Effect of Dentin Pretreatment on Bond Strength Stability of Self-etching and Etch-and-Rinse Adhesives to Intracoronally Bleached Dentin

PURPOSE

To evaluate the effect of chlorhexidine or glutaraldehyde pretreatment on the bonding stability of selfetching and etch-and-rinse adhesives to bleached dentin.

MATERIALS AND METHODS

The occlusal surface of 80 third molars was abraded to expose a flat mid-dentin surface, which was then subjected to a bleaching procedure using 20% hydrogen peroxide and sodium perborate for 14 days. Afterwards, the specimens were kept in distilled water, followed by application of either a three-step etchand- rinse (Adper Scotchbond Multi-Purpose Plus, SBMP) or a two-step self-etching (Clearfil SE Bond, CSE) adhesive system. For each approach, the bleached dentin was treated with chlorhexidine or glutaraldehyde, or left untreated, prior to the adhesive procedure. Unbleached dentin was used as a control. Composite cylinders were built up over the adhesive-covered dentin followed by parallel sectioning of specimens to obtain 1-mm slices. The slices were trimmed to obtain hourglass-shaped specimens with approximately 1.0 mm2 of bonding interface. Half of the specimens were subjected to microtensile bond strength (μTBS) testing after 24 h, while the other half were stored in distilled water for 3 months prior to the μTBS test. The mode of failure was analyzed using optical microscopy.

RESULTS

For the SBMP protocol, the highest μTBS was achieved with glutaraldehyde-treated dentin, and the same μTBS values were maintained after 3 months of storage. For the CSE protocol, the highest μTBS was obtained with chlorhexidine-treated dentin.

CONCLUSION

Glutaraldehyde and chlorhexidine pretreatment should be considered to improve the μTBS of adhesives to bleached dentin, while the pretreatment effect was adhesive dependent.

Ceramic Repair Without Hydrofluoric Acid

PURPOSE

To evaluate the bond strength between composite resin and feldspathic ceramic following repair protocols with and without hydrofluoric acid and aging by thermocycling.

MATERIALS AND METHODS

Forty-eight glass feldspathic ceramic blocks (8 x 8 x 6 mm) were divided into three groups on the basis of their surface repair treatment: 1. 10% hydrofluoric acid + Signum Ceramic Primer I + Signum Ceramic Primer II (control group); 2. abrasive rubber tips + Signum Ceramic Primer I + Signum Ceramic Primer II (test group); 3. Signum Ceramic Primer I + Signum Ceramic Primer II (negative control group). The treated surface of each block was built up with composite and then sectioned to produce nontrimmed bars (adhesive area = 1 mm²). Half of the bars from each group were aged by 6000 cycles of 30-s immersions in water baths at 5°C and 55°C, with a transfer time of 2 s. The other bars were immediately subjected to microtensile bond strength testing. The mean bond strength for each block was then recorded and submitted to two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

The aging protocol influenced the bond strength values of all groups (p = 0.000). The non-aged groups submitted to surface treatment protocols 1 (13.1 ± 2.5 MPa) and 2 (11.5 ± 5.1 MPa) presented the highest bond strength values.

CONCLUSIONS

The interface bond strength of all groups was susceptible to aging. Surface treatment protocol 2, with abrasive rubber tips and no hydrofluoric acid, appeared to be the most promising option, as the resulting bond strength values were similar to those of the control group.

Posterior Vertical Bite Reconstructions of Erosively Worn Dentitions and the "Stamp Technique" - A Case Series with a Mean Observation Time of 40 Months

PURPOSE

In the present case series, the authors report on seven cases of erosively worn dentitions (98 posterior teeth) which were treated with direct resin composite.

MATERIALS AND METHODS

In all cases, both arches were restored by using the so-called stamp technique. All patients were treated with standardized materials and protocols. Prior to treatment, a waxup was made on die-cast models to build up the loss of occlusion as well as ensure the optimal future anatomy and function of the eroded teeth to be restored. During treatment, teeth were restored by using templates of silicone (ie, two "stamps," one on the vestibular, one on the oral aspect of each tooth), which were filled with resin composite in order to transfer the planned, future restoration (ie, in the shape of the waxup) from the extra- to the intraoral situation. Baseline examinations were performed in all patients after treatment, and photographs as well as radiographs were taken. To evaluate the outcome, the modified United States Public Health Service criteria (USPHS) were used.

RESULTS

The patients were re-assessed after a mean observation time of 40 months (40.8 ± 7.2 months). The overall outcome of the restorations was good, and almost exclusively "Alpha" scores were given. Only the marginal integrity and the anatomical form received a "Charlie" score (10.2%) in two cases.

CONCLUSION

Direct resin composite restorations made with the stamp technique are a valuable treatment option for restoring erosively worn dentitions.

Effect of adjunctive application of epigallocatechin-3-gallate and ethanol-wet bonding on adhesive-dentin bonds

OBJECTIVES

To determine the effect of the combined use of epigallocatechin-3-gallate (EGCG) and ethanol-wet bonding (EWB) on resin-dentin bonds.

METHODS

Sixty molars were sectioned, polished, and randomly divided into six groups (n=10) according to the following pretreatments: group 1, water-wet bonding (WWB); group 2, WWB with 0.02% (w/v) EGCG; group 3, WWB with 0.1% EGCG; group 4, EWB; group 5, EWB with 0.02% EGCG; and group 6, EWB with 0.1% EGCG. An etch-and-rinse adhesive was then used, followed by the resin composites building. The microtensile bond strength (MTBS), failure modes and interfacial nanoleakage were separately determined after 24h water storage or 10,000 runs of thermocycling.

RESULTS

Both pretreatment method (P<0.05) and thermocycling (P<0.05) significantly influenced bond strength and nanoleakage. Irrespective of thermocycling, the 0.02% EGCG/ethanol (group 5) pretreated adhesive-dentin interfaces showed higher MTBS than the control group (P<0.05). Nanoleakage expression of all groups increased after thermocycling (P<0.05) except group 5. Adhesive failure was the main fracture pattern in all groups.

CONCLUSION

This study showed that pretreatment with 0.02% EGCG/ethanol solutions can effectively improve immediate bond strength and bond stability of etch-and-rinse adhesives on dentin.

CLINICAL SIGNIFICANCE

The adjunctive application of EGCG and EWB provides a new strategy for dentists to obtain the desired bond effectiveness during adhesive restoration in clinical practice.

Effectiveness of Disposable (Single-use) Tips for Dental Air-water Syringes

BACKGROUND

Single-use dental syringe (SUS) tips eliminate cross-infection risks. Many dental materials are moisture sensitive; therefore bonding could be affected by remaining moisture from SUS tips.

METHODS

An air-water syringe was calibrated to 50 PSI and the air pressure measured. SUS tips were then attached and pressure re-measured. Seven tips were tested; moisture content and spray pattern were investigated. Ethical approval was granted. Twenty third molar teeth were sectioned, stored in phosphate buffered saline and randomly allocated into groups with a SUS tip. They were mounted in acrylic and polished. Specimens were dried with a tip under standardised conditions, treated using a 3-step etch-prime-bond technique, then had a post bonded perpendicular to the dentine surface. The force to detach them was measured. Data were analysed using one-way analysis of variance (ANOVA) and Chi-squared tests.

RESULTS

The difference in output pressure between groups proved significant (p < 0.001). Tensile force at failure was significantly different between groups (p = 0.19).

CONCLUSIONS

The pressure output of the syringe and bond strength are influenced by the SUS tip.

Is chlorhexidine-methacrylate as effective as chlorhexidine digluconate in preserving resin dentin interfaces?

OBJECTIVES

The aim of the current study was to evaluate the effect of 2% CHX and 2% CHX-methacrylate compared to the resin-dentin bonds created by a two-step etch-and-rinse adhesive system after 24h, 6min and 12min.

