Nano-controlled molecular interaction at adhesive interfaces for hard tissue reconstruction

From Tooth Adhesion to Bioadhesion: Development of Bioabsorbable Putty-like Artificial Bone with Adhesive to Bone Based on the New Material "Phosphorylated Pullulan"

Bioabsorbable materials have a wide range of applications, such as scaffolds for regenerative medicine and cell transplantation therapy and carriers for drug delivery systems. Therefore, although many researchers are conducting their research and development, few of them have been used in clinical practice. In addition, existing bioabsorbable materials cannot bind to the body's tissues. If bioabsorbable materials with an adhesive ability to biological tissues can be made, they can ensure the mixture remains fixed to the affected area when mixed with artificial bone or other materials. In addition, if the filling material in the bone defect is soft and uncured, resorption is rapid, which is advantageous for bone regeneration. In this paper, the development and process of a new bioabsorbable material "Phosphorylated pullulan" and its capability as a bone replacement material were demonstrated. Phosphorylated pullulan, which was developed based on the tooth adhesion theory, is the only bioabsorbable material able to adhere to bone and teeth. The phosphorylated pullulan and β-TCP mixture is a non-hardening putty. It is useful as a new resorbable bone replacement material with an adhesive ability for bone defects around implants.

Composite Containing Calcium Phosphate Particles Functionalized with 10-MDP

The phosphate ester monomer 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) is capable of bonding to hydroxyapatite and, for this reason, is a key component of several self-etch adhesives. In this study, dicalcium phosphate dihydrate particles (DCPD; CaHPO4.2H2O) were functionalized with 10-MDP and used to formulate an experimental composite with 50 vol% inorganic content (3:1 DCPD:silanated barium glass ratio) dispersed in a BisGMA/TEGDMA matrix. The tested hypothesis was that DCPD functionalization would improve the composite's mechanical performance without compromising Ca2+ release. Composites containing nonfunctionalized DCPD or only reinforcing glass (in both cases, with or without 10-MDP mixed in the resin phase) were used as controls. Materials were tested for degree of conversion (DC; by Fourier transform infrared spectroscopy), water sorption (WS) and solubility (SL; according to ISO 4049), biaxial flexural strength (BFS)/modulus (FM) after 24 h and 5 mo in water, and 28-d Ca2+ release in water (by plasma-coupled optical emission spectroscopy). Data were analyzed using analysis of variance/Tukey test (alpha: 5%). DCPD functionalization did not interfere with DC. The composite containing functionalized DCPD showed significantly lower WS and SL in comparison with the material formulated with nonfunctionalized particles. The presence of 10-MDP (as a functionalizing agent or dispersed in the resin phase) reduced the composite's initial BFS and FM. After 5 mo in water, the composite with functionalized DCPD and both glass-only composites were able to maintain their mechanical properties at levels statistically similar to what was observed after 24 h. Ca2+ release was significantly reduced in both formulations containing 10-MDP. In conclusion, DCPD functionalization with 10-MDP increased the composite's resistance to hydrolytic degradation, improving its mechanical stability after prolonged water storage. However, the impaired water transit at the particle-matrix interface led to a reduction in Ca2+ release.

Prolonged polymerization of a universal adhesive in non-carious cervical lesions: 36-month double-blind randomized clinical trial

OBJECTIVE

To evaluate the effect of prolonged (P) polymerization time of a universal adhesive system applied in etch-and-rinse (ER) or self-etch (SE) strategies on the clinical performance of restorations in non-carious cervical lesions (NCCLs), after 36 months of clinical service.

METHODS

A total of 140 restorations were randomly placed in 35 subjects according to the polymerization time groups: ER (10 s); ER-P (40 s); SE (10 s); and SE-P (40 s) at 1,200 mW/cm2. Composite resin was placed incrementally. The restorations were evaluated immediately and after 6, 12, 18, and 36 months using the FDI criteria. Data were analyzed using the Kaplan-Meier survival test for retention loss, and the Kruskal-Wallis' test for secondary outcomes (α = 0.05).

RESULTS

After 36 months, 19 restorations were lost: ER 6, ER-P 2, SE 9, SE-P 2. The retention rates were 82.3% for ER; 94.1 % for ER-P; 73.5 % for SE; and 94.1 % for SE-P, with a significant difference between ER vs. ER-P and SE vs. SE-P, as well as ER vs. SE-P and ER-P vs. SE (p < 0.0001). Minor defects were observed in 18 restorations for the marginal staining criteria: ER 5, ER-P 2, SE 8, SE-P 3; and in 33 restorations for the marginal adaptation criteria: ER 11, ER-P 4, SE 12, and SE-P 6 (p > 0.05). No restorations showed recurrence of caries or postoperative sensitivity.

CONCLUSIONS

A prolonged polymerization time of 40 s improves the clinical performance of the universal adhesive for both adhesive strategies evaluated, even after 36 months.

CLINICAL SIGNIFICANCE

Prolonging the polymerization time of a universal adhesive from 10 to 40 s has been shown to improve its clinical performance when used in NCCLs.

Prolonged application time effects on universal adhesives in non-carious cervical lesions: An 18-month split mouth randomized clinical trial

OBJECTIVE

This double-blind, split mouth randomized clinical trial aimed to assess the clinical performance of Clearfil Universal Bond Quick (CBUq) universal adhesive under different application times (no waiting and waiting) compared to Clearfil SE Bond adhesive in non-carious cervical lesions (NCCLs) over 18 months.

METHODS

One hundred and eighty-three restorations were distributed randomly into three groups based on the adhesive system and waiting time: CUBq without waiting time (CUBq-NW), CUBq with a 20 s waiting time (CUBq-W), and CSE with a 20 s waiting time. After placement, restorations were evaluated after 18 months using the International Dental Federation (FDI) and United States Public Health Service (USPHS) criteria. Statistical analyses involved Friedman repeated measures analysis of variance and Wilcoxon tests, with a significance level set at 5 %.

RESULTS

Over the 18-month period, no restorations were lost across the tested groups. Marginal adaptation evaluation indicated minor discrepancies in 21 restorations (8 CUBq-NW, 6 CUBq-W, and 7 CSE). There were no significant differences observed among the three groups following the 18-month clinical assessment (p > 0.05). Only two restorations showed marginal discoloration after 18 months (1 CUBq-NW and 1 CSE).

CONCLUSIONS

The application of Clearfil Universal Bond Quick using either the "waiting" or "no-waiting" technique exhibited excellent clinical results in NCCLs during the 18-month follow-up period, demonstrating comparable performance to Clearfil SE Bond in all assessed outcomes.

CLINICAL SIGNIFICANCE

The findings suggest that the new universal adhesive applied using the no-waiting technique demonstrates promising clinical performance when compared to conventional application methods.

TRIAL REGISTRATION

ClinicalTrials.gov identifer RBR-69p7mpr.

Clinical performance of non-carious cervical lesions restored with using self-etch mode of adhesives according to the FDI criteria

AIM

The purpose of this study was to evaluate the 18-month retrospective study of self-etch adhesive (Prime&Bond One Select) and self-etch mode of universal adhesives (Single Bond Universal, Gluma Bond Universal) applied to non-carious cervical lesions according to the World Dental Federation criteria.

MATERIALS AND METHODS

Thirty patients without any systemic disease, good oral hygiene, having at least 20 teeth and six non-carious cervical lesions treated using a self-etch mode of adhesives operated between January and March 2017. Accordingly, 335 restorations were evaluated according to the World Dental Federation criteria at 3, 6, 12 and 18 months. Pillai's Trace test was used to determine the interaction of criteria with time and adhesive systems. IBM SPSS Statistics 21.0 program was used in the analysis. Value of P < 0.05 was accepted as a criterion for statistical significance.

