Improved sealant retention with bonding agents: a clinical study of two-bottle and single-bottle systems

Bonding agents in pit and fissure sealants: a review

Dental adhesive systems used for bonding dental resins to enamel and dentin have evolved through several "generations," with changes in chemistry, mechanism, number of bottles, application technique, and clinical effectiveness. The trend in the latest generation of dental bonding systems is to reduce the number of components and clinical placement steps. The introduction of i bond, a single-bottle dental adhesive system, is the latest of the new generation materials, and combines etchant, adhesive, and desensitizer in one component. This paper describes different dentin bonding agents, its evolution, mechanism of action and different commercially available dentin bonding agents and their role in the retention of pit and fissure sealant.

Bond strength of a pit-and-fissure sealant associated to etch-and-rinse and self-etching adhesive systems to saliva-contaminated enamel: individual vs. simultaneous light curing

This study evaluated in vitro the shear bond strength (SBS) of a resin-based pit-and-fissure sealant [Fluroshield (F), Dentsply/Caulk] associated with either an etch-and-rinse [Adper Single Bond 2 (SB), 3M/ESPE] or a self-etching adhesive system [Clearfil S3 Bond (S3), Kuraray Co., Ltd.] to saliva-contaminated enamel, comparing two curing protocols: individual light curing of the adhesive system and the sealant or simultaneous curing of both materials. Mesial and distal enamel surfaces from 45 sound third molars were randomly assigned to 6 groups (n=15), according to the bonding technique: I - F was applied to 37% phosphoric acid etched enamel. The other groups were contaminated with fresh human saliva (0.01 mL; 10 s) after acid etching: II - SB and F were light cured separately; III - SB and F were light cured together; IV - S3 and F were light cured separately; V - S3 and F were light cured simultaneously; VI - F was applied to saliva-contaminated, acid-etched enamel without an intermediate bonding agent layer. SBS was tested to failure in a universal testing machine at 0.5 mm/min. Data were analyzed by one-way ANOVA and Fisher's test (alpha=0.05).The debonded specimens were examined with a stereomicroscope to assess the failure modes. Three representative specimens from each group were observed under scanning electron microscopy for a qualitative analysis. Mean SBS in MPa were: I-12.28 (+/-4.29); II-8.57 (+/-3.19); III-7.97 (+/-2.16); IV-12.56 (+/-3.11); V-11.45 (+/-3.77); and VI-7.47 (+/-1.99). In conclusion, individual or simultaneous curing of the intermediate bonding agent layer and the resin sealant did not seem to affect bond strength to saliva-contaminated enamel. S3/F presented significantly higher SBS than the that of the groups treated with SB etch-and-rinse adhesive system and similar SBS to that of the control group, in which the sealant was applied under ideal dry, noncontaminated conditions.

Enamel deproteinization and its effect on acid etching: an in vitro study

PURPOSE

The goal of this in vitro study was to identify the topographical features of the enamel surface deproteinized and etched with phosphoric acid (H3PO4) compared to phosphoric acid alone.

MATERIALS AND METHOD

Ten extracted lower first and second permanent molars were polished with pumice and water, and then divided into 4 equal buccal sections having similar physical and chemical properties. The enamel surfaces of each group were subjected to the following treatments: Group A: Acid Etching with H3PO4 37% for 15 seconds. Group AH1: Sodium Hypochlorite (NaOCl) 5.25% for 30 seconds followed by Acid Etching with H3PO4 37% for 15 seconds. Group AH2; Sodium Hypochlorite (NaOCl) 5.25% for 60 seconds followed by Acid Etching with H3PO4 37% for 15 seconds. Results showed that group AH2 etching technique reached an area of 76.6 mm2 of the total surface, with a 71.8 mm2 (94.47%), type 1 and 2 etching pattern, followed by group AH1 with 55.9 mm2 out of 75.12 mm2 (74.1%), and finally group A with only 36.8 mm2 (48.83%) out of an area of 72.7 mm2. A significant statistical difference (P < 0.05) existed between all groups, leading to the conclusion that enamel deproteinization with 5.25% NaOCl for 1 minute before H3PO4, etching increases the enamel conditioning surface as well as the quality of the etching pattern.