METHODS

Microtensile bond strengths and interfacial nanoleakage within resin-dentin interfaces created by Adper Single Bond 2, with or without CHX or CHX-methacrylate pre-treatment for 30s on acid-etched dentin surfaces, were evaluated after 24h, 6min and 12min of storage in distilled water at 37°C.

RESULTS

Twelve months of storage resulted in a significant decrease in microtensile bond strength in the control group, and significant increases in silver nanoleakage. In contrast, Single Bond 2+CHX, and to a greater extent CHX-methacrylate, significantly reduced the rate of deterioration of resin-dentin interfaces over the 12min water storage period, in terms of bond strength.

CONCLUSIONS

Similar to Single Bond 2+CHX, Single Bond+CHX-methacrylates reduced the degradation of resin-bonded interfaces over a 12 month storage period. Thus it can be concluded that Single Bond 2+CHX-methacrylate may be important to improve durability of bonded interfaces and therefore, prolong the life span of adhesive restorations.

CLINICAL SIGNIFICANCE

Although CHX primers have been shown to enhance the durability of etch-and-rinse adhesives, that protection is lost after 2h. The use of CHX-methacrylate should last much longer since it may copolymerize with adhesive monomers, unlike CHX.

[Analysis of type-I collagen fibrils and chondroitin sulfate distribution in human dentin by confocal laser scanning microscopy combined with dual immunofluorescent labeling technique]

OBJECTIVE

To introduce the method of dual immunofluorescence labeling of human dentin matrix without demineralization of the whole dentin fragments, and to analyze the distribution of type-I collagen fibrils and chondroitin sulfate in human dentin.

METHODS

Forty 30 µm- thick middle coronal dentin sections were obtained from 8 freshly extracted human third molars and etched with 37% phosphoric acid(PA) gel for 15 s. After preconditioning with or without tosyl- phenylalanyl chloromethyl ketone(TPCK) treated trypsin digestion, sections were subjected to dual immunofluorescent labeling and scanned by confocal laser scanning microscopy to identify the type-I collagen fibrils and chondroitin sulfate.

RESULTS

Chondroitin sulfate was localized in the lumens of the dentin tubules and peritubular dentin, while the type-I collagen fibrils were localized in intertubular dentin and peritubular dentin. After preconditioning with TPCK treated trypsin digestion, the red fluorescence was decreased or disappeared.

CONCLUSIONS

The dual immunofluorescence labeling methodology can be used to study the human dentin matrix without demineralization of the whole dentin fragments. Chondroitin sulfate was localized in the lumens of the dentin tubules and peritubular dentin, while the type-I collagen fibrils were localized in intertubular dentin and peritubular dentin.

Bond Strength of a Flowable Bulk-fill Resin Composite in Class II MOD Cavities

PURPOSE

To evaluate the microtensile bond strength (μTBS) of a bulk-fill low-stress resin-based composite to dentin from gingival walls of Class II MOD cavities.

MATERIALS AND METHODS

Class II MOD cavities were prepared in 44 human molars with the distal and mesial proximal boxes 4 and 6 mm deep, respectively. Eight experimental groups (n = 11) were obtained by a factorial design including 1. "composite" in two levels: a bulk-fill low-stress composite (SureFil SDR Flow, Dentsply Caulk) and a conventional composite (Filtek Z350 XT, 3M ESPE); 2. "filling technique" in two levels: bulk-fill (Bf) and incremental (In); and 3. "depth" in two levels: 4 mm and 6 mm in order to create different polymerization conditions. Twenty-four hours after placement of restorations, teeth were sectioned into beams with a cross-sectional bonded area of approximately 1 mm2. Bonded beams obtained from the gingival walls of the proximal boxes were tested in tension at a crosshead speed of 1 mm/min. Data were submitted to a 3-way ANOVA followed by a post-hoc Tukey's test (p < 0.05).

RESULTS

ANOVA failed to identify significant differences for the triple and double interaction between factors. However, significant differences were observed for the factors "composite" and "filling technique" (p < 0.05). SDR presented significantly higher μTBS values for bulk and incremental filling techniques (p < 0.05), and the incremental filling technique presented significantly higher μTBS values for both composites (p < 0.05).

CONCLUSION

It can be concluded that the bulk-fill flowable composite SDR may improve the bond strength to the gingival walls of Class II MOD cavities.

Practice of Sealants and Preventive Resin Restorations Among Malaysian Dentists

PURPOSE

To assess the knowledge, attitude and utilisation regarding fissure sealants (FS) and preventive resin restorations (PRR) among Malaysian dentists.

MATERIALS AND METHODS

A questionnaire consisting of 35 questions was distributed by mail or an online survey to 425 registered dentists selected according to place of work by stratified random sampling.

RESULTS

One hundred fifty-three dentists responded to the survey. A positive attitude towards FS and PRR was noted among most Malaysian dentists. About half of the respondents used FS/PRR occasionally (48.4%), while few (13.7%) applied them routinely. The majority of the dentists agreed that minimally invasive dentistry is important and FS are effective in caries prevention, using them on high caries-risk individuals. Most of the dentists used pumice or paste to clean teeth before placing FS/PRR. A significant number of dentists used a bonding agent prior to placing FS. Although only 57.5% dentists were aware of guidelines for FS use, most dentists agreed that guidelines are important.

CONCLUSION

Although there was a positive attitude towards FS/PRR, few dentists applied them routinely. Some of the steps undertaken for placement of FS and PRR were outdated. Updating local guidelines for dentists to ensure uniform practice of FS and PRR is justified.

Bond strength and micro-computed tomographic evaluation of pre-coated brackets

OBJECTIVES

The aim of the present study was to assess and compare the shear bond strength (SBS) of metal pre-coated orthodontic brackets bonded to fluorotic and non-fluorotic teeth treated with three different etching techniques. A second aim was to determine the volume of adhesive remaining on the tooth at debond using micro-computed tomography (μCT).

METHODS

Ninety extracted premolars were selected to include 45 fluorotic (test group) and 45 non-fluorotic (control group) teeth. Each group was divided into three subgroups of 15 each, which were treated as follows: 1) micro-etched; 2) acid-etched; and 3) both micro-etched and acid-etched. A bonding agent was applied to the prepared surfaces; pre-coated and light-cured brackets were attached to all teeth. An Instron universal testing machine was used to record the debonding force. Specimens were then scanned using a microCT to evaluate the amount of adhesive remaining on the teeth. The significance of the statistical tests was pre-determined at p < 0.05.

RESULTS

Two-way ANOVA showed that fluorosis of teeth had no influence on the SBS (p = 0.165) whereas the volume of adhesive remnants was significantly higher in the control group compared with the test group (p < 0.001).

CONCLUSIONS

Fluorosis had no influence on the SBS of brackets, whereas it had a negative influence on retaining adhesives onto the tooth surfaces.

Shear bond strength of different fixed orthodontic retainers

OBJECTIVE

To compare the shear bond strength of different fixed retainer wire diameters bonded using a conventional composite resin or a specific retainer composite.

MATERIALS AND METHODS

One-hundred-and-twenty extracted human premolar teeth were divided into six groups. After conventional acid etching with a 37% phosphoric acid gel for 30 seconds, twist flex wires of various diameters (0.0175", 0.0215", 0.032") were bonded as fixed retainers. Conventional bracket adhesive (Filtek Z250) or retainer specific adhesives (Transbond LR) were used. After curing, the specimens were stored for 24 hours in distilled water at 37 degrees C and, thereafter, subjected to 500 thermal cycles. The specimens were then debonded using a Universal Instron machine. The site of failure was recorded for each specimen and the shear bond strength calculated. Statistical analyses were provided using a Chi-square test for failure site and a two-way ANOVA test to assess shear bond strength.

RESULTS

The site of failure was predominantly at the wire composite interface in all groups. The specific retainer composite showed a significantly higher shear bond strength compared with conventional composite (p < 0.001). There was a statistically significant difference between the three wire diameters (p < 0.001); the 0.0215" wire had the highest shear bond strength, whereas the 0.032" wire had the least shear bond strength.