RESULTS

At the end of 18 months, participation was 100%. There was a statistically significant difference P < 0.05 between Prime&Bond One Select and Single Bond Universal, Prime&Bond One Select and Gluma Bond Universal in the 18-month period. In terms of marginal staining, fracture of material and retention, recurrence of caries, erosion and abfraction, tooth integrity criteria at the end of the 18 months, Prime&Bond One Select performed clinically very good, Single Bond Universal and Gluma Bond Universal performed clinically good according to World Dental Federation criteria. Marginal adaptation criteria, Prime&Bond One Select, Single Bond Universal and Gluma Bond Universal performed clinically good. Retention loss rate was found to be the lowest in Prime&Bond One Select and the highest in Gluma Bond Universal.

CONCLUSION

Accordingly, 18-month evaluation of all adhesives used in the study showed clinically acceptable results in all of the World Dental Federation criteria.

Bonding performance of universal adhesives to eroded dentine: A 6-year evaluation

OBJECTIVES

To evaluate the microtensile bond strength (µTBS) and nanoleakage (NL) of several universal adhesives to eroded dentine (ED) using etch-and-rinse (ER) and self-etch (SE) strategies, immediately and after 6 years of water storage.

MATERIAL AND METHODS

Four hundred and eighty human molars were distributed into 60 groups according to dentine substrate (sound dentine [SD], eroded with soft drink, or eroded with citric acid), application method of the adhesive (SE or ER), and the adhesives used: 1. All-Bond Universal, 2. Ambar Universal, 3. Clearfil Universal, 4. Futurabond U, 5. One Coat 7 Universal, 6. Peak Universal Bond, 7. Prime&Bond Elect, 8. Scotchbond Universal, 9. Tetric n-bond Universal, and 10. Xeno Select. The restoration was then performed with a composite resin, and the specimens were sectioned into resin-dentine bonded sticks. The sticks were tested (immediately or after 6 years of storage) for µTBS (0.5 mm/min) or used to assess NL. The eroded dentine surfaces were also examined using FE-SEM to evaluate the NL. Data for µTBS were analyzed by four-way ANOVA and Tukey's post-hoc test (a = 0.05), and the NL was analyzed by Kruskal-Wallis and the Wilcoxon Signed Rank Sum test (a = 0.05).

RESULTS

In ED, there was no difference in μTBS and NL between ER and SE strategies (p > 0.05). Most μTBS and NL values obtained for ED were lower and higher, respectively, than those for SD (p < 0.005). Additionally, the worst results (μTBS and NL) were observed for erosion with citric acid groups in comparison with erosion with soft-drink groups (p < 0.007). After 6y, μTBS was generally lower and NL higher for all substrates, adhesives, and strategies (p < 0.05), except for AMB, SBU, and TEU in dentine eroded with citric acid. The lowest μTBS and highest NL values were observed for ABU, FBU, OCU, PUB, PBE, and XEN in both types of eroded dentine and evaluation times (p < 0.002).

CONCLUSION

The use of MDP-containing adhesives seems to be essential to maintain adhesion to eroded dentine. However, other factors such as acidity should be considered.

CLINICAL SIGNIFICANCE

The bonding of eroded dentine is a challenge. However, the use of MDP-containing universal adhesives showed less degradation after long-term evaluation.

Effect of the Absence of HEMA on the Bonding Properties of Universal Adhesive Systems Containing 10-MDP: An In Vitro Study

OBJECTIVES

To evaluate the absence of 2-hydroxyethyl methacrylate (HEMA) on the adhesive properties with enamel and dentin of universal adhesive systems containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP).

METHODS AND MATERIALS

One hundred and twelve caries-free third molars were used to test adhesion to dentin (n=64) and enamel (n=48). For each substrate, teeth were divided into eight experimental groups: four different adhesives each using two adhesive strategies. The adhesives used were: (1) Scotchbond Universal (SBU, 3M Oral Care, St Paul, MN, USA) as a HEMA-containing universal adhesive; (2) Gluma Bond Universal (GBU, Kulzer, Hanau, Germany); (3) Solare Universal Bond (SUB, GC, Tokyo, Japan); and (4) Zipbond Universal (ZIP, SDI, Victoria, Australia) as HEMA-free universal adhesives. The adhesive strategies used were etch-and-rinse (ER) and self-etch (SE). For dentin tests, the occlusal third of the crown of all teeth was removed and an adhesive protocol was applied. After completing the restoration, specimens were sectioned into bonded sticks (0.8 mm 2) and tested for microtensile bond strength (μTBS), in situ degree of conversion (DC), and nanoleakage (NL) by scanning electron microscopy. For enamel tests, teeth were sectioned into four parts (buccal, lingual, and proximal), and an adhesive protocol was applied. After completing the restoration, the specimens were tested for their microshear bond strength (μSBS). For in situ degree of conversion (DC) and nanoleakage (NL) evaluation of enamel, the specimens were sectioned in slices to be evaluated. The data for each substrate were subjected to two-way ANOVA and Tukey's test (α=0.05) for each property evaluated.

RESULTS

The SBU and ZIP adhesives showed the highest μSBS, and DC (dentin and enamel) and lower NL (dentin) values compared to GBU and SUB (p=0.001). However, SBU showed better results in terms of μTBS and μSBS (SE strategy), and DC (dentin and enamel) than ZIP. Strategy ER presented higher values of μTBS and μSBS when compared to strategy SE (p=0.001), except for SBU.

CONCLUSION

The effect of the absence of HEMA in commercial universal adhesive systems on enamel and dentin adhesive properties appears to be material-dependent.

Phosphoric Acid Etch Partially Restores the Initial Bond Strength of Composite to Silver Diamine Fluoride-Treated Enamel Using Universal Adhesives

BACKGROUND

Restoring bonding composite to silver diamine fluoride (SDF)-treated enamel is challenging. This study investigates if phosphoric acid etch restores composite bond strength to SDF-treated enamel using universal adhesives.

METHODS

Twenty-four recently extracted permanent teeth were randomly divided into 4 (2 experimental (SDF) and 2 control (CTR)) groups: SDF+Water: SDF (1 min) then water rinse (15 mL); CTR+Water: no treatment and water rinse (15 mL); SDF+Etch+Water: SDF (1 min), 35% phosphoric acid (40 s) then water rinse (15 mL); CTR+Etch+Water no treatment, 35% phosphoric acid (40 s) then water rinse (15 mL). The enamel surface in all the groups was bonded (All-Bond Universal) to 4-5 mm composite blocks (Z-250). Each sample was sectioned, and 6-8 beams (1 mm × 1 mm) were selected. The micro-tensile bond strength was measured by dividing the micro-tensile force peak by the adhesive surface area. Univariate ANOVA and Chi-square were used for between-group comparisons with p < 0.05.

RESULTS

SDF+Water had significantly lower tensile strength compared to all the groups (p < 0.05). Although no difference was found in the tensile strength between the SDF+Etch+Water and the CTR+Etch+Water, the SDF+Etch+Water had significantly more adhesive failures compared to the CTR+Etch+Water (p = 0.047).

CONCLUSIONS

While phosphoric acid etch seems to restore the initial composite bond strength to SDF-treated enamel, the long-term success of composite restorations bonded to SDF-treated enamel may need further investigation.