Clinical Evaluation of a Nanofilled Fissure Sealant Placed with Different Adhesive Systems: 24-month Results

The use of an etch-and-rinse adhesive prior to the placement of sealants yielded better retention than did the use of a self-etch adhesive.

Can caries fissures be sealed as adequately as sound fissures?

Sealing caries fissures is considered an appropriate treatment option for arresting the caries process. However, little information is available regarding the sealing of occlusal cavitated dentin lesions. The hypothesis tested in this in vitro study was that no difference in microleakage and sealant penetration depth exists between cavitated and sound sealed fissures when a resin is used. Eighty molars, each with an occlusal cavitated dentin lesion, were treated according to 5 experimental protocols and compared with a control group of sealed sound molars. In the experimental groups, fissure sealants were placed with and without an adhesive, and in various ways. All teeth were sectioned, and microleakage and sealant penetration into the fissure were evaluated. Sealed caries fissures showed significantly more microleakage and insufficient sealant penetration depth than sound fissures. Neither the use of an adhesive nor its intermediate curing influenced the microleakage score and the penetration ability of sealants.

Retention of resin-based pit and fissure sealants: A systematic review

The aim of the present study was to perform a systematic review on the retention of resin-based sealants (RBSs) according to the material used and the clinical procedure. An electronic search in MEDLINE, EMBASE, Cochrane library and SCOPUS was completed by a hand search in conference proceedings. One hundred and twenty-four studies were identified, 31 of which were included. The retention rate of auto-polymerized and light-cured RBSs did not differ significantly. Light-cured RBSs had a significantly higher retention rate than fluoride-containing light-cured RBSs at 48 months (RR = 0.80, 95% CI: 0.72-0.89) and more. Concerning the clinical procedure, the scarcity of well-conducted studies made judgement difficult, except for the isolation stage. If using a rubber dam did not affect retention of auto-polymerized RBSs, it did for fluoride-containing light-cured RBSs (RR = 2.03, 95% CI: 1.51-2.73).

Inhibition of mineral loss at the enamel/sealant interface of fissures sealed with fluoride- and non-fluoride containing dental materials in vitro

OBJECTIVE

In this in vitro study we evaluated the enamel mineral loss effect of fluoride-containing and non-fluoride-containing materials at different distances from the sealant margin, and verified the fluoride-releasing capability of these materials.

MATERIAL AND METHODS

Extracted molars were randomly assigned into nine groups (n = 12): Concise (C), FluroShield (F), Helioseal Clear Chroma (H), Vitremer (V), Fuji II-LC (FII), Ketac Molar (KM), Fuji IX (FIX), Single Bond (SB), and Clearfil Protect Bond (CF). All groups were subjected to thermo and pH cycling. Enamel mineral loss was evaluated by cross-section micro-hardness analysis at distances: -100 microm, 0 microm, 100 microm, 200 microm. The mineral loss data were analyzed using a multi-factor ANOVA with split-plot design, and fluoride-released data were submitted to ANOVA and Tukey tests.

RESULTS

FIX demonstrated a lower mineral loss than C, F, and H, but did not differ from the SB, CF, V, FII, and KM groups, which also demonstrated no difference among them. C, F, H, and V presented the highest mineral loss, with no difference among them. V did not differ from the other groups (p > 0.05). Regarding the different distances from the sealant margin, -100 microm presented the lowest mineral loss. FIX showed the highest fluoride release on the 7th and 14th days of evaluation, while CF showed high fluoride release only on the 7th day.

CONCLUSION

Resin sealant did not prevent enamel mineral loss, contrary to glass-ionomer cement, which showed the highest capacity for fluoride release. It is not exclusively the presence of fluoride in a material's composition that indicates its capability to interfere with the development of enamel caries-like lesions.

Effect of enamel preparation method on in vitro marginal microleakage of a flowable composite used as pit and fissure sealant

OBJECTIVES

The aim of this in vitro study was to evaluate the microleakage in occlusal surfaces, after preparation with Er:YAG laser and compared to the diamond-bur conventional technique.