CONCLUSIONS

The site of failure was unrelated to wire diameter or adhesive. The optimal combination to maximise the bond strength of fixed retainers appeared to be a specific retainer adhesive and a wire diameter of 0.0215".

Comparison of shear bond strength of self-etch and self-adhesive cements bonded to lithium disilicate, enamel and dentin

Comparison of shear bond strength of self-etch and self-adhesive cements bonded to lithium disilicate, enamel and dentin.

AIMS

With several self-adhesive resin cements currently available, there is confusion about which product and technique is optimal for bonding ceramic restorations to teeth. The objective of this study was to compare the shear bond strength of lithium disilicate cemented to enamel and dentin using 5 adhesive cements.

MATERIALS AND METHODS

100 lithium disilicate rods were pretreated with 5% hydrofluoric acid, silane, and cemented to 50 enamel and 50 dentin surfaces using five test cements: Variolink II (etch-and-rinse) control group, Clearfil Esthetic (two step self-etch), RelyX Unicem, SpeedCEM, and BifixSE (self-adhesive). All specimens were stored (37 degrees C, 100% humidity) for 24 hours before testing their shear bond strength using a universal testing machine (Instron). Debonded surfaces were observed under a low-power microscope to assess the location and type of failure.

RESULTS

The highest bond strength for both enamel and dentin were recorded for Variolink II, 15.1MPa and 20.4MPa respectively, and the lowest were recorded for BifixSE, 0.6MPa and 0.9MPa respectively. Generally, higher bond strengths were found for dentin (7.4MPa) than enamel (5.3MPa). Tukey's post hoc test showed no significant difference between Clearfil Esthetic and SpeedCem (p = 0.059), Unicem and SpeedCem (p = 0.88), and Unicem and BifixSE (p = 0.092). All cements bonded better to lithium disilicate than to enamel or dentin, as all bond failures occurred at the tooth/adhesive interface except for Variolink II.

CONCLUSIONS

Bond strengths recorded for self-adhesive cements were very low compared to the control "etch and rinse" and self-etch systems. Further improvements are apparently needed in self-adhesive cements for them to replace multistep adhesive systems.

CLINICAL IMPLICATIONS

The use of conventional etch and rinse cements such as Veriolink II should be preferred for cementing all ceramic restorations over self-adhesive cements until the bond strengths are improved.

Evaluation of dentin tubule occlusion after laser irradiation and desensitizing agent application

PURPOSE

To evaluate the effects of lasers (Nd:YAG and Er:YAG) and of topical desensitizing agents on dentin tubule occlusion by measuring real-time dentin fluid flow (DFF).

METHODS

32 molars were prepared with V-shape cavity at the cervical area, acid-etched, water rinsed, blotted dry, and treated with (1) Nd:YAG laser; (2) Er:YAG laser; (3) SuperSeal, a desensitizing agent; (4) ClinproXT, a resin-modified glass-ionomer (RMGI) varnish (n = 8 each). A real-time fluid flow measuring instrument (nano-Flow) was used to measure the DFF throughout the procedures. The DFF rates before and after the treatment were compared. Moreover, the surface topography of dentin tubules after each desensitizing method was examined using SEM.

RESULTS

DFF varied among the groups. The DFF rate was significantly reduced after laser irradiation/application of the desensitizing agents (P < 0.05). ClinproXT showed the greatest reduction of DFF rate (71.9%), followed by the SuperSeal (34.8%) and laser groups (P< 0.05). However, there was no significant difference between the Nd:YAG (24.1%) and Er:YAG (20.6%) groups (P > 0.05). In SEM images, narrowed dentin tubules were observed in both lased groups and SuperSeal group. In the ClinproXT group, the occluded dentin tubules by the RMGI covering were observed.

Diffusion of HEMA from resin cements through different dentin thicknesses in vitro

PURPOSE

To evaluate the in vitro diffusion of 2-hydroxyethyl methacrylate (HEMA) from the resin cements through different thicknesses of dentin using high-performance liquid chromatography (HPLC) at two time intervals.

METHODS

60 freshly extracted caries- and restoration-free human third molar teeth were used in this study. Standardized box-shaped Class I inlay cavities (6 mm long, 3 mm wide and 2 mm deep) were prepared in all teeth with a high-speed handpiece mounted on a standard cavity machine. The remaining dentin thickness (RDT) between the pulpal wall of the cavity and the roof of the pulp chamber was measured at multiple points for each tooth so that two main groups of 30 teeth each were prepared with an RDT range 0.5-1.9 and 2.0-3.5 mm, respectively. Each of these main groups was divided into three subgroups (n = 10), according to the resin cements tested (RelyX ARC, Panavia F 2.0, Multilink Automix). Lithium disilicate-based ceramic inlays (IPS Empress 2) were manufactured to restore the prepared cavities. A polypropylene chamber containing 1 ml distilled water was attached to the cemento-enamel junction of each tooth. Then, ceramic inlays were cemented with resin cements according to the manufacturers' instructions. Water elutes were analyzed by HPLC at 4.32 minutes and 24 hours. HEMA diffusion amounts were analyzed using three-way ANOVA and Tukey's HSD tests (P < 0.05).

RESULTS

HEMA was detected in the pulp chamber elutes of all the teeth. The amounts of released HEMA did not significantly differ between time periods. The diffused HEMA amounts were significantly different between the RDT of 0.5-1.9 and 2.0-3.5 mm (P < 0.05) and between resin cements tested (P < 0.05). Decreasing RDT substantially increased the amount of HEMA that diffused through the dentin to the pulp space.

Effect of Adhesive Resin Type for Bonding to Zirconia Using Two Surface Pretreatments

PURPOSE

This laboratory study evaluated the short-term adhesive properties of one 10-MDP-containing and two MDP-free resin composite cements, using two types of zirconia surface pretreatments.

MATERIALS AND METHODS

Eighteen sintered zirconia disks (Procera, Nobel Biocare) were randomly divided into three study groups according to their surface treatment: (a) polished surface (control group); (b) airborne-particle abraded (grit blasted) with 50-μm aluminum trioxide (APA); and (c) selective infiltration etching (SIE). The zirconia disks were then bonded to 180 pre-aged composite resin disks (0.9 mm×0.7 mm) using three different resin composite cements (Panavia F2.0, Esthetic, and Aegis). Resin-zirconia adhesion strength was evaluated using the microshear bond strength test (μSBS) after 24 h (baseline) and 2 weeks of storage in deionized water at 37°C. Three-way ANOVA, one-way ANOVA, and Scheffé's post-hoc tests were used to analyze the data (p=0.05).

RESULTS

Surface treatments significantly influenced the μSBS (p<0.001). The highest mean μSBS values were recorded with the MDP-containing resin composite cement (Panavia F2.0) in both SIE (32.4±5.3 MPa) and APA (28.6±8.8 MPa) groups. Water storage significantly reduced the bond strength obtained with the MDP-free cements (Esthetic and Aegis) and in the control group, while the bond strength in SIE and APA groups using the 10- MDP-containing resin composite cement exhibited relatively unchanged values.

CONCLUSION

SIE and APA in combination with the 10-MDP-containing resin composite cement established a strong, durable bond to zirconia substrates under short-term aging conditions. The cement containing amorphous calcium phosphate (Aegis) did not bond to zirconia surfaces. During the observation period, μSBS decreased significantly due to hydrolytic degradation, except when the 10-MDP-containing resin composite cement (Panavia F2.0) was used in the SIE and APA groups.

Responses of dental pulp cells to a less invasive bleaching technique applied to adhesive-restored teeth

PURPOSE

To assess the cytotoxicity of 35% hydrogen peroxide (HP) bleaching gel applied for 15 min to sound or restored teeth with two-step self-etching adhesive systems and composite resin.