Are universal adhesives in etch-and-rinse mode better than old 2-step etch-and-rinse adhesives? One-year evaluation of bonding properties to dentin

OBJECTIVES

This study compared the bonding properties of dentin of three 2-step etch-and-rinse adhesives (2-ERAs) to those of three universal adhesives (UAs) applied with an etch-and-rinse strategy (ER), immediately and after 1 year of water storage.

METHODS

Sixty caries-free molars were divided into 6 groups according to the adhesive systems used (n = 10). The 2-ERA systems included were: 1) Adper Single Bond 2 (SB), 2) Tetric N-Bond (TB), and 3) Ambar (AM); and the UAs systems were: 4) Single Bond Universal (SBU) 5) Tetric N-Bond Universal (TBU), and 6) Ambar Universal (AMU). The occlusal third of each tooth was removed and the adhesives were applied. After the composite build-up, specimens were sectioned and tested for microtensile bond strength (µTBS) and nanoleakage (NL) immediately and after 1 year of water storage. In situ degree of conversion (DC) was only evaluated in the immediate time. For water sorption (WS), solubility (SO), and mass change (MC) tests, 48 disk-shaped specimens were prepared (n = 8) and assessed according to ISO 4049:2009.

RESULTS

UAs showed higher µTBS and lower NL values than 2-ERAs did after 1 year of water storage (p = 0.001). Regarding DC, 2-ERAs showed higher DC values than UAs (p = 0.001). Regarding WS, 2-ERAs showed higher WS values than those of UAs (p = 0.00001), except for AM and AMU. Lower WS was observed for AM than for other 2-ERAs (p = 0.00001).

CONCLUSION

The use of UAs applied with the ER strategy seems to be a more effective technique for maintaining adhesion to dentin substrate than 2-ERAS.

CLINICAL SIGNIFICANCE

This study may support clinicians in selecting the most adequate adhesive system to be used in ER strategy in dentin, demonstrating that UAs were more effective, considering the longevity of the resin restorations.

Acrylamide monomers in universal adhesives

OBJECTIVES

The mono-functional monomer 2-hydroxyethyl methacrylate (HEMA) is often added to universal adhesives (UAs) to improve surface wetting and prevent phase separation. Nevertheless, HEMA promotes water sorption and hydrolysis at adhesive interfaces, hereby affecting long-term bonding to dentin. This study investigated if two acrylamide monomers could replace HEMA in an UA formulation applied in etch-and-rinse (2E&R) and self-etch (1SE) bonding mode.

METHODS

Four experimental UAs were bonded to bur-cut dentin. In addition to 12 wt% 10-MDP, 25 wt% Bis-GMA and 10 wt% TEGDMA as common monomer composition, 20 %wt ethanol and 15 %wt water as solvent, and 3 wt% polymerization-related additives, the four formulations solely differed for either the acrylamide cross-linker monomer 'FAM-201' as TEGDMA alternative and HEMA replacement, the hydroxyethyl acrylamide monomer 'HEAA' as HEMA alternative, HEMA ('HEMA+'), or extra TEGDMA in a HEMA-free control ('HEMA-'), all added in a 15 wt% concentration. The split-tooth study design involved application in 2E&R mode on one tooth half versus 1SE mode on the corresponding half. Micro-tensile bond strength of half of the micro-specimens was measured upon 1-week distilled water storage ('immediate' 1w μTBS), with the other half measured after additional 6-month storage ('aged' 6 m μTBS). Statistics involved linear mixed-effects (LME) modelling (p < .05). Additionally, interfacial TEM characterization, thin-film (TF) XRD surface analysis, LogP determination, and a cytotoxicity assay were carried out.

RESULTS

FAM-201 revealed significantly higher μTBS than HEMA+ at 1w and 6 m when applied both in E&R and SE bonding modes. HEAA's μTBS was significantly lower than that of HEMA+ at 1w when applied in SE mode. TF-XRD and TEM revealed similar chemical and ultrastructural interfacial characterization, including stable 10-MDP_Ca salt nano-layering. FAM-201 was least cytotoxic and presented with an intermediary LogP, while HEAA presented with the highest LogP, indicating high hydrophilicity and water-sorption sensitivity.

SIGNIFICANCE

The acrylamide co-monomer FAM-201 could replace HEMA in an UA formulation, while HEAA not.

Effect of Extra Hydrophobic Resin Layer on Bonding of Universal Adhesive Systems to Enamel

OBJECTIVE

The objective of this study was to compare the effect of solvent in universal adhesives (UA) and the application of an extra layer of hydrophobic bonding resin on enamel shear bond strengths (SBS).

METHODS AND MATERIALS

Crowns of 224 bovine mandibular incisors were embedded in acrylic resin, wet-polished up to 600-grit silicon carbide paper and assigned to 3 UAs with different solvents (n=32): ethanol-based UA (ADU, AdheSE Universal, Ivoclar Vivadent); isopropanol-based UA (PBU, Prime&Bond Universal, Dentsply Sirona); and acetone-based UA (OPT, OptiBond Universal, Kerr Co). The same UAs were also applied with an extra layer of a hydrophobic bonding resin (HLB, Heliobond, Ivoclar Vivadent): ADU + HLB; PBU + HLB; and OPT + HLB. HLB alone was used as control. Enamel was etched with 37.5% H3PO4 (Kerr Gel Etchant, Kerr Co) for 15 seconds, rinsed with water, and air dried. UAs were applied according to the respective manufacturer's instructions. After adhesive application, composite cylinders (Filtek Z250, 3M Oral Care) were built up and light-cured (40 seconds/increment, 40 J/cm2) keeping the light tip in contact with the mold. Specimens were stored in water for 24 hours (24H) or for 6 months (6M). A knife-edged metallic rod (Ø=2.8-mm semicircular notch) loaded the composite cylinders until fracture. Mode of failure was analyzed with optical microscopy (40×). Statistics included twoway analysis of variance (ANOVA; adhesive strategy and water storage) and Tukey honestly significant difference (HSD) post hoc test (α=95%).

RESULTS

Mean enamel SBS ranged from 3.6 (±2.2) MPa (HLB/6M) to 24.7 (±7.1) MPa (ADU + HLB/6M). ANOVA revealed significant differences for adhesive strategy (p≤0.001) but no significant differences for water storage (p>0.05). All UAs resulted in similar mean enamel SBS with or without an extra layer of HLB at 24H. After 6M, only ADU resulted in higher enamel SBS when an extra layer of HLB was applied. All UAs resulted in higher mean enamel SBS than HLB (control). Most failures were adhesive exception for PBU/HLB/6M, which had mostly mixed failures.

CONCLUSIONS

UAs resulted in statistically higher enamel SBS than the nonsolvated hydrophobic bonding resin (control), regardless of the solvent in their composition. Application of an extra layer of hydrophobic bonding resin over UAs did not improve mean enamel SBS for isopropanol- and acetone-based UAs but did improve mean enamel SBS for the ethanol-based UA after 6M. Resin composite bonding to enamel using a hydrophobic bonding resin alone is not recommended.

A randomized clinical study of the performance of self-etching adhesives containing HEMA and 10-MDP on non-carious cervical lesions: A 2-year follow-up study

OBJECTIVE

To evaluate the association of HEMA and 10-MDP in the clinical performance of self-etching adhesives in the restoration of NCCLs during 2-years.