METHODS

Thirty premolars were divided into three groups: I - high-speed handpiece + 37% phosphoric acid; II - Er:YAG laser (350 mJ, 4 Hz and 112 J/cm(2)) + 37% phosphoric acid; and III - Er:YAG laser (350 mJ, 4 Hz and 112 J/cm(2)) + Er:YAG laser (80 mJ, 4 Hz, and 25 mJ/cm(2)). All cavities received the same adhesive system and were restored with flowable composite according to manufacturer's instructions. Teeth were submitted to thermal cycling and immersed in 50% silver nitrate solutions for 8 h in total darkness. Specimens were sectioned longitudinally in the bucco-lingual direction, in slices of 1 mm thick. Each slice was immersed into photo developing solution and was photographed, and microleakage was scored from 0 to 7, by three calibrated examiners.

RESULTS

A statistically significant difference (P < 0.0001) was observed between Er:YAG laser prepared and etched specimens and those in the other groups.

CONCLUSIONS

It can be concluded that no significant difference was noted between the two types of enamel preparation when etching was performed. Preparing and treating the enamel surface exclusively by Er:YAG laser resulted in the highest degree of leakage.

Effects of aging methods on microleakage of an adhesive system used as a sealant on contaminated surfaces

This study evaluated the effects of aging methods on the microleakage of an adhesive system used for sealing pit and fissure surfaces. After acid etching, the occlusal surfaces of 60 permanent teeth were contaminated with 1mL of human plasma and then sealed with OptiBond dual cure, activated in the ramp mode (Optilux 501). The sample was then divided into eight experimental and a control groups. Aging was performed for 20 days in 5, 37, 55 and 5-55ºC (200 cycles/day) under water contact or not. After subjecting the specimens to the AgNO(3) technique, they were sectioned twice. Dye penetration was measured and the mean values were subjected to ANOVA. No group provided hermetic seal against dye penetration, even the control group (without treatment). Significant aging x water interaction effect (p=0.033) was observed. The group without water contact at 5ºC (p=0.015) showed the least dye penetration value. The results led to the main conclusions: 1) all groups showed dye penetration, even the control group; 2) storage teeth at 5ºC on dry condition provided the lowest degree of dye penetration; 3) in the presence of water, the temperature variations seem not to affect the microleakage values.

Microtensile adhesion of sealants to intact enamel

Contamination of etched enamel with saliva has been shown to result in sealant failure. Hydrophilic adhesives improve retention of sealants when enamel is contaminated.

OBJECTIVE

The objective of the present study was to characterize the adhesion of two sealants to unprepared enamel etched with phosphoric acid or conditioned with the all-in-one, self-etch adhesive Adper Prompt L-Pop.

METHODS

The two proximal enamel surfaces of 16 sound molars were assigned to four conditioning regimens: (1) 35% phosphoric acid for 15 s; (2) Adper Prompt L-Pop, one layer light-cured prior to sealant placement; (3) Adper Prompt L-Pop, two layers light-cured prior to sealant placement; and (4) Adper Prompt L-Pop, one layer co-cured with sealant. One of two sealants, i.e. Clinpro or Delton DDS, was applied, light-cured, followed by a composite build-up to provide support for microtensile bond testing.

RESULTS

The highest mean bond strengths were obtained when Adper Prompt L-Pop was applied in two layers and light-cured prior to the insertion of Clinpro Sealant. Co-cure of Adper Prompt L-Pop with either sealant resulted in bond strengths which were not significantly different from those of the phosphoric acid control. The use of Adper Prompt L-Pop in one layer cured prior to sealant placement resulted in statistically lower bond strengths than any other application technique regardless of the sealant used. Clinpro Sealant resulted in statistically higher bond strengths than Delton DDS Sealant.

CONCLUSIONS

Application of one layer of Adper Prompt L-Pop co-cured with the sealant resulted in bond strengths similar to those obtained with phosphoric acid etching.

Sealant and composite bond strength to enamel with antibacterial/self-etching adhesives

INTRODUCTION

The enamel in pits and fissures undergoing preventive or ultraconservative resin restorations may be affected by secondary caries. An antibacterial adhesive bond may be a useful choice to prevent and reduce demineralization.