MATERIALS AND METHODS

Sound and restored enamel/dentin disks were stored in water for 24 h or 6 months + thermocycling. The disks were adapted to artificial pulp chambers and placed in compartments containing culture medium. Immediately after bleaching, the culture medium in contact with dentin was applied for 1 h to previously cultured odontoblast-like MDPC-23 cells. Thereafter, cell viability (MTT assay) and morphology (SEM) were assessed. Data were analyzed by two-way ANOVA and Tukey's test (a = 5%).

RESULTS

In comparison to the negative control group (no treatment), no significant cell viability reduction occurred in those groups in which sound teeth were bleached. However, a significant decrease in cell viability was observed in the adhesive-restored bleached groups compared to negative control. No significant difference among bleached groups was observed with respect to the presence of restoration and storage time.

CONCLUSION

The application of 35% HP bleaching gel to sound teeth for 15 min does not cause toxic effects in pulp cells. When this bleaching protocol was performed in adhesive-restored teeth, a significant toxic effect occurred.

Bonding Performance of a Multimode Adhesive to Artificially-induced Caries-affected Primary Dentin

PURPOSE

To investigate the bonding of a new universal adhesive applied using different etching strategies on sound and caries-affected dentin of primary teeth.

MATERIALS AND METHODS

Flat dentin surfaces from 50 primary molars were randomly assigned to 10 groups according to substrate (sound dentin [SD] vs caries-affected dentin [CAD] pH cycled for 14 days) and bonding approach (Scotchbond Universal Adhesive: self-etching, vs dry or wet-bonding etch-and-rinse strategies; Adper Single Bond Plus [two-step etch-and-rinse adhesive] and Clearfil SE Bond [two-step self-etching system] as controls). After 24 h of water storage, bonded sticks with cross-sectional areas of 0.8 mm2 were tested for microtensile bond strength (μTBS). Two sticks from each tooth were immersed in silver nitrate solution in order to evaluate nanoleakage (NL) with SEM. The μTBS means were analyzed using two-way ANOVA and Tukey's tests. For NL, the Kruskal-Wallis and Mann-Whitney tests were used (α = 0.05).

RESULTS

The influence of the etching strategy on the bonding performance of the universal adhesive was substrate dependent. The self-etching approach resulted in lower μTBS values and higher silver nitrate uptake into hybrid layers for Scotchbond Universal Adhesive on SD, while no difference among experimental groups was observed in CAD.

CONCLUSION

It is preferable to use the universal adhesive following either a dry- or wet-bonding etch-and-rinse approach on both sound and caries-affected primary dentin.

Effect of experimental silane-based primers with various contents of 2-hydroxyethyl methacrylate on the bond strength of orthodontic adhesives

AIM

To evaluate in vitro the effect of different concentrations of 2-hydroxyethyl methacrylate (HEMA) in experimental silane-based primers on shear bond strength of orthodontic adhesives.

METHODS

Different volume percentages of HEMA were tested in four experimental silane-based primer solutions (additions of HEMA: 0, 5.0 vol%, 25.0 vol% and 50.0 vol%). An experimental silane blend (primer) of 1.0 vol% 3-isocyanatopropyltrimethoxysilane (ICMS) + 0.5% bis-1,2-(triethoxysilyl) ethane (BTSE) was prepared and used. The experimental primers together with the control group were applied onto acid-etched premolars for attachment of orthodontic brackets. After artificial aging by thermocycling the shear-bond strength was measured. The fractured surfaces of all specimens were examined under scanning electron microscopy (SEM) to evaluate the failure mode on the enamel surface.

RESULTS

The experimental primers showed the highest shear-bond strength of 21.15 MPa (SD ± 2.70 MPa) and with 25 vol% showed a highly significant increase (P < 0.05) in bond strength. The SEM images showed full penetration of adhesive agents when using silane-based primers. In addition, the SEM images suggested that the predominant failure type was not necessarily the same as for the failure propagation.

CONCLUSIONS

This preliminary study suggested that nonacidic silane-based primers with HEMA addition might be an alternative to for use as adhesion promoting primers.

Long-term Bond Strength between Layering Indirect Composite Material and Zirconia Coated with Silicabased Ceramics

PURPOSE

This study evaluated the long-term shear bond strength between an indirect composite material and a zirconia framework coated with silica-based ceramics, taking the effect of different primers into account.

MATERIALS AND METHODS

A total of 165 airborne-particle abraded zirconia disks were subjected to one of three pretreatments: no pretreatment (ZR-AB), airborne-particle abrasion of zirconia coated with feldspathic porcelain (ZR-PO-AB), and 9.5% hydrofluoric acid etching of zirconia coated with feldspathic porcelain (ZR-PO-HF). An indirect composite material (Estenia C&B) was then bonded to the zirconia disks after they were treated with one of the following primers: Clearfil Photo Bond (CPB), Clearfil Photo Bond with Clearfil Porcelain Bond Activator (CPB + Activator), Estenia Opaque Primer (EOP), Porcelain Liner M Liquid B (PLB), or no priming (CON, control group). Shear bond strength was tested after 100,000 thermocycles, and the data were analyzed using the Steel-Dwass U-test (α = 0.05).

RESULTS

For ZR-PO-AB and ZR-PO-HF specimens, bond strength was highest in the CPB+Activator group (25.8 MPa and 22.4 MPa, respectively). Bond strengths were significantly lower for ZR-AB specimens in the CON and PLB groups and for ZR-PO-AB specimens in the CON, CPB, and EOP groups.

CONCLUSION

Combined application of a hydrophobic phosphate monomer (MDP) and silane coupling agent enhanced the long-term bond strength of indirect composite material to a zirconia coated with silica-based ceramics.

Effect of Chlorhexidine and Ethanol Application on Long-term Push-out Bond Strength of Fiber Posts to Dentin

AIM

The aim of this study was to evaluate the effect of chlorhexidine and ethanol application on the push-out bond strength and bond durability of fiber posts cemented with an etch-and-rinse adhesive system/resin cement to intraradicular dentin.

MATERIALS AND METHODS

Fifty-four bovine roots were shaped for the cementation of a fiberglass post and received the application of 37% phosphoric acid. They were then randomly divided into three groups, according to the type of dentin treatment (n = 18) performed: no treatment (control group), 100% ethanol, or 2% chlorhexidine. Next, the adhesive system (Adper Scotch Bond Multipurpose Plus, 3M ESPE) was applied to the dentin, according to the manufacturer's instructions. Glass fiber posts were cemented with dual resin cement (Rely X ARC, 3M ESPE). After 48 hours, the specimens were serially sectioned for push-out test analysis, providing two slices from each root third (cervical, medium and apical), one of which was tested immediately and the other stored in distilled water for 180 days. The data were analyzed with three-way analysis of variance (ANOVA) for repeated measures and Tukey's test at a 5% significance level.

RESULTS

Intraradicular treatment with chlorhexidine yielded the highest bond strength means, followed by ethanol treatment. The control group presented the lowest bond strength means. Water storage exerted no effect on bond strength values.

CONCLUSION

Both chlorhexidine and ethanol improved push-out bond strength to intraradicular dentin, with the former providing the best results, regardless of the storage time.

CLINICAL SIGNIFICANCE

The application of 2% chlorhexidine or 100% ethanol may be an important step that can be taken to enhance bond strength of fiber posts to intraradicular dentin, when dual resin cements are used.

Retention of Moisture-tolerant and Conventional Resin-based Sealant in Six- to Nine-year-old Children

PURPOSE

The purpose of this study was to evaluate and compare the retention rates and development of caries in permanent molars in children sealed with moisture-tolerant, resin-based (Embrace WetBond), and conventional resin-based (Helioseal) sealant over a period of one year.

METHODS

This was a double blind, split-mouth, randomized controlled trial among six- to nine-year-olds. Sixty-eight permanent mandibular first molars in 34 children were randomly assigned to be sealed with Embrace WetBond or Helioseal sealant.