MATERIALS AND METHODS

60 restorations were performed in 17 volunteers and randomized into three groups: G1 (n = 20) - Prime and Bond Universal (10-MDP); G2 (n = 20) - Optibond All-in-One (HEMA); and G3 (n = 20) - Clearfil SE (10-MDP and HEMA). No cavity preparation was performed. After 2 years, the restorations were evaluated using the modified USPHS criteria for retention, marginal adaptation/ staining, postoperative sensitivity and secondary caries. The results were analyzed using Fisher's exact test and Kruskal-Wallis test.

RESULTS

All groups showed 100% retention rate, except G1, who lost two restorations (p > 0.05). Regarding marginal adaptation, G1 showed greater deficiency, as only eight restorations (40%) remained intact (p < 0.05). Regarding marginal staining, G1 and G2 showed higher rate, as only 12 restorations (65%) in each one were free of staining (p < 0.05). All groups showed similar results for postoperative sensitivity and secondary caries (p > 0.05).

CONCLUSION

The association of HEMA and 10-MDP monomers in the self-etching adhesives did not influence the clinical performance of the NCCL restorations with respect to retention, postoperative sensitivity, and incidence of secondary caries. However, positively influenced the marginal adaptation and marginal staining at the 2-year follow-up.

CLINICAL SIGNIFICANCE

The association of HEMA and 10-MDP monomers in the self-etching adhesives positively influence the clinical performance of the NCCL restorations with respect to marginal adaptation and marginal staining.

Effect of adhesive strategy of universal adhesives in noncarious cervical lesions - an updated systematic review and meta-analysis

OBJECTIVE

To determine the effect of adhesive strategy (total etch or self-etch) of universal adhesives in non-carious cervical lesions.

DATA SOURCE

A search was made in PubMed, Scopus, Cochrane, Web Of Science, Open Gray, Clinical Registries.

DATA SELECTION

Randomized Controlled Clinical Trials, studies on non-carious cervical lesions restored using Universal Adhesives, and studies in which universal adhesives have been used in total etch and self -etch strategies were included in this systematic review.

DATA EXTRACTION

A total of 17 articles were included in the systematic review and 13 in the meta-analysis. Meta-analysis was conducted to assess the clinical performance of NCCLs in terms of retention, marginal adaptation, marginal discoloration, secondary caries and post-operative sensitivity at 18, 24, 36 month follow-up using USPHS as well as FDI criteria, separately.

DATA SYNTHESIS

Overall there was no significant difference between total etch and self etch adhesive strategies for any of the five outcome measures using either the FDI or the USPHS criteria. p > 0.05, 95% CI, I² value of 0%. A strongly suspected publication bias in the retention domain was seen at 18 month follow up under FDI criteria.

CONCLUSION

Most universal adhesives show acceptable clinical performance. There is no significant effect of the adhesive strategy of universal adhesives on their clinical performance according to the results of our meta-analysis.

Bond Strength and Adhesion Mechanisms of Novel Bone Adhesives

Bone adhesives offer distinct advantages over the use of screws to attached internal fixation plates (IFPs). As the chemical composition of bone is similar to dentine, it is possible that the types of monomers used to make dentine adhesives could be utilised to affix IFPs to bone. The ability to attach a bio-resorbable IFP to porcine bone was assessed for the monomer 10-methacryloyloxydecyl dihydrogen phosphate (MDP), used either as a homopolymer or a copolymer with urethane dimethacrylate (MDP + U). Additionally, the addition of a priming step (MDP + U + P) was evaluated. The chemical interactions of the monomers with bone were assessed using XRD and imaged using TEM, revealing the formation of nano-layered structures with the MDP primer, something we believe has not been reported on bone. In a 6-week artificial aging study both MDP + U and MDP + U + P demonstrated adequate shear bond strength to affix bio-resorbable IFPs. The cytotoxicity profiles of the adhesive formulations were determined using indirect and direct contact with MC3T3 cells, with indirect conditions suggesting the MDP + U + P is as cytocompatible as the resorbable IFP. The findings of this study suggest our newly developed adhesive has the potential to be used as a bone adhesive to affix bioresorbable IFPs.

Effect of Fluorographene Addition on Mechanical and Adhesive Properties of a New Core Build-Up Composite

This study aims to develop a restorative material having such mechanical and adhesive properties that it can be used both as a reconstruction material and as a luting cement. The experimental core build-up composite (CBC) was derived from a self-adhesive cement by the modification of its chemical formula, requiring the use of dedicated dentin and ceramic primers. The adhesive properties to zirconia and dentin were analyzed with a micro-Shear Bond Strength test (mSBS). The mechanical properties were analyzed by a flexural strength test. The results were compared with those obtained for other commercially available cements and core build-up materials, both before and after addition of 2 wt.% fluorographene. The CBC obtained average values in the mSBS of 49.7 ± 4.74 MPa for zirconia and 32.2 ± 4.9 MPa for dentin, as well as values of 110.9 ± 9.3 MPa for flexural strength and 6170.8 ± 703.2 MPa for Young's modulus. The addition of fluorographene, while increasing the Young's modulus of the core build-up composite by 10%, did not improve the adhesive capabilities of the primers and cement on either zirconia or dentin. The CBC showed adhesive and mechanical properties adequate both for a restoration material and a luting cement. The addition of 2 wt.% fluorographene was shown to interfere with the polymerization reaction of the material, suggesting the need for further studies.

Clinical Outcomes and Quantitative Margin Analysis of a Universal Adhesive Using a Randomized Clinical Trial over Three Years

The effectiveness of a universal adhesive applied in different application modes for the preparation of Class V composite restorations was evaluated both clinically and by quantitative marginal analysis (QMA). In each of the 22 patients, four non-carious cervical lesions (NCCL) were restored with Filtek^™ Supreme XTE (3M). The adhesive Scotchbond^™ Universal (SBU, 3M) was applied in self-etch (SE), selective-enamel-etch (SEE) or etch-and-rinse (ER) modes. The etch-and-rinse adhesive OptiBond^™ FL (OFL, Kerr) served as a control. The restorations were clinically evaluated (FDI criteria) after 14 days (BL), 6, 12, 24, and 36 months. Additionally, QMA was conducted on all restorations of 11 randomly selected patients. The FDI criteria and marginal gap were statistically compared between the groups at each recall as well as for the time periods between recalls. The cumulative failure rate was non-significantly higher in the OFL group when compared to all of the SBU groups. Marginal adaptation in the OFL and SBU-SE/ER groups was significantly decreased (BL-36 m, p: 0.004) in comparison to the SBU-SEE group (BL-36 m, p: 0.063). More marginal gaps were found in the OFL group than in the SBU-SEE (BL to 36 m, p: 0.063-0.003) and SBU-ER (24/36 m, p: 0.066/0.005) groups as well as in the SBU-SE group when compared to the SBU-SEE (12-36 m, p_i ≤ 0.016) and SBU-ER (24/36 m, p: 0.055/0.001) groups. SBU-SEE performed most effectively. The clinical evaluation and QMA corresponded, yet QMA detected group differences earliest after 6 months and is thus a valuable extension to clinical evaluations.

