Progress in Dental Adhesive Materials

There have been significant advances in adhesive dentistry in recent decades, with efforts being made to improve the mechanical and bonding properties of resin-based dental adhesive materials. Various attempts have been made to achieve versatility, introducing functional monomers and silanes into the materials' composition to enable the chemical reaction with tooth structure and restorative materials and a multimode use. The novel adhesive materials also tend to be simpler in terms of clinical use, requiring reduced number of steps, making them less technique sensitive. However, these materials must also be reliable and have a long-lasting bond with different substrates. In order to fulfill these arduous tasks, different chemical constituents and different techniques are continuously being developed and introduced into dental adhesive materials. This critical review aims to discuss the concepts behind novel monomers, bioactive molecules, and alternative techniques recently implemented in adhesive dentistry. Incorporating monomers that are more resistant to hydrolytic degradation and functional monomers that enhance the micromechanical retention and improve chemical interactions between adhesive resin materials and various substrates improved the performance of adhesive materials. The current trend is to blend bioactive molecules into adhesive materials to enhance the mechanical properties and prevent endogenous enzymatic degradation of the dental substrate, thus ensuring the longevity of resin-dentin bonds. Moreover, alternative etching materials and techniques have been developed to address the drawbacks of phosphoric acid dentin etching. Altogether, we are witnessing a dynamic era in adhesive dentistry, with advancements aiming to bring us closer to simple and reliable bonding. However, simplification and novelty should not be achieved at the expense of material properties.

Dental anomalies as a possible clue of 1p36 deletion syndrome due to germline mosaicism: a case report

Background

Monosomy 1p36 is the most common terminal deletion syndrome with an autosomal dominant pattern of inheritance. This syndrome is defined by an extremely wide spectrum of characteristics; however, developmental delay and intellectual disability of various degree are present in all patients and about the 90% of patients have a severe intellectual disability. Dental agenesis or other dental anomalies have not been described in previous reports.

Case presentation

We report the case of two little sisters born from healthy and non-consanguineous parents, presenting with dental anomalies and one of them with epilepsy, dilated cardiomyopathy with left-ventricular non-compaction, strabismus, history of poor growth, hypotonia and mild language delay. Patients were evaluated in several departments (genetic, child neuropsychiatric, cardiology, odontostomatology, ophthalmology, otorhinolaryngology) of Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy. They underwent investigations such as electrocardiogram, echocardiogram, dental orthopantomography X-Ray and Computed Tomography, electroencephalograms, abdomen ultrasound, blood tests, IQ tests, genetic analysis. They both have an Intelligence Quotient greater than 70 and a negative neurologic exam. Each sister carries the same 1p36 deletion of about 2.3 Mb. Genetic analysis of the parents’ blood samples (Single Nucleotide Polymorphism- array, karyotype and Fluorescent In Situ Hybridization) did not reveal any deletion, translocation or inversion and confirmed the paternity. A third sib of the probands does not carry the 1p36 deletion or other quantitative alterations.

Conclusion

This report describes a new trait linked to monosomy 1p36, namely a mild intellectual outcome associated with significant dental anomalies. Our finding suggests that 1p36 deletion syndrome may present with a mild cognitive impairment or even with a normal intellectual development: this is very important for the genetic counselling, especially in a prenatal setting. Moreover, we report the third study with recurrent 1p36 deletion syndrome in two siblings, likely due to germline mosaicism. Finally, we believe that the dental anomalies should be investigated in 1p36 deletion syndrome and that the spectrum of the condition could be broader than we assume.

Academy of Dental Materials guidance-Resin composites: Part I-Mechanical properties

OBJECTIVE

The objective of this project, which was initiated from the Academy of Dental Materials, was to review and critically appraise methods to determine fracture, deformation and wear resistance of dental resin composites, in an attempt to provide guidance for investigators endeavoring to study these properties for these materials.

METHODS

Test methods have been ranked in the priority of the specific property being tested, as well as of the specific test methods for evaluating that property. Focus was placed on the tests that are considered to be of the highest priority in terms of being the most useful, applicable, supported by the literature, and which show a correlation with clinical findings. Others are mentioned briefly for the purpose of being inclusive. When a standard test method exists, including those used in other fields, these have been identified in the beginning of each section. Also, some examples from the resin composite literature are included for each test method.