RESULTS

The final sample was 32 children with 64 teeth. At 12 months, 23 of 32 (72 percent) sealants were completely retained in Embrace WetBond, whereas only 16 of 32 (50 percent) were retained in the Helioseal group. There was a statistically significant difference in retention rates of Embrace WetBond and Helioseal sealants at 12 months (P<.05). At 12 months follow-up, only two teeth developed caries in Embrace WetBond; in the Helioseal group, five teeth developed caries (two initial and three enamel caries).

CONCLUSIONS

Embrace WetBond was superior to Helioseal sealant, as Embrace exhibited higher retention and lower caries scores. Embrace WetBond can be preferred over conventional resin-based sealants for community and outreach sealant programs where use of rubber dam for moisture control is difficult to practice.

Evaluation of an alternative technique to optimize direct bonding of orthodontic brackets to temporary crowns

OBJECTIVE

To compare shear bond strength of different direct bonding techniques of orthodontic brackets to acrylic resin surfaces.

METHODS

The sample comprised 64 discs of chemically activated acrylic resin (CAAR) randomly divided into four groups: discs in group 1 were bonded by means of light-cured composite resin (conventional adhesive); discs in group 2 had surfaces roughened with a diamond bur followed by conventional direct bonding by means of light-cured composite resin; discs in group 3 were bonded by means of CAAR (alternative adhesive); and discs in group 4 had surfaces roughened with a diamond bur followed by direct bonding by means of CAAR. Shear bond strength values were determined after 24 hours by means of a universal testing machine at a speed of 0.5 mm/min, and compared by analysis of variance followed by post-hoc Tukey test. Adhesive remnant index (ARI) was measured and compared among groups by means of Kruskal-Wallis and Dunn tests.

RESULTS

Groups 3 and 4 had significantly greater shear bond strength values in comparison to groups 1 and 2. Groups 3 and 4 yielded similar results. Group 2 showed better results when compared to group 1. In ARI analyses, groups 1 and 2 predominantly exhibited a score equal to 0, whereas groups 3 and 4 predominantly exhibited a score equal to 3.

CONCLUSIONS

Direct bonding of brackets to acrylic resin surfaces using CAAR yielded better results than light-cured composite resin. Surface preparation with diamond bur only increased shear bond strength in group 2.

Enamel Bond Strength of New Universal Adhesive Bonding Agents

PURPOSE

Universal bonding agents have been introduced for use as self-etch or etch-and-rinse adhesives depending on the dental substrate and clinician's preference. The purpose of this study was to evaluate the shear bond strength (SBS) of composite to enamel using universal adhesives compared to a self-etch adhesive when applied in self-etch and etch-and-rinse modes over time.

METHODS AND MATERIALS

Extracted human third molars were used to create 120 enamel specimens. The specimens were ground flat and randomly divided into three groups: two universal adhesives and one self-etch adhesive. Each group was then subdivided, with half the specimens bonded in self-etch mode and half in etch-and-rinse mode. The adhesives were applied as per manufacturers' instructions, and composite was bonded using a standardized mold and cured incrementally. The groups were further divided into two subgroups with 10 specimens each. One subgroup was stored for 24 hours and the second for six months in 37°C distilled water and tested in shear. Failure mode was also determined for each specimen.

RESULTS

A three-way analysis of variance (ANOVA) found a significant difference between groups based on bonding agent (p<0.001) and surface treatment (p<0.001) but not on time (p=0.943), with no significant interaction (p>0.05). Clearfil SE in etch-and-rinse and self-etch modes had more mixed fractures than either universal adhesive in either mode.

CONCLUSIONS

Etching enamel significantly increased the SBS of composite to enamel. Clearfil SE had significantly greater bond strength to enamel than either universal adhesive, which were not significantly different from each other.

Effects of sandblasting before orthophosphoric acid etching on lingual enamel: in-vitro roughness assessment

INTRODUCTION

In this study, we evaluated changes in lingual enamel roughness due to sandblasting with 27-, 50-, and 90-μm aluminum oxide particles followed by 37% orthophosphoric acid etching.

METHODS

Twenty-four maxillary premolars were included in the study. The lingual enamel roughness of 20 teeth was evaluated using a laser confocal microscope before and after enamel conditioning. Group 1 (control) was etched with 37% orthophosphoric acid; groups 2, 3, and 4 were sandblasted with 27-, 50-, and 90-μm aluminum oxide particles, respectively, before acid etching. The lingual surfaces of the other 4 teeth were evaluated using scanning electron microscopy after they had received one of the conditioning methods under study. Paired t tests were used to compare the roughness parameters obtained before and after conditioning in each group, and 1-way analysis of variance was used to compare the surface roughness between groups. The significance level was set at 5% for all statistical analyses.

RESULTS

The 4 conditioning methods significantly increased the roughness of the lingual enamel. However, the roughness increases in the groups that were sandblasted with 27-, 50-, and 90-μm aluminum oxide particles before orthophosphoric acid etching were statistically greater than was the increase in the group conditioned only with orthophosphoric acid. Scanning electron microscopy showed different conditioning patterns among specimens that were conditioned only with orthophosphoric acid and those sandblasted with aluminum oxide before acid etching.

CONCLUSIONS

Lingual enamel conditioning with aluminum oxide sandblasting before acid etching results in greater roughness and produces a conditioning pattern different from that of acid etching alone.

Fibre-reinforced composite (FRC) bridge--a minimally destructive approach

Replacing missing teeth is an integral part of the clinical services of the dental practitioner. The fibre-reinforced composite (FRC) bridge is a relatively new method for replacing missing teeth. This article will explain and discuss this alternative treatment option. Practical instructions on how to construct a FRC bridge will be given, by means of a clinical case. Different technique options will be illustrated to provide the reader with a good understanding of the most practical way to use the FRC strips. The fibre-reinforced composite provides a non-destructive, aesthetically pleasing and cost-effective way to restore missing teeth. Clinical Relevance: Minimally invasive options should always be considered and destruction of healthy enamel and dentine during the preparation phase of a replacement treatment should be avoided as much as possible.

Nd:YAG Laser to obtain Irregularities on the Inner Surface of Porcelain

AIM

The aim of this study was to evaluate the inner surface of two ceramic systems: IPS Empress II (Ivoclar Vivadent, Germany) and In-Ceram Alumina (Vita Zahnfabrick, Germany) submitted to surface treatments, especially by Nd:YAG laser.

MATERIALS AND METHODS

Fifty samples were prepared in pellet form for each ceramic system according to manufacturers' specifications. The samples were stored at room temperature and then be subjected to surface treatment: without treatment (T0) (control), hydrofluoric acid-etched (T1), hydrofluoric acid-etched associated with the airborne particle-abraded (T2); CoJet system (T3), Nd:YAG laser (T4). The data were performed the statistical analysis by ANOVA and Tukey's test (p < 0.001).

RESULTS

The group control (T0) of the ceramics, the analysis showed the lowest roughness values; for the System Alumina In-Ceram, treatment with hydrofluoric acid (T1), associated with hydrofluoric acid and airborne particle-abraded (T2) and Nd:YAG laser (T4), had no statistically significant difference, whereas for the IPS Empress System II treatment with hydrofluoric acid (T1) and hydrofluoric acid associated with airborne particle-abraded (T2), had no statistically significant difference between the system and also CoJet (T3) and hydrofluoric acid associated with the airborne particle-abraded (T2). Photomicrographs of scanning electron microscopy showed different characteristics to the treatments for each ceramic system.

CONCLUSION

The IPS Empress II had the appearance of favoring the retention when treated with hydrofluoric acid, as well as its association with the airborne particle-abraded. Uncertainty in Alumina, treatment with hydrofluoric acid associated with the airborne particle-abraded and CoJet system and provided a surface with irregularities. With respect to the laser further studies should be performed for parameters that are ideal for your application.

CLINICAL RELEVANCE

The ceramic restorations are attractive due of their excellent esthetics and the ability to stay for long periods. However, the retention of ceramic requires further study.