The durability of resin-dentine bonds are enhanced by epigallocatechin-3-gallate-encapsulated nanohydroxyapatite/mesoporous silica

Biomimetic nanohydroxyapatite (nHAp) has long been used as a biocompatible material for bone repair, bone regeneration, and bone reconstruction due to its low toxicity to local or systemic tissues. Various cross-linkers have been employed to maintain the structure of collagen; these include epigallocatechin-3-gallate (EGCG), which can fortify the mechanical properties of collagen and withstand the degradation of collagenase. We hypothesized that EGCG combined with nHAp may promote resin-dentin bonding durability. Here, we examined the effect of epigallocatechin-3-gallate-encapsulated nanohydroxyapatite/mesoporous silica (EGCG@nHAp@MSN) on thermal stability and remineralization capability of dentin collagen. Dentin slices (2 × 2 × 1 mm³ ) were obtained and completely demineralized in a 10% phosphoric acid water solution. The resulting dentin collagen matrix was incubated with deionized water, EGCG, nHAp@MSN, and EGCG@nHAp@MSN. The collagen thermal degradation temperature was assessed utilizing differential scanning calorimetry analysis, which indicated that EGCG, nHAp@MSN, and EGCG@nHAp@MSN reinforced collagen's capability to resist thermal degradation. EGCG@nHAp@MSN resulted in the highest increase in denaturation temperature. Thermogravimetric analysis showed that both nHAp@MSN and EGCG@nHAp@MSN achieved a higher residual mass than the EGCG and control groups. Fourier transform infrared spectroscopy was performed to examine the interaction between EGCG@nHAp@MSN and dentin collagen. The EGCG@nHAp@MSN sample exhibited stronger dentin microhardness and uppermost bond strength after thermocycling. EGCG significantly enhanced collagen's capability to resist thermal degradation. In summary, EGCG and nHAp@MSN may work together to assist the exposed collagen to improve resistance to thermal cycling and promote remineralization while also strengthening the durability of resin-dentin bonds.

Hydroxyapatite Affects the Physicochemical Properties of Contemporary One-Step Self-Etch Adhesives

The study aimed to evaluate the influence of the manipulation surfaces on the physical properties of one-step self-etch adhesives (1-SEAs). Scotchbond Universal (SBU), Clearfil Universal Bond Quick ER (UBQ), and an experimental adhesive (UBQ_exp) were manipulated on different surfaces: manufacturer's Teflon-based dispensing dish (TD) or hydroxyapatite plate (HA). After manipulation of the adhesives, the pH of each 1-SEA was measured. Samples of each adhesive/manipulation surface were prepared and subjected to water sorption (WS)/solubility (SL) and flexural strength tests. The modulus of elasticity (E) was measured in dry and wet conditions before and after 24 h water storage, and the percentage of variation of E (ΔE) was calculated. Results were analyzed using the t-test with Bonferroni corrections (α = 0.05). When adhesives were manipulated on the HA plate, there was a significant increase in the adhesives' pH. WS and SL of all 1-SEAs decreased when the HA was used. Only SBU showed higher flexural strength when manipulated on the HA compared to the manipulation on TD under dry and wet conditions. For each 1-SEA, the use of HA resulted in significantly higher E in dry and wet conditions. ΔE of all adhesives was smaller with the manipulation on HA than on TD. It was concluded that the manipulation of 1-SEA on a hydroxyapatite plate considerably affected the adhesives' properties.

The effect of desensitizing agents on the bond strength of dentin bonding agents: A systematic review

Background

Dentinal hypersensitivity (DH) is a common dental problem and is treated non-invasively using topical application of various desensitizing agents. When there is loss of tooth structure or tooth preparation is to be followed by a bonded restoration, it requires application of dentin bonding agent. However, the effect of desensitizers on bond strength is still controversial.

Aim and Objective

To evaluate the influence of different desensitizing agents on the bond strength of the dentin bonding agents.

Methods and Materials

PICO strategy was used to formulate the research question. In-vitro studies conducted on human teeth to evaluate the bond strength of dentin bonding agent following the application of desensitizing agent were included. Electronic databases PubMed and Cochrane and google scholar were searched using search terms alone or in combination from the year 2010 till 2020. Search was conducted using the key words and MeSH terms (hypersensitivity, bond strength, dental adhesives, dentin bonding agents). The title and abstract were read to verify the inclusion and exclusion criteria and if further any details required, full article was accessed to check the criteria and then included or excluded. Data extraction was done using a customized data extraction form. The risk of bias was evaluated using modified Cochrane Collaboration Quality Assessment tool.

Results

Total no of studies identified in the search were 146, after scrutiny 23 articles were eligible to be included in this study. Out of 23 articles, 17 articles were of medium bias and 6 articles were of high risk after risk of bias assessment.

Conclusion

According to the various articles included in this study, GLUMA and 8.0%Arginine and CaCO3 when used as desensitizing agents along with different bonding agents, were found to be highly compatible without interfering with the bond strength of the dentin adhesives.

Evaluating the shear bond strength and remineralization effect of calcium silicate-based and conventional self-adhesive resin cements to caries-affected dentin

OBJECTIVE

Given the importance of preserving caries-affected dentin (CAD) in conservative dentistry, the shear bond strength (SBS) of different resin cements to CAD has been investigated. Here, we aimed to compare the SBS and remineralizing effect of a calcium silicate (TheraCem) and conventional self-adhesive cement (Panavia SA) on the SBS of CAD.

MATERIALS AND METHODS

Forty-eight extracted third molars (24 sound and 24 CAD) were used. In each group, 12 teeth were prepared for bonding to TheraCem or Panavia SA. After removal of the enamel and caries, resin composite cylinders were luted on the prepared dentin. After 28 days of storage in the artificial saliva, SBS was measured and the failure mode analysis was investigated. The images of fractured sections were analyzed using scanning electron microscopy and energy-dispersive X-ray to evaluate the Ca/P weight ratio.

RESULTS

SBS of CAD and sound dentin was not different when cemented with TheraCem (9.56 ± 4.51 vs. 9.17 ± 2.76, p = .806), but the CAD showed significantly lower SBS to Panavia SA (9.4 ± 2.36 vs. 7.39 ± 2.18, p = .015). The Ca/P ratio in CAD was significantly higher when bonded to both TheraCem and Panavia-SA than that of the controls (p = .001); however, this ratio was not different for those bonded to TheraCem compared to Panavia SA.

CONCLUSIONS

Based on our results, TheraCem as a calcium silicate cement shows better SBS to attach the restoration to CAD as compared to Panavia SA. Obliteration and mineralization of the dentinal tubules in TheraCem were also higher than in Panavia SA. However, their ability to improve the amount of the Ca/P ratio in CAD was similar.

Influence of Irradiance and Exposure Times on the Mechanical and Adhesive Properties of Universal Adhesives with Dentin

OBJECTIVES

This study evaluated the influence of irradiance/exposure time on the Knoop hardness (KHN) and polymer cross-linking density (PCLD), as well as microtensile bond strength (μTBS), nanoleakage (NL), and in situ degree of conversion (DC) of universal adhesives.

METHODS AND MATERIALS

Two universal adhesive systems, Clearfil Universal Bond Quick (CUQ) and Scotchbond Universal Adhesive (SBU), were light-cured using various irradiance/exposure times: 1400 mW/cm2 for 5 s (1400*5); 1400 mW/cm2 for 10 s (1400*10); 3200 mW/cm2 for 5 s (3200*5); and 3200 mW/cm2 for 10 s (3200*10). Adhesive disks from each group were used to measure PCLD by KHN. One hundred and twenty-eight human molars were randomly assigned to 16 groups according to the following variables: adhesive system vs adhesive strategies vs radiance/exposure times. After restoration, specimens were sectioned into resin-dentin sticks and tested for μTBS, NL, and DC. The data from PCLD (%), KHN, μTBS (MPa), NL (%), and DC (%) data were subjected to ANOVA and Tukey's test (α=0.05).