RESULTS

The properties for evaluating resin composites were ranked in the priority of measurement as following: (1) Strength, Elastic Modulus, Fracture toughness, Fatigue, Indentation Hardness, Wear-abrasion (third body) and Wear-attrition (contact/two body), (2) Toughness, Edge strength (chipping) and (3) Wear determined by toothbrush.

SIGNIFICANCE

The following guidance is meant to aid the researcher in choosing the proper method to assess key properties of dental resin composites with regard to their fracture, deformation and wear resistance.

Degree of Conversion of Self-etch Adhesives: In Situ Micro-Raman Analysis

Purpose: Degree of conversion (DC) affects the physicochemical properties of dental adhesives. The aim of this study was to measure the DC within the hybrid layer of four one-step self-etch adhesives using Raman microspectroscopy. The hypothesis tested was that there was no difference among the tested adhesives.

Methods and Materials: The selected one-step self-etch adhesives (Clearfil S3 Bond Plus, I-BOND, G-BOND, and Adper Easy Bond) were applied on human dentin disks and polymerized in accordance with the manufacturers' instructions. Specimens were transversally cut to expose the bonded interfaces to the micro-Raman beam, and Raman spectra were collected along the dentin/adhesive interface. Measurements were performed at 1-μm intervals. The relative intensities of bands associated with the C=C bond (at 1640 cm−1) and an internal stable peak (1610 cm−1) were determined to calculate the degree of conversion within the hybrid layer. Data were statistically analyzed with Kolmogorov-Smirnov and Bartlett tests and Kruskal-Wallis and Mann-Whitney U-tests.

Results: The DC ranked as follows: G-BOND (93%±6%) ≥ Adper Easy Bond (92%±6%) ≥ I-BOND (89%±7%) > Clearfil S3 Bond Plus (80%±14%) (p<0.05).

Conclusions: Based on the results of this study, all of the tested self-etch adhesives showed a clinically acceptable DC that was material dependent.

The importance of size-exclusion characteristics of type I collagen in bonding to dentin matrices

The mineral phase of dentin is located primarily within collagen fibrils. During development, bone or dentin collagen fibrils are formed first and then water within the fibril is replaced with apatite crystallites. Mineralized collagen contains very little water. During dentin bonding, acid-etching of mineralized dentin solubilizes the mineral crystallites and replaces them with water. During the infiltration phase of dentin bonding, adhesive comonomers are supposed to replace all of the collagen water with adhesive monomers that are then polymerized into copolymers. The authors of a recently published review suggested that dental monomers were too large to enter and displace water from collagen fibrils. If that were true, the endogenous proteases bound to dentin collagen could be responsible for unimpeded collagen degradation that is responsible for the poor durability of resin-dentin bonds. The current work studied the size-exclusion characteristics of dentin collagen, using a gel-filtration-like column chromatography technique, using dentin powder instead of Sephadex. The elution volumes of test molecules, including adhesive monomers, revealed that adhesive monomers smaller than ∼1000 Da can freely diffuse into collagen water, while molecules of 10,000 Da begin to be excluded, and bovine serum albumin (66,000 Da) was fully excluded. These results validate the concept that dental monomers can permeate between collagen molecules during infiltration by etch-and-rinse adhesives in water-saturated matrices.

Kinetics of polymerization and contraction stress development in self-adhesive resin cements

OBJECTIVES

The aim of the study was to evaluate the contraction stress, microhardness and polymerization kinetics of three self-adhesive cements vs. conventional dual-cure resin cement.

METHODS

Cements tested were: RelyX Unicem (3M ESPE, St. Paul, MN, USA), MaxCem Elite (Kerr, Orange, CA, USA), Clearfil SA Cement (Kuraray, Tokyo, Japan) and Duolink (Bisco Inc., Schaumburg, IL, USA). Cements were irradiated with a LED-curing unit (bluephase, IvoclarVivadent) for 20 or 40 s and the contraction forces (N) generated during polymerization were continuously recorded for 6 h with a universal testing machine. Polymerization kinetics were monitored using micro-Raman spectroscopy and degree of conversion was calculated. Vickers microhardness was also recorded. All measurements were performed at 10 min and 6h. Data were statistically analyzed by three-way ANOVA with repeated measures and Tukey's post hoc test (α=0.05).