Preparing and Restoring Composite Resin Restorations. The Advantage of High Magnification Loupes or the Dental Surgical Operating Microscope

Use of magnification, such as 6x to 8x binocular surgical loupes or the surgical operating microscope, combined with co-axial illumination, may facilitate the creation of stable composite resin restorations that are less likely to develop caries, cracks or margin stains over years of service. Microscopes facilitate observation of clinically relevant microscopic visual details, such as microscopic amounts of demineralization or caries at preparation margins; microscopic areas of soft, decayed tooth structure; microscopic amounts of moisture contamination of the preparation during bonding; or microscopic marginal gaps in the composite. Preventing microscope-level errors in composite fabrication can result in a composite restoration that, at initial placement, appears perfect when viewed under 6x to 8x magnification and which also is free of secondary caries, marginal staining or cracks at multi-year follow-up visits.

Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth

OBJECTIVES

The aim of this study was to evaluate the fracture resistance of endodontically-treated teeth restored with nano-hybrid composite resin, bulk-fill flowable and short fibre-reinforced-composite in the absence/presence of retention slots.

MATERIALS AND METHODS

One hundred and ten extracted non-carious human mandibular molars received endodontic treatment followed by mesio-occlusodistal (MOD) cavities with 3 ± 0.2 mm thicknesses of buccal and lingual walls. Teeth were divided into two main groups according to the retention slot preparation. The dove-tail retention slots were prepared on the middle of opposite buccal and lingual walls to create mechanical interlocking. Each group was further divided into four sub-groups according to restorative material types: control (no restoration), nano-hybrid composite resin (Filtek™ Z550), bulk-fill flowable (Filtek™ Bulk Fill) and short fibre-reinforced-composite (everX Posterior™). Restored teeth were subjected to compressive load at a strain rate of 1 mm/min. The data were statistically analysed using two-way ANOVA and Tukey's test for multiple comparisons.

RESULTS

The fracture resistance was significantly affected by the presence of the retentive slots and restorative material (p < 0.05). Restored teeth with retentive slots significantly increased the fracture resistance compared with restored teeth without retentive slots (p < 0.05). Short fibre-reinforced-composite with retentive slot cavities had significantly higher fracture resistance values compared with the other test groups (p < 0.05).

CONCLUSIONS

The preparation of retention slots may increase the fracture resistance of endodontically-treated teeth, especially, when restored with short fibre-reinforced composite. The use of short fibre-reinforced composite with retentive slots could be an alternative technique to prevent cuspal fracture on endodontically-treated teeth with MOD cavity.

Ultraviolet-C irradiation to titanium implants increases peri-implant bone formation without impeding mineralization in a rabbit femur model

OBJECTIVES

Volume and bone quality of peri-implant supporting bone, in particular, at implant neck region, as well as bone-implant contact ratio, is important for long-term stability of implants. Ultraviolet-C (UVC) irradiation is known to enhance the osseointegration capability of titanium implants. However, the histological determination was performed only on a rat model, but not pre-clinical animal model such as a rabbit model. The purpose of this study was to determine the effects of UVC irradiation on titanium implants on the volume and mineral density of peri-implant supporting bone formation in a rabbit femur model.

MATERIALS AND METHODS

Acid-etched pure titanium screw implants with or without 3 mW/cm2 UVC irradiation for 48 h were placed in rabbit femur diaphyses. Peri-implant bone tissue formation was analyzed at 3 and 8 weeks post-operatively by histology and micro-CT-based bone morphometry after calibration with hydroxyl apatite phantoms.

RESULTS

UVC pre-irradiated implants accumulated a higher density of cells and thicker and longer bone tissue attachments that continued into the inner basic lamellae of the surface of existing cortical bone at 3 and 8 weeks than the implants without irradiation. Although the bone mineral density around both implants was equivalent to that of the existing cortical bone, bone volume was greater with UVC pre-irradiation in two-thirds or more of the apical region throughout the observation period.

CONCLUSIONS

These results indicate that UVC treatment increased the volume of cortical-like bone tissue in the coronal region of titanium implants without deterioration of bone mineral density.

The Impact of Expasyl® Gingival Retraction Paste on the Bond Strength of Self-etch and Total-etch Systems

OBJECTIVE

To evaluate the influence of Expasyl® gingival retraction paste on the shear bond strength of self-etch and total-etch adhesive systems.

MATERIALS AND METHODS

Twenty-four specimens of extracted, caries-free, sound human molars were used in this study. The molars were then cut vertically into halves through the buccal and lingual cusps. Forty-eight specimens were divided into four groups (total-etch, total-etch with Expasyl application, self-etch, self-etch with Expasyl application) and the shear bond strength was tested.

RESULTS

Expasyl significantly reduced the shear bond strength of the self-etch and total-etch adhesive systems. The self-etch system showed relatively lower performance compared with the total-etch adhesive system. The shear bond strength values of the total-etch adhesive without Expasyl showed the highest bond strength (21.48 ± 2.89), while the self-etching group adhesive treated with Expasyl showed the lowest shear bond strength value (14.89 ± 1.81).

CONCLUSION

From the observations of this in vitro study, it can be concluded that the use of Expasyl® gingival retraction system can negatively affect bond strength of adhesives. The total-etch system showed better compatibility to the Expasyl gingival retraction system than the self-etch.

Microtensile Bond Strength and Micromorphology of Bur-cut Enamel Using Five Adhesive Systems

PURPOSE

This study compared the microtensile bond strengths (μTBS) of two etch-and-rinse (ER) (OptiBond FL [OBFL]; Prime & Bond NT [PBNT]) and three self-etching (SE) (Clearfil SE Bond [CSEB]; Xeno III [XIII]; Xeno V+ [XV+]) adhesives systems to bur-prepared human enamel considering active (AA) and passive (PA) application of the self-etching systems.

MATERIALS AND METHODS

Ninety-six enamel surfaces were prepared with a medium-grit diamond bur and randomly allocated into 8 groups to receive adhesive restorations: G1: OBFL; G2: PBNT; G3: CSEB/PA; G4: CSEB/ AA; G5: XIII/PA; G6: XIII/AA; G7: XV+/PA; G8: XV+/AA. After composite buildup, samples were sectioned to obtain a total of 279 bonded sticks (1 mm2) that were submitted to microtensile testing (μTBS; 0.5 mm/min) after 24-h water storage (37°C). Etching patterns and adhesive interfacial ultramorphology were also evaluated with confocal laser scanning (CLSM) and scanning electron microscopy (SEM). Data was analyzed with one-way ANOVA (α = 0.05). Weibull probabilistic distribution was also determined.

RESULTS

Regarding μTBS, both adhesive system and application mode yielded statistically significant differences (p < 0.05) among groups. ER adhesive systems together with CSEB/AA and XIII/PA recorded the highest and statistically similar bond strength results. XV+ presented very low bond strength values, regardless of the application mode. Among self-etching adhesives, CSEB produced significantly higher μTBS values when applied actively. Qualitative evaluation by SEM and CLSM revealed substantial differences between groups both in adhesive interfaces and enamel conditioning patterns.

CONCLUSIONS

ER and SE adhesive systems presented distinctive bond strengths to bur-cut enamel. The application mode effect was adhesive dependent. Active application improved etching patterns and resin interfaces micromorphology.

Effect of low speed drilling on osseointegration using simplified drilling procedures

Our aim was to find out whether simplified drilling protocols would provide biological responses comparable to those of conventional drilling protocols at the low rotational speed of 400rpm. Seventy-eight root form endosseous implants with diameters of 3.75, 4.2, and 5mm were placed into canine tibias and allowed to heal for 3 and 5 weeks. After the dogs had been killed, the samples of implanted bone were retrieved and processed for non-decalcified histological sectioning. Bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) analyses were made on the histological sections. Implants treated by the simplified protocol resulted in BIC and BAFO values comparable to those obtained with the conventional drilling protocol, and there were no significant differences in the technique or diameter of the drilling. The results suggest that the simplified procedure gives biological outcomes comparable to those of the conventional procedure.