RESULTS

Significant reductions in KHN, μTBS, and DC (p=0.00001) values and an increase in NL and PCLD (p=0.00001) values were observed for 3200*10 when compared with other groups. Higher KHN, μTBS, and DC (p=0.000001) values were observed for 3200*5 in comparison with the other groups. The 1400*5 (7 J/cm2) and 1400*10 (14 J/cm2) groups showed intermediate values (p=0.000001).

CONCLUSION

Although similar results in terms of hardness, polymer cross-linking density and nanoleakage were observed when 5 seconds at 3200 mW/cm2 and 10 seconds at 1400 mW/cm2 groups were compared, the use of higher irradiance (3200 mW/cm2) for only 5 seconds showed better results in terms of bond strength and degree of conversion for both universal adhesives to dentin. The prolonged exposure time (10 seconds) at the higher irradiance (3200 mW/cm2) showed the worst results.

Injectable Click Fibroin Bioadhesive Derived from Spider Silk for Accelerating Wound Closure and Healing Bone Fracture

Wound closure is a critical step in postoperative wound recovery. Substantial advancements have been made in many different means of facilitating wound closure, including the use of tissue adhesives. Compared to conventional methods, such as suturing, tissue bioadhesives better accelerate wound closure. However, several existing tissue adhesives suffer from cytotoxicity, inadequate tissue adhesive strength, and high costs. In this study, a series of bioadhesives was produced using non-swellable spider silk-derived silk fibroin protein and an outer layer of swellable polyethylene glycol and tannic acid. The gelation time of the spider silk-derived silk fibroin protein bioadhesive is less than three minutes and thus can be used during rapid surgical wound closure. By adding polyethylene glycol (PEG) 2000 and tannic acid as co-crosslinking agents to the N-Hydroxysuccinimide (NHS), and 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) reaction, the adhesive strength of the bioadhesive became 2.5 times greater than that of conventional fibrin glue adhesives. Silk fibroin bioadhesives do not show significant cytotoxicity in vitro compared with other bioadhesives. In conclusion, silk fibroin bioadhesive is promising as a new medical tool for more effective and efficient surgical wound closure, particularly in bone fractures.

The roles of 10-methacryloyloxydecyl dihydrogen phosphate and its calcium salt in preserving the adhesive-dentin hybrid layer

OBJECTIVES

10-Methacryloyloxydecyl dihydrogen phosphate (MDP) has been regarded as the most effective dentin-bonding monomer for more than 20 years. Although the dentin-bonding promoting effect of MDP has been well demonstrated, the mechanisms by which it benefits the stably of collagen within the adhesive-dentin hybrid layer are not currently fully understood. The objective of this study was to investigate the roles of MDP and its calcium salt in preserving the adhesive-dentin hybrid layer.

METHODS

MDP-conditioned collagen was investigated by Fourier-transform infrared spectroscopy, Ultraviolet-visible spectroscopy, and molecular docking. The structural changes to the dentin surface upon acid-etching and MDP-conditioning were observed by SEM. X-ray diffraction and nuclear magnetic resonance were used to investigate the chemical interactions between MDP and HAp. The collagen-protecting effects of MDP and its Ca salt were investigated using in-situ zymography, rhMMP-9 colorimetric assay, hydroxyproline assay, and molecular docking.

RESULTS

MDP forms a stable collagen-phosphate complex through hydrogen bonding with the collagen in dentin. Furthermore, it generates MDP-Ca salts that are deposited on the dentin collagen scaffold, protecting it from degradation. Moreover, both free MDP and the MDP-Ca salt inhibit matrix metallopeptidase and exogenous proteases, with the inhibitory effect of the calcium salt being significantly stronger than that of the free form.

SIGNIFICANCE

MDP-based adhesives preserve the collagen within the hybrid layer by simultaneously improving collagen's resistance to exogenous enzymes and inhibiting MMP activity, both of which contribute to the longevity of dentin-resin bonding.

Evaluation of the Bond Strength of Self-Etching Adhesive Systems Containing HEMA and 10-MDP Monomers: Bond Strength of Adhesives Containing HEMA and 10-MDP

The aim of this in vitro study was to assess the bond strength of self-etching adhesives containing HEMA and 10-MDP monomers. Twenty-four bovine teeth were divided into three groups. Two cylinders of composite resin were made in each tooth (n = 16): G1-Prime and Bond Universal (control); G2-OptiBond All-in-One (HEMA); and G3-Clearfil SE (10-MDP and HEMA). After 24-hour storage in distilled water, the specimens were fixed to a universal testing machine (Kratos Equipamentos Ltda.) for the microshear test at a speed of 0.5 mm/min. A qualitative analysis of the fracture pattern was also performed using scanning electron microscopy (500× magnification). The normality of sample data distribution was determined using the Shapiro–Wilk test. The results were assessed using the Kruskal–Wallis test, and α level of 5% was used for the analysis. The results indicated a statistical difference (p > 0.05) between G3 (15.6080 MPa) and G2 (11.2180 MPa). No statistical difference was observed when G1 (14,6325 MPa) was compared with the other two groups. It was also observed that a mixed fracture pattern was predominant in all groups. The self-etching adhesive containing HEMA and 10-MDP monomers showed to be promising in increasing the bond strength between the dental substrate and the composite resin, whereas the adhesive containing only HEMA exhibited lower bond strength to dentin.

Impact of Immediate and Delayed Photo-activation of Self-adhesive Resin Cements on Bonding Efficacy and Water Uptake Under Simulated Pulpal Pressure

This study investigated the effect of immediate versus delayed photo-activation on the bonding performance and water uptake of self-adhesive (SA) resin cements under simulated pulpal pressure (SPP). The occlusal dentin surface was exposed in 66 extracted third molars. Resin composite cylinders were cemented to dentin under SPP, with either RelyX Unicem 2 (RU) (3M Oral Care, St Paul, MN, USA) or Maxcem Elite (MC) (Kerr, Orange, CA, USA). Each cement group was equally divided into three groups (n=8 each) according to the time elapsed between placement and photo-activation: immediate activation (IM), 30-second delayed activation (D30), or 120-second delayed activation (D120). Shear bond strength (SBS) was measured, and the type of failure was determined using a stereomicroscope. Three additional samples from each experimental subgroup were used for confocal laser scanning microscopy (CLSM) analysis. A fluorescent dye solution was added to the pulpal fluid reservoir, then a CLSM was used to detect the dye distribution within the tooth-restoration interface. Two-way analysis of variance (ANOVA) and the Tukey post-hoc test were used to analyze the SBS results (α=0.05). D30 resulted in a significantly higher mean SBS in the two cement groups than IM and D120 (p<0.05). RU showed significantly higher SBS values than MC regardless of the time of light activation (p<0.05). RU showed less dye uptake confined to the cement-dentin interface compared to the MC groups, which showed dye uptake throughout the entire thickness of the cement layer and gap formation at the interface, especially in the D120 group. The 30-second photo-activation delay group significantly improved the bond strength of SA cements. Delaying the photo-activation to 120 seconds increased pulpal fluid uptake by SA cements and compromised the integrity of the bonded interfaces.

Interactions of two phosphate ester monomers with hydroxyapatite and collagen fibers and their contributions to dentine bond performance

OBJECTIVES

To evaluate the interactions of two phosphate ester monomers [10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and dipentaerythritol penta-acrylate phosphate (PENTA)] with hydroxyapatite and collagen and understand their influence on dentine bonding.

METHODS

Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, nuclear magnetic resonance, ultraviolet-visible, and molecular docking were applied for separately evaluating the interactions of two monomers with hydroxyapatite and collagen. Hydrophilicity tests and morphological observation were employed to characterize pretreated dentine. Microtensile bond strength (μTBS) and nanoleakage were investigated to evaluate the bonding performance. Hydroxyproline assay, in situ zymography, and matrix metalloproteinase-9 (MMP-9) activity assay were used to confirm the MMP inhibition.