RESULTS

Irrespective of exposure time, stress analysis ranked in the following order: Clearfil SA Cement<MaxCem<RelyX Unicem≤Duolink (p<0.05). Stress was correlated with microhardness values (p<0.05). Kinetic curves showed that maximum degree of conversion was attained more quickly than maximum stress after light activation.

SIGNIFICANCE

The conventional resin-based cement showed higher stress values than the self-adhesive cements. The results were material-dependent and probably correlated to the composition of each material.

Carbodiimide cross-linking inactivates soluble and matrix-bound MMPs, in vitro

Matrix metalloproteinases (MMPs) cause collagen degradation in hybrid layers created by dentin adhesives. This in vitro study evaluated the feasibility of using a cross-linking agent, 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC), to inactivate soluble rhMMP-9, as an example of dentin MMPs, and matrix-bound dentin proteases. The inhibitory effects of 5 EDC concentrations (0.01-0.3 M) and 5 incubation times (1-30 min) on soluble rhMMP-9 were screened with an MMP assay kit. The same EDC concentrations were used to evaluate their inhibitory effects on endogenous proteinases from completely demineralized dentin beams that were incubated in simulated body fluid for 30 days. Decreases in modulus of elasticity (E) and dry mass of the beams, and increases in hydroxyproline content of hydrolysates derived from the incubation medium were used as indirect measures of matrix collagen hydrolysis. All EDC concentrations and pre-treatment times inactivated MMP-9 by 98% to 100% (p < 0.05) compared with non-cross-linked controls. Dentin beams incubated in 0.3 M EDC showed only a 9% decrease in E (45% decrease in control), a 3.6% to 5% loss of dry mass (18% loss in control), and significantly less solubilized hydroxyproline when compared with the control without EDC cross-linking (p < 0.05). It is concluded that EDC application for 1 min may be a clinically relevant and effective means for inactivating soluble rhMMP-9 and matrix-bound dentin proteinases if further studies demonstrate that EDC is not toxic to pulpal tissues.

The inhibitory effects of quaternary ammonium methacrylates on soluble and matrix-bound MMPs

Matrix metalloproteinases (MMPs) bound to dentin contribute to the progressive degradation of collagen fibrils in hybrid layers created by dentin adhesives. This study evaluated the MMP-inhibiting potential of quaternary ammonium methacrylates (QAMs), with soluble rhMMP-9 and a matrix-bound endogenous MMP model. Six different QAMs were initially screened by a rhMMP-9 colorimetric assay. For the matrix-bound endogenous MMPs, we aged demineralized dentin beams for 30 days in calcium- and zinc-containing media (CM; control), chlorhexidine, or QAMs in CM to determine the changes in dry mass loss and solubilization of collagen peptides against baseline levels. The inhibitory effects of QAMs on soluble rhMMP-9 varied between 34 and 100%. Beams incubated in CM showed a 29% decrease in dry mass (p < 0.05), whereas beams incubated with QAMs showed only 0.2%-6% loss of dry mass. Significantly more solubilized collagen was detected from beams incubated in CM (p < 0.05). It is concluded that QAMs exhibited dentin MMP inhibition comparable with that of chlorhexidine, but required higher concentrations.

Influence of luting material filler content on post cementation

Luting of fiber posts to intra-radicular dentin represents the worst-case scenario in terms of control of polymerization shrinkage. This study tested the hypothesis that filler content of resin cements does not influence luting of fiber posts to intra-radicular dentin, by assaying polymerization stress, push-out bond strength, and nanoleakage expression. The polymerization stress of experimental cements containing 10%, 30%, 50%, or 70% in filler content was investigated. Post spaces were prepared in endodontically treated teeth, and fiber posts were cemented with the experimental cements. A push-out test was performed, and interfacial nanoleakage expression was analyzed. Results showed that luting cements with higher filler content were related to increased polymerization stress (p < 0.05), decreased push-out bond strength (p < 0.05), and increased interfacial nanoleakage expression (p < 0.05). Conversely, lower-stress luting materials increased bonding of fiber posts to intra-radicular dentin. Further in vivo studies are needed to investigate the long-term clinical performance of these materials.