applied according to the manufacturers' instructions on prepared surfaces in the study groups, respectively. Then composite cylinders were bonded and specimens were divided into two subgroups. One subgroup was stored in water for 24 hours. The second subgroup was subjected to 3000 thermocycle shocks and then was stored in 37°C water for 3 months. Finally, all teeth were subjected to the microshear bond strength test. Data were analyzed using two-way ANOVA and Tukey HSD tests. One specimen similar to each subgroup was also prepared for SEM evaluation.

RESULTS

After one-day storage, the SBMP showed the highest bond strength followed by CSE, PLPM, SB and PLP. After three months storage, the highest bond strength was observed in SBMP followed by PLPM, CSE, SB, and PLP.

CONCLUSION

SBMP showed the best bond strength while CSE represented acceptable bond durability. Resin coating on PLP improved bond strength and durability.

Cytotoxicity of dental adhesives in vitro

OBJECTIVES

The purpose of this study was to evaluate the cytotoxic effect of six dental adhesives (Admira Bond, Clearfil Liner Bond 2V, ED Primer II, Fuji Bond LC, Gluma Comfort Bond, and NanoBond) applied to cell cultures.

METHODS

The experiments were performed on two cell lines, rat pulp cells (RPC-C2A) and human lung fibroblasts (MRC5). Samples of the adhesives were light-cured and placed in culture medium for 24 hours. The extraction media was applied on the RPC-C2A and the MRC5 cells. Complete medium was used as a control. Cytotoxicity was evaluated with a modified sulforhodamine B (SRB) assay after 24 hours of exposure.

RESULTS

The cell survival of RPC-C2A cells exposed to Fuji Bond LC, NanoBond, Clearfil Liner Bond 2V, ED Primer II, Admira Bond and Gluma Comfort Bond was 73%, 67%, 50%, 20%, 18% and 5% respectively, relative to the cell survival with the control medium. In the MRC5 cell line, the relative survival was 98%, 80%, 72%, 41%, 19% and 7% after exposure to NanoBond, Fuji Bond LC, Clearfil Liner Bond 2V, ED Primer II, Admira Bond and Gluma Comfort Bond, respectively.

CONCLUSIONS

Different types of dental adhesives showed different cytotoxic effects on cells in vitro. The self-etch adhesives were superior in terms of cytotoxicity. The different cytotoxic effects of dental adhesives should be considered when selecting an appropriate adhesive for operative restorations.