RESULTS

Chemoanalytic characterization confirmed the interactions of 10-MDP and PENTA with hydroxyapatite and collagen. The interactions of PENTA were weaker than 10-MDP. PENTA possessed better dentine tubule sealing after etching than 10-MDP. Dentine treated with PENTA was more hydrophilic than 10-MDP. 10-MDP and PENTA treating significantly increased the initial μTBS than the control group without primer conditioning. μTBS decreased significantly during aging, and the decrease was more severe in the PENTA group than 10-MDP. The 10-MDP and PENTA groups exhibited relatively less fluorescence than the control. The relative inhibition percentages of MMP-9 decreased in the order of 10-MDP-Ca salt, 10-MDP and PENTA. The 10-MDP, PENTA, and 10-MDP-Ca salt groups showed significantly lower hydroxyproline contents than the control.

CONCLUSIONS

Although PENTA adsorbed on hydroxyapatite, it did not form a stable calcium salt. The interactions of 10-MDP with hydroxyapatite and collagen are different than those of PENTA.

CLINICAL SIGNIFICANCE

The sealing of dentinal tubules by PENTA and the inhibition of MMP by 10-MDP and its calcium salts contribute to improving the dentine bonding durability.

Influence of Acidic Environment on Hydrolytic Stability of MDP-Ca Salts with Nanolayered and Amorphous Structures

Purpose

This study aimed to investigate the hydrolytic stability of 10-methacryloyloxydecyl dihydrogen phosphate calcium (MDP-Ca) salts with nanolayered and amorphous structures in different pH environments.

Methods

The MDP-Ca salts were synthesized from MDP and calcium chloride and characterized by X-ray diffraction (XRD), nuclear magnetic resonance (NMR), and transmission electron microscopy (TEM). Inductively coupled plasma-mass spectrometry (ICP-MS) was used to quantify the release of calcium from the synthesized MDP-Ca salt, MDP-treated hydroxyapatite (MDP-HAp), and untreated HAp after soaking in acidic and neutral solutions for 1, 7, and 30 days. To study the hydrolytic process, we carried out molecular dynamics (MD) simulations of the nanolayered MCS-MD (monocalcium salt of the MDP dimer) and DCS-MD (dicalcium salt of the MDP dimer) structures, as well as of the amorphous-phase MCS-MM (monocalcium salt of the MDP monomer).

Results

The TEM images showed that the nanolayered structures were partially degraded by acid attack. Based on the ICP-MS results, the hydrolysis rate of the MDP-Ca salt in acidic and neutral environments followed the order HAp > MDP-HAp > MDP-Ca salt. The MD simulations showed that, in acidic environments, clusters of MDP remained aggregated and all Ca²⁺ ions separated from the MDP monomer to interact with water molecules in aqueous solution. In neutral environments, Ca²⁺ ions always interacted with phosphate groups, OH⁻ ions, and water molecules to form clusters centered on Ca²⁺ ions.

Conclusion

MDP-Ca presented higher hydrolysis rates in acidic than neutral environments. Nanolayered MCS-MD possessed the highest resistance to acidic hydrolysis, followed by amorphous MCS-MM and DCS-MD.

Five-year Randomized Clinical Trial on the Performance of Two Etch-and-rinse Adhesives in Noncarious Cervical Lesions

OBJECTIVES

To evaluate the 5-year clinical performance of two-step etch-and-rinse adhesives in noncarious cervical lesions (NCCL).

METHODS AND MATERIALS

The sample comprised 35 adults with at least two similar-sized NCCL. Seventy restorations were placed, according to one of the following groups: Adper Single Bond 2 (SB) and Ambar (AM). The restorations were placed incrementally using a resin composite (Opallis). The restorations were evaluated at baseline and after 6 and 18 months and 5 years using some items of the FDI criteria. The differences in the ratings of the two materials after 6 months, 18 months, and 5 years were performed with Friedman repeated measures ANOVA by rank and McNemar test for significance in each pair (α=0.05).

RESULTS

Five patients did not attend the 60-month recall. No significant differences were observed between the materials for any criteria evaluated. Twenty-one restorations failed (12 for SB and 9 for AM) after 60 months. Thus, the retention rate for SB at 60 months were 55.6% for SB and 71% for AM (p=0.32). After 60 months, 12 restorations (6 for SB and 6 AM) showed some loss of marginal adaptation (p=1.0). Slight marginal discoloration was observed in 10 restorations (6 for SB and 4 AM; p=0.91). Five restorations (2 for SB and 3 for AM) showed recurrences of caries (p=1.0).

CONCLUSIONS

Both two-step etch-and-rinse adhesives-Adper Single Bond 2, a polyalkenoic acid-containing adhesive, and Ambar, a 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing adhesive-showed acceptable clinical performance after 60 months.

Visualization of Ion|Surface Binding and In Situ Evaluation of Surface Interaction Free Energies via Competitive Adsorption Isotherms

Function and properties at biologic as well as technological interfaces are controlled by a complex and concerted competition of specific and unspecific binding with ions and water in the electrolyte. It is not possible to date to directly estimate by experiment the interfacial binding energies of involved species in a consistent approach, thus limiting our understanding of how interactions in complex (physiologic) media are moderated. Here, we employ a model system utilizing polymers with end grafted amines interacting with a negatively charged mica surface. We measure interaction forces as a function of the molecule density and ion concentration in NaCl solutions. The measured adhesion decreases by about 90%, from 0.01 to 1 M electrolyte concentration. We further demonstrate by molecular resolution imaging how ions increasingly populate the binding surface at elevated concentrations, and are effectively competing with the functional group for a binding site. We demonstrate that a competing Langmuir isotherm model can describe this concentration-dependent competition. Further, based on this model we can quantitatively estimate ion binding energies, as well as binding energy relationships at a complex solid|liquid interface. Our approach enables the extraction of thermodynamic interaction energies and kinetic parameters of ionic species during monolayer level interactions at a solid|liquid interface, which to-date is impossible with other techniques.

Improved bond performances of self-etch adhesives to enamel through increased MDP-Ca salt formation via phosphoric acid pre-etching

OBJECTIVES

The chemical affinity between 10-methacryloyloxydecyl dihydrogen phosphate (MDP) and hydroxyapatite (HAp) is an important factor in the enamel bonding provided by MDP-based self-etch (SE) adhesives, besides microinterlocking mechanisms. This study aimed to investigate how phosphoric acid pre-etching affects MDP-Ca salt formation in the application of MDP-based SE adhesives.

METHODS

Single Bond Universal (SBU), All Bond Universal (ABU), Clearfil Universal Bond Quick (CBQ), and a MDP-based all-in-one adhesive (EXP) were used in both SE and etch-and-rinse (ER) modes, along with Clearfil SE Bond and untreated enamel (UE) as controls. The MDP-Ca salts produced with or without etching were examined by nuclear magnetic resonance, Raman spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, and Fourier-transform infrared spectroscopy. Zeta potential, contact angle, and scanning electron microscopy measurements were employed to elucidate the mechanism behind the changes in MDP/HAp chemical affinity upon pre-etching.