OBJECTIVES

The purpose of this study was to determine the shear bond strength of an experimental antibacterial bond, a self-etch bond, and an ormocer-based adhesive bond using an ormocer-based fissure sealant and a composite resin on intact enamel.

METHODS

Twenty-four extracted human molars were sectioned bucco-lingually to obtain two flat and sound enamel surfaces. Forty-eight specimens were randomly assigned into four groups. The groups were prepared to receive the following treatments: (1) Admira Bond + Admira Seal (n = 10); (2) ABF Bond + Admira Seal (n = 11); (3) Clearfil SE Bond + Clearfil AP-X (n = 12); and (4) ABF Bond + Clearfil AP-X (n = 11). A cylindrical mould was placed over the bonded surface, and both materials were applied according to the instructions. The teeth were thermocycled 500 cycles between 5 and 55 degrees with a dwell time of 30 s. For shear bond strength testing, the load was applied vertically to the base of the mould. The cross-head speed was 5 mm min(-1).

RESULTS

The maximum load that a specimen can withstand until failure was determined and shear bond strength was calculated by dividing the load at failure by the surface area of the mould. The results (median, minimum and maximum, respectively) for the four groups were: (1) 7.9, 4.2 and 13.6 MPa; (2) 8.6, 2.6 and 15.9 MPa; (3) 5.9, 5.3 and 8.2 MPa; and (4) 8.8, 3.0 and 19.2 MPa. Kruskal-Wallis and Mann-Whitney U-tests were performed for the statistical analysis. Groups 3 and 4 were statistically significantly different (P = 0.005; P < 0.05). There was no statistically significant difference between the sealant and composite groups for ABF (P = 0.375). Fracture sites were viewed by microscope under x 16 magnification to determine if the mode of failure was adhesive or cohesive. The results (number of adhesive failed specimens and number of cohesive failed specimens, respectively) for the four groups were: (1) 7 and 3; (2) 3 and 8; (3) 2 and 9; and (4) 8 and 3.

CONCLUSION

The ABF bond has sufficiently physical qualities to be used under fissure sealant and composite resin on uncut enamel, its antibacterial efficiency notwithstanding.

Microtensile bond strength to ground enamel by glass-ionomers, resin-modified glass-ionomers, and resin composites used as pit and fissure sealants

OBJECTIVES

To measure the microtensile bond strength to ground enamel of different types of materials used as pit and fissure sealants in combination with different substrate conditioners.

METHODS

From 40 sound extracted molars, eight groups of five teeth were randomly formed. The experimental groups were: (1) (C) 37% phosphoric acid/ClinPro Sealant (3M ESPE); (2) (G) 37% phosphoric acid/Guardian Seal (Kerr); (3) (E/TF) 37% phosphoric acid/Excite/Tetric Flow (Ivoclar-Vivadent) (4) (OS/UF) 37% phosphoric acid/One Step (Bisco)/UniFil Flow (GC); (5) (OS/AE) 37% phosphoric acid/One Step/AEliteflo (Bisco); (6) (UB/UF) UniFil Bond/UniFil Flow (GC); (7) (CC/FVII) GC Cavity Conditioner/Fuji VII (GC); (8) (CC/FII) GC Cavity Conditioner/Fuji II LC Improved (GC). On the buccal of each tooth, a 5mm high build-up was created by incrementally adding layers of the sealing material on the conditioned enamel. By serially cutting the built-up tooth, multiple beam-shaped specimens about 1mm x 1mm in cross section were obtained, and loaded in tensile (0.5 mm/min) until failure occurred.

RESULTS

The bond strengths measured in MPa were: (C) 20.41+/-11.79; (G) 16.02+/-7.99; (E/TF) 24.06+/-9.67; OS/UF 15.63+/-9.00; (OS/AE) 9.31+/-6.05; (UB/UF) 4.96+/-3.46; (CC/FVII) 1.70+/-2.19; (CC/FII) 2.19+/-1.44.