Role of chlorhexidine in bond strength to artificially eroded dentin over time

PURPOSE

To assess the long-term effect of a 2% aqueous chlorhexidine (CHX) solution on bond strength to artificially eroded dentin compared to sound dentin.

MATERIALS AND METHODS

Flat mid-coronal dentin surfaces of extracted third molars (n = 28) were subjected only to grinding with a 600-grit SiC paper for 1 min (sound dentin S, n = 14) or additionally to erosive pH cycling with a cola-based soft-drink (eroded dentin E, n = 14). After acid etching, rinsing, and air drying, S and E were rehydrated with 1.5 μl of 2% CHX (S2%, n = 7; E2%, n = 7) or of distilled water (control SC, n = 7; EC, n = 7). Composite buildups were incrementally constructed with Filtek Z350 following Adper Single Bond 2 application. Specimens were sectioned into beams, which were subjected to microtensile testing immediately or after 6 or 12 months of aging. Fractured surfaces were observed under a digital microscope (50X magnification). Microtensile bond strength (μTBS) (MPa) was analyzed by three-way ANOVA and Tukey's tests (α = 0.05) and failure mode by the Kruskal-Wallis test (α = 0.05).

RESULTS

Compared to sound dentin, eroded dentin was consistently related to lower μTBS. Immediately and after 12-month aging, the effect of CHX was insignificant, but it was significant after 6-month aging, when it conserved the bond strength to both eroded and sound dentin. The percentage of adhesive and mixed failures were equivalent, and significantly more frequent than cohesive failures, whether in dentin or in composite.

CONCLUSION

The 2% CHX effect on bond strength conservation to both eroded and sound dentin was not found to be persistent.

Effects of different pre-treatment methods on the shear bond strength of orthodontic brackets to demineralized enamel

OBJECTIVE

To compare the effects of different treatment methods used for the enamel damage, on the shear bond strength (SBS) and fracture mode of orthodontic brackets.

MATERIALS AND METHODS

Freshly-extracted 140 premolars were randomly allocated to seven groups: Group I was considered as the control of other groups. The remaining groups were exposed to demineralization. In group II, brackets were directly bonded to the demineralized enamel surface. CPP-ACP paste (GC Tooth Mousse), fluoride varnish (Bifluorid 12), microabrasion with a mixture prepared with 18% hydrochloric acid and fine pumice powder, microabrasion with an agent (Opalustre) and resin infiltrant (Icon®) were applied in Groups III, IV, V, VI and VII, respectively. The specimens were tested for SBS and bond failures were scored according to the Adhesive Remnant Index (ARI). Analysis of variance and Tukey tests were used to compare the SBS of the groups. ARI scores were compared with G-test. The statistical significance was set at p < 0.05 level.

RESULTS

Statistically significant differences were found among seven groups (F = 191.697; p < 0.001). The SBSs of groups I (mean = 18.8 ± 2.0 MPa) and VII (mean = 19.1 ± 1.4 MPa) were significantly higher than the other groups. No statistically significant difference was found between groups IV (mean = 11.5 ± 1.2 MPa) and V (mean = 12.6 ± 1.5 MPa). The differences in ARI scores of the groups were statistically significant (p < 0.01).

CONCLUSIONS

All demineralization treatment methods improve bonding to demineralized enamel. Resin infiltrant application after demineralization showed similar bond strength values as intact enamel.

Bond Strength of Experimental Low-viscosity Resin Materials to Early Enamel Caries Lesions: Effect of Diluent/Solvent Addition

PURPOSE

To evaluate the effect of different concentrations of monomers and solvents/diluents on the microtensile bond strength (μTBS) bond strength of experimental low-viscosity resins (infiltrants) to enamel caries-like lesions (ECLL).

MATERIALS AND METHODS

Flat enamel blocks obtained from sound human third molars were submitted to ECLL formation and randomly distributed into 9 groups (n = 10): G1: TEG-DMA 100%; G2: TEG-DMA 80%, ethanol 20%; G3; TEG-DMA 80%, HEMA 20%; G4: TEG-DMA 75%, UDMA 25%; G5: TEG-DMA 60%, UDMA 20%, ethanol 20%; G6: TEG-DMA 60%, UDMA 20%, HEMA 20%; G7: TEG-DMA 75%, bis-EMA 25%; G8: TEG-DMA 60%, bis-EMA 20%, ethanol 20%; G9: TEG-DMA 60%, bis-EMA 20%, HEMA 20%. After etching with 37% phosphoric acid for 60 s, experimental infiltrants were actively applied and photocured for 60 s, then stored in 100% humidity (24 h, 37°C). Hourglass-shaped specimens were obtained and the μTBS test performed (MPa). The fracture patterns were assessed by SEM. Data were submitted to two way-ANOVA and Tukey's tests (α = 0.05).

RESULTS

The highest μTBS value was observed for G4 (TEG-DMA/UDMA, 19.18 MPa) and the lowest for G5 (TEG-DMA/UDMA/ethanol, 9.00 MPa). A significant decrease in μTBS was observed for all groups containing ethanol (G2, G5, and G8). The addition of HEMA did not affect μTBS values. Most groups showed a high frequency of mixed failure between infiltrant and enamel.

CONCLUSION

The addition of bis-EMA or UDMA to TEG-DMA-based infiltrants did not improve bond strength to carious enamel. The ethanol addition negatively affected the bonding strength of infiltrants to enamel caries-like lesions, regardless of the resin matrix composition of the infiltrant.

Repair Bond Strength of Aged Silorane-based Composite Using Intermediate Adhesive Systems Based on Different Monomers

PURPOSE

To investigate the effect of pre-repair aging periods and intermediate adhesive systems based on different monomers on the repair bond strength of silorane-based resin composite.

MATERIALS AND METHODS

A total of 32 Filtek P90 (3M ESPE) substrate specimens (4 mm diameter and 4 mm height) were made. Substrate specimens were grouped according to the pre-repair time periods into four groups (n = 8/group): 15 to 30 min, 24 h, 1 month, and 3 months. All substrate specimens were ground flat using a diamond stone and were etched using Scotchbond phosphoric acid etchant (3M ESPE). The specimens of each pre-repair time period were equally distributed among the two repair groups, using either silorane-based (P90 System Adhesive) or acrylamide-based (AdheSE One F, Ivoclar Vivadent) intermediate adhesive systems. Specimens of P90 System adhesive received Filtek P90 as the repair resin composite, and Tetric N-Ceram (Ivoclar Vivadent) was used with AdheSE One F specimens. Additional specimens were made from the repair resin composite materials to study the cohesive strength. Specimens were sliced into sticks (0.6 ± 0.01 mm2) for microtensile bond strength testing (μTBS). Modes of failure were determined.

RESULTS

Two-way ANOVA with repeated measures revealed no significant effect for the pre-repair aging periods, intermediate adhesive systems based on different monomers, or their interaction on repair bond strength of silorane-based resin composite.

CONCLUSION

Up to 3 months of pre-aging the repaired silorane-based resin composite had no negative effect on its repair bond strength, even when an intermediate adhesive system based on a different monomer (acrylamide) was used.

Effects of Diode Laser Debonding of Ceramic Brackets on Enamel Surface and Pulpal Temperature

AIM

Debonding of ceramic brackets due to their high bond strength and low fracture toughness is one of the most challenging complications of orthodontic clinicians. Application of lasers might be effective in the debonding of ceramic brackets as they reduce bond strength of resins and, therefore, can eliminate the risk of enamel damage. However, the thermal effects of laser radiation on dental tissue can cause undesirable results. The aim of this study is to evaluate the enamel surface characteristics and pulpal temperature changes of teeth after debonding of ceramic brackets with or without laser light.