CONCLUSIONS

The conventional and the resin-modified glass ionomers measured bond strengths significantly lower than those of any resin-based materials. Failure frequently occurred cohesively within the cement. Flowable composites in combination with phosphoric acid and a total-etch adhesive performed similarly to resin-based materials specifically conceived for sealings, such as ClinPro Sealant and Guardian Seal. The bond achieved by resin composite when treating enamel with the self-etching primer used in this study (UniFil Bond) was significantly lower than that developed when the substrate was etched with 37% phosphoric acid.

Twelve-month sealant retention in a school-based program using a self-etching primer/adhesive

OBJECTIVES

Very little independent research has been done on the new self-etching primer/adhesives in dentistry. A recent clinical study compared two sealant application techniques involving self-etching primer adhesives and the traditional phosphoric acid etch. The purpose of this study was to compare these two techniques in an Iowa school-based sealant program.

METHODS

Twelve-month sealant retention data on 208 students from the Des Moines, Iowa, school-based sealant program were analyzed retrospectively.

RESULTS

Sealant retention reported at the person level showed that 60 percent of the students who received sealants at the five schools had to be recalled at one year to have one or more surfaces resealed. A logistic regression model at the person level demonstrated that the phosphoric acid technique was six times as likely to have retention of all the sealed tooth surfaces as those sealed with Prompt-L-Pop.

CONCLUSIONS

In this study, many students had to be recalled to the chair 12 months after sealant application due to incomplete retention. Though sealants were retained in larger numbers with phosphoric acid, overall sealant retention at the tooth level was lower than previously published for clinical studies and school-based programs. Examining retention data at the person level, however, allows program administrators to plan resources more effectively and reevaluate sealant protocol to ensure as few children return for sealant reapplication.

Effect of saliva contamination and re-etching time on the shear bond strength of a pit and fissure sealant

The aim of this study was to evaluate the effect of saliva contamination (SCT) and re-etching time (RET) on the shear bond strength (SBS) of the Fluroshield sealant. Forty-five extracted third molars were sectioned and flattened until reach an enamel surface area. Then, all samples were etched for 30 sec with 35% phosphoric acid and then they were distributed into 9 groups (n=10) according to SCT and RET (seconds), respectively: G1- control (no SCT and no RET); G2- 30s and 0s; G3- 60s and 0s; G4-30s and 2s; G5- 30s and 5s; G6- 30s and 15s; G7-60s and 2s; G8- 60s and 5s; G9- 60s and 15s. The sealant was applied according to the manufacturer's instructions. The samples were stored in distilled water at 37ºC for 72h and subjected to the SBS test. The results indicated that there was no statistically significant difference between the groups (p>0.05). However, it could be noticed that: 1- the longer the SCT, the lower the SBS values; 2 - the longer the RET, the higher the SBS values. It could be concluded that there was a tendency to the shortest SCT (30s) associated to the longest RET (5 and 15s) to reach similar SBS values for the control group.

Using survival methodologies in demonstrating caries efficacy

Exploiting recent advances in statistical methods, particularly for correlated intra-subject data, could increase the efficiency of caries clinical trials. Methods of analysis using the tooth surface as the unit should be investigated. Whole-mouth measures such as the DMFS increment ignore the variation in the number of surfaces at risk between subjects and within a subject over time. The use of "survival time" for each surface as the outcome measure--i.e., the time from the start of the trial to when a surface is recorded as decayed or filled--is proposed. Data from caries clinical trials could be described as clustered survival data, where clustering of tooth surfaces exists such that survival times within the same cluster or subject are correlated. Advances in the analysis of clustered survival data, such as the use of marginal models with robust variance estimators, have recently been exploited in the analysis of caries clinical trials. The analysis produced results similar to those achieved by conventional DMFS-based analysis. The results using survival analysis are easily interpreted-for example, the median survival time of tooth surfaces in female subjects using a toothpaste with a higher level of fluoride (1500 ppm F) is 1.07 times the median survival time of surfaces in female subjects using toothpaste with less fluoride (1000 ppm F). Further research is required to investigate if survival analysis is a more sensitive method of analysis, i.e., whether causative factors can be identified with fewer subjects than with the conventional method of analysis.

Microleakage assessment of pit and fissure sealant with and without the use of pumice prophylaxis

OBJECTIVES

This study evaluated the effect of pumice prophylaxis on the level of microleakage around and between the sealant and enamel.

MATERIALS AND METHODS

A total of 32 freshly extracted sound upper first premolars, assigned as suitable for sealant application, were chosen and divided randomly into two groups: (1) a test group, without prophylaxis; and (2) a control group, with prophylaxis. Sealant was applied to all teeth using the same conventional technique, with prophylaxis being omitted in the test group. The sealed teeth were thermocycled (120 x 30 s, 5 and 55 degrees C cycles) and then immersed in 2% Basic Fuchsin solution for 72 h. Each tooth was sectioned and examined for dye penetration under a stereomicroscope (x 60 magnification).

RESULTS

No dye penetration was seen in 19 (29.6%) of the teeth in the test group and 36 (56.2%) of the teeth in the control group. Dye had penetrated to the base of the fissure in 31 (48.4%) of the teeth in the test group and 23 (35.9%) of the teeth in the control group. Using a chi-square test for trend, the frequency of microleakage was significantly higher in the test group compared to the controls (P < 0.016).

CONCLUSION

Prophylaxis has a role in improving sealant retention. Removing this step may cause an increase in microleakage.

Effects of saliva contamination on resin-resin bond strength

OBJECTIVE

The purpose of this study is to evaluate the effects of saliva contamination on microtensile bond strength (microTBS) between resin interfaces and to determine which decontamination methods best re-established the original resin-resin bond strength.

MATERIALS AND METHODS

Ninety-six light-cured resin composite cylinders of Z-250, Renew, Clearfil APX, and Pertac II were randomly divided into six groups. For each material, one group of specimens was not contaminated, serving as the control. For the other specimens, the top surface of each block was treated with saliva that was slowly dried (Treatment 1); dried forcefully (Treatment 2); slowly dried, rinsed, and dried (Treatment 3); slowly dried, rinsed, dried, and bonded with Single Bond, One-Step, Clearfil SE Bond, or Prompt L-Pop (Treatment 4); or slowly dried, but not rinsed, and bonded using the same adhesives (Treatment 5). Two 2-mm increments of resin composite were applied and light-cured. After 24 h, the assemblies were trimmed for microtensile bond testing and were loaded to failure at 1 mm/min. Data were analyzed using two-way and one-way ANOVA and Fisher's PLSD (p<0.05).

RESULTS

Control values ranged from 45.1 MPa for Pertac II to 71.5 MPa for APX. Treatment 1 caused significant reduction in resin-resin bond strength for all materials tested but for two of the materials in treatment 2. Pertac II was the only material that did not show a statistical difference from control group for treatment 3. Treatment 4 re-established the control values for Z-250 and Renew and treatment 5 was the only one to show no statistical difference for all materials tested. SEM observation revealed a smooth surface in treatment 1, but treatment 3 showed a few craters. Treatment 4 and 5 showed a mixture of cohesive failure in the composite and adhesive.

SIGNIFICANCE

The most reliable method for decontaminating saliva from resin surfaces involves the application of adhesives.

Using weighted Kaplan-Meier statistics in nonparametric comparisons of paired censored survival outcomes

This research introduces methods for nonparametric testing of weighted integrated survival differences in the context of paired censored survival designs. The current work extends work done by Pepe and Fleming (1989, Biometrics 45, 497-507), which considered similar test statistics directed toward independent treatment group comparisons. An asymptotic closed-form distribution of the proposed family of tests is presented, along with variance estimates constructed under null and alternative hypotheses using nonparametric maximum likelihood estimates of the closed-form quantities. The described method allows for additional information from individuals with no corresponding matched pair member to be incorporated into the test statistic in sampling scenarios where singletons are not prone to selection bias. Simulations presented over a range of potential dependence in the paired censored survival data demonstrate substantial power gains associated with taking into account the dependence structure. Consequences of ignoring the paired nature of the data include overly conservative tests in terms of power and size. In fact, simulation results using tests for independent samples in the presence of positive correlation consistently undershot both size and power targets that would have been attained in the absence of correlation. This additional worrisome effect on operating characteristics highlights the need for accounting for dependence in this popular family of tests.