MATERIALS AND METHODS

Thirty polycrystalline brackets were bonded to 30 intact extracted premolars, and later debonded conventionally or through a diode laser (2.5 W, 980 nm). The laser was applied for 10 seconds with sweeping movement. After debonding, the adhesive remnant index (ARI), the lengths and frequency of enamel cracks were compared among the groups. The increase in intrapulpal temperature was also measured. The collected data were analyzed by Chi-squared test and paired t-test using Statistical Package for Social Sciences (SPSS) software.

RESULTS

There was no case of enamel fracture in none of the groups. Laser debonding caused a significant decrease in the frequency and lengths of enamel cracks, compared to conventional debonding. In laser debonding group, the increase in intrapulpal temperature (1.46°C) was significantly below the benchmark of 5.5°C for all the specimens. No significant difference was observed in ARI scores among the groups.

CONCLUSION

Laser-assisted debonding of ceramic brackets could reduce the risk of enamel damage, without causing thermal damage to the pulp. However, some increases in the length and frequency of enamel cracks should be expected with all debonding methods.

Effect of different surface pre-treatment methods on the microleakage of two different self-adhesive composites in Class V cavities

AIM

To evaluate the effect of different surface pre-treatment methods on the microleakage of self-adhesive flowable composites (SAFCs) in comparison with a conventional flowable composite applied with an etch-and-rinse adhesive system.

MATERIALS AND METHODS

One hundred and thirty-five standardised Class V cavities were randomly divided into nine groups: (1) three-step etch-and-rinse adhesive (Optibond FL - Kerr, Orange, USA)/flowable composite (Clearfil Majesty Flow - Kuraray, Tokyo, Japan) (E&Ra/flowC); (2) Fusio Liquid Dentin (Pentron Clinical, Orange, USA); (3) Er:YAG Laser/Fusio Liquid Dentin (Er&Las/Fusio Liquid Dentin); (4) Phosphoric Acid/Fusio Liquid Dentin (PhosA/Fusio Liquid Dentin); (5) Polyacrylic Acid/Fusio Liquid Dentin (PolyA/Fusio Liquid Dentin); (6) Vertise Flow (Kerr, Orange, USA); (7) Er:YAG Laser/Vertise Flow (Er&Las/Vertise Flow); (8) Phosphoric Acid/Vertise Flow (PhosA/Vertise Flow); (9) Polyacrylic Acid/Vertise Flow (PolyA/Vertise Flow). After thermocycling and immersion in a 0.5% basic fuchsin, the restorations were evaluated under a stereomicroscope (n = 30). The data were statistically analysed (α = 0.05).

RESULTS

Both SAFCs showed higher leakage scores than E&Ra/flowC in enamel and dentin (p < 0.05). Vertise Flow showed lower leakage than Fusio Liquid Dentin in dentin (p < 0.05). Pre-phosphoric acid etching reduced the microleakage scores of Fusio Liquid Dentin in both enamel and dentin (p < 0.05), while all surface pre-treatment methods led to a significant reduction in the microleakage scores of Vertise Flow at the enamel margin (p < 0.05).

CONCLUSION

Pre-etching of enamel and dentin by phosphoric acid may be satisfactory in improving the sealing ability of Fusio Liquid Dentin, while phosphoric acid or polyacrylic acid etching or laser irradiation may be used to improve the adhesion of Vertise Flow to enamel.

The Bond Strength of Resin Bonded Bridge Retainers to Abutments of Differing Proportions of Enamel and Composite

Four groups of specimens were constructed using bovine enamel and composite resin. After a period of ageing, the specimens were roughened and acid etched before they were cemented to air abraded base metal alloy beams with a universal resin cement. After further ageing, tensile peel testing was carried out using a Universal Testing Machine. The force required to produce failure increased as the amount of composite resin on the bonding surface of the abutment increased. This difference reached statistical significance (p < 0.5) when the abutments contained > 50% composite. The mode of failure was mixed on the majority of retainers. Within the limitations of the study, findings suggest that RBB retainers can be cemented to abutments restored with composite resin without a reduction in bond strength.

Bond strength of novel CAD/CAM restorative materials to self-adhesive resin cement: the effect of surface treatments

PURPOSE

To evaluate the effect of different surface treatments on the microtensile bond strength (μTBS) of novel CAD/CAM restorative materials to self-adhesive resin cement.

MATERIALS AND METHODS

Two types of CAD/CAM restorative materials (Vita Enamic [VE] and Lava Ultimate [LU]) were used. The specimens were divided into five groups in each test according to the surface treatment performed; Gr 1 (control; no treatment), Gr 2 (sandblasted [SB]), Gr 3 (SB+silane [S]), Gr 4 (hydrofluoric acid [HF]), and Gr 5 (HF+S). A dual-curing self-adhesive resin cement (Bifix SE [BF]) was applied to each group for testing the adhesion after 24 h of storage in distilled water or after 30 days using the μTBS test. Following fracture testing, specimens were examined with a stereomicroscope and SEM. Surface roughness and morphology of the CAD/CAM restorative materials were characterized after treatment. Data were analyzed using ANOVA and Tukey's test.

RESULTS

The surface treatment, type of CAD/CAM restorative material, and water storage periods showed a significant effect on the μTBS (p<0.001). For the LU/BF system, there was no significant difference in the bond strength values between different surface treatments (p>0.05). On the other hand, for the VE/BF system, surface treatment with HF+S showed higher bond strength values compared with SB and HF surface treatments (p<0.05). Surface roughness and SEM analyses showed that the surface topography of CAD/CAM restorative materials was modified after treatments.

CONCLUSION

The effect of surface treatments on the bond strength of novel CAD/CAM restorative materials to resin cement is material dependent. The VE/BF CAD/CAM material provided higher bond strength values compared with the LU/BF CAD/CAM material.

Microtensile bond strength of lithium disilicate ceramics to resin adhesives

PURPOSE

To evaluate the influence of the internal structure of lithium disilicate glass ceramics (LDC) on the microtensile bond strength to a resin adhesive using two surface treatments.

MATERIALS AND METHODS

Milling blocks of three types of LDC were sectioned (4 mm thick) using a precision cutting machine: IPS Empress 2 (conventional LDC), IPSe.max CAD (a refined crystal high strength LDC), and Celtra (zirconia reinforced LDC). Cut specimens received crystallization heat treatment as suggested by the manufacturers. Two surface treatments were performed on each group: hydrofluoric acid etching (HF) and airborne particle abrasion using 50-μm glass beads, while the as-cut surface served as control. Treated surfaces were examined using scanning electron microscopy (SEM). The disks were coated with a silane primer and bonded to pre-aged resin composite disks (Tetric EvoCeram) using a resin adhesive (Variolink II) and then stored in water for 3 months. Bonded specimens were sectioned into micro-bars (1x1x6 mm) and microtensile bond strength test (MTBS) was performed. Data were analyzed using two-way ANOVA and Tukey's post-hoc test (α=0.05).

RESULTS

Statistical analysis revealed significant differences in microtensile bond strength values between different LDCs (F=67, p<0.001), different surface treatments (F=232, p<0.001), and interaction between LDC and surface treatments (F=10.6, p<0.001). Microtensile bond strength of Celtra ceramic (30.4±4.6 MPa) was significantly higher than both IPS Empress 2 (21.5±5.9 MPa) and IPSe.max ceramics (25.8±4.8 MPa), which had almost comparable MTBS values. SEM images demonstrated homogenous glassy matrix and reinforcing zirconia fillers characteristic of Celtra ceramic. Heat treatment resulted in growth and maturation of lithium disilicate crystals. Particle abrasion resulted in abrasion of the glass matrix and exposure of lithium disilicate crystals, while HF etching produced a microrough surface, which resulted in higher MTBS values and reduction in the percentage of adhesive failure for all groups.

CONCLUSIONS

Within the limitations of this study, bond strength to lithium disilicate ceramics depends on proper surface treatment and on the chemical composition of the glass ceramic.