RESULTS

The percentage of MDP-Ca salt in EXP_ER (73.13%) was higher than that in EXP_SE (43.27%). Characteristic CH₂ (1130, 1441, 2853, and 2909 cm^-1), CC (1641 cm^-1), and CO (1718 cm^-1) bands were observed in the Raman spectra of EXP_ER. Pre-etching increased the negative zeta potential of the enamel surface compared to that of UE (P < 0.001). The contact angles of MDP-based adhesives applied to pre-etched enamel were significantly lower than those of the self-etched surface (P < 0.05).

SIGNIFICANCE

The increased MDP-Ca salt formation is a significant advantage of phosphoric acid pre-etching, improving the MDP/HAp chemical affinity in addition to increasing surface wettability.

Does Addition of 10-MDP Monomer in Self-etch Adhesive Systems Improve the Clinical Performance of Noncarious Cervical Lesion Restorations? A Systematic Review and Meta-analysis

BACKGROUND

Functional acidic monomers are able to chemically interact with hydroxyapatite, and this bond appears to be very stable. Therefore, this aspect of the 10-MDP molecule made it attractive and added to self-etch adhesives.

OBJECTIVES

The objective of this Systematic Review (SR) and Meta-analysis (MA) was to determine whether systems with the 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) functional monomer in their formula showed better clinical performance in restorations placed in noncarious cervical lesions (NCCL) when compared to systems without it. The PROSPERO registration number of the MA is CRD42016050538.

DATA AND SOURCES

An e-search was conducted through MEDLINE via PubMed, Cochrane Library, Scopus, Web of Science, OpenGrey, Clinical Trials, Current Controlled Trials, and EU Clinical Trials Register, and a search through the references of included studies was also performed. Randomized Controlled Clinical Trials, in which the effectiveness of self-etch adhesive systems, with or without the 10-MDP functional monomer for NCCL, was discussed, were included. Risk of bias was performed according to the Cochrane Collaboration tool, and the certainty of evidence was evaluated through GRADE.

STUDY SELECTION

The data were grouped, heterogeneity (I2) was tested, and after duplicate removal, 4208 manuscripts were retrieved. From these, 11 studies were included in the qualitative analysis (risk of bias), with nine classified as low risk and two unclear. GRADE analysis detected moderate-to-high certainty of evidence, so the quantitative synthesis [Meta-analysis (MA)] was performed including the 11 studies.

RESULTS AND CONCLUSION

There were no statistical differences in the clinical performance of restorations conducted using "with or without 10-MDP" adhesive types, for all evaluated criteria (p=0.05), with heterogeneity ranging from 0% to 53%. Thus, the presence of 10-MDP functional monomer did not influence the clinical performance of restorations placed in NCCL.

Fluoride-Releasing Self-Etch Adhesives Create Thick ABRZ at the Interface

A fluoride-releasing adhesive system is expected to promote mineralization of demineralized dentin/enamel around a composite restoration, thereby contributing to the longevity of the restoration. Scanning electron microscopic (SEM) and transmission electron microscopic (TEM) observations revealed the formation of an “acid–base resistant zone” (ABRZ) beneath the hybrid layer when dentin was treated with a self-etch adhesive system. A thicker ABRZ was formed from the upper slope to the end of the outer lesion, indicating greater resistance against an acid-base challenge, when a fluoride-releasing self-etch adhesive system was used. The slope formation of a fluoride-releasing adhesive is believed to be due to fluoride-release from the adhesive. Quantitative assessment of the acid resistance was performed at the interface using the region of interest (ROI) mode of a digital image analysis software package. The area of the ABRZ is influenced by the concentration of fluoride release from the adhesive resin. The threshold of fluoride concentration in the adhesive may exist to influence the morphology of the ABRZ. X-ray absorption fine structure (XAFS) analysis of the dentin treated with different concentrations of NaF-mouth rinses suggested that different fluoride concentrations result in the formation of different chemical compounds, such as fluorapatite and CaF₂-like structures, on the dentin surface. This may explain the differences in μTBS values and morphological appearance of the ABRZ. NaF is effective in enhancing the enamel/dentin bond durability and also helps create a high quality of ARBZ to improve the clinical success of restorations.

Effect of different adhesive strategies and storage time on bond strength of bifunctional monomers to simulated endodontically-treated dentin

Adhesive strategies were evaluated on the bond strength of bi-functional monomers bonded to endodontically-treated-dentin (ETD). Superficial dentin was removed on human molars. Teeth were immersed in 5 mL 2.5% NaOCl, followed by immersion in 5 mL 17% EDTA. Dentin surface impregnated with epoxy resin-based sealer was then divided four groups (n=10): Scotchbond Multi-Purpose (SBMP); Single Bond Universal (SBU); Optibond All-in-One (OPB); and Tetric-N-Bond Universal (TBU). After 24-h or 1-year-of-storage specimens were submitted to microtensile bond strength (µTBS) and failure classification. A confocal laser scanning microscope (CLSM) evaluated the hybrid layer formation. Two-way ANOVA and Tukey-HSD test were performed (α=5%). The µTBS did not present statistical differences among adhesive strategies after 24-h. Significant differences were found after 1-year-of-storage. CLSM analysis showed water infiltration and consequently degradation of the hybrid layer after 1-year-of-storage. The use of SBU universal adhesive on the self-etching mode on ETD produced more stable bond over the 1-year-of-storage.

Effects of Solvents and pH Values on the Chemical Affinity of 10-Methacryloyloxydecyl Dihydrogen Phosphate toward Hydroxyapatite

This study aimed to investigate the effects of solvents and pH values on the chemical interaction between 10-methacryloyloxydecyl dihydrogen phosphate (MDP) and hydroxyapatite (HAp). The chemical affinity of MDP toward HAp dissolved in different solvents (E-MDP: 10 wt % MDP and 90 wt % ethanol; E-W-MDP₁: 10 wt % MDP, 75 wt % ethanol, and 15 wt % water; A-W-MDP: 10 wt % MDP, 75 wt % acetone, and 15 wt % water; and E-W-MDP₂: 10 wt % MDP, 45 wt % ethanol, and 45 wt % water) was investigated. The pH of E-W-MDP₂ was increased from 2.04 to 5 (E-W-MDP_2/5) and to 7 (E-W-MDP_2/7). The reaction products were characterized by Fourier transform infrared spectroscopy, X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA), and nuclear magnetic resonance (NMR). XRD and NMR results revealed that no MDP-calcium salt formed in E-MDP. XRD, TGA, and XPS results indicated that MDP interacted with HAp, producing the MDP-calcium salt in all groups except E-MDP. NMR results revealed that the dicalcium salt of the MDP dimer (DCS-MD) and the MDP tripolymer (DCS-MT) and the monocalcium salt of the MDP monomer and the MDP dimer were formed in E-W-MDP₁. DCS-MD and DCS-MT were also formed in E-W-MDP₂ and A-W-MDP. In E-W-MDP_2/5 and E-W-MDP_2/7, DCS-MD was obtained. Both the solvents and pH values affect the chemical interactions between MDP and HAp and the types of reaction products formed. MDP and HAp do not form any MDP-calcium salt in pure ethanol; the structural stability of MDP-calcium salts is dependent on the solvent water content and the pH value. The ethanol/water mixture is recommended as the main solvent in an MDP-containing primer, and the ideal pH value is 2-7; if these conditions are satisfied, sufficient amounts of MDP-calcium salts with stable structures are expected to be formed, thus improving the longevity of dentin/enamel bonding.

Varying 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) level improves polymerisation kinetics and flexural strength in self-adhesive, remineralising composites

OBJECTIVES

To assess the influence of systematically varying concentrations of 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) versus 3% 4-META on the polymerisation kinetics and shrinkage, biaxial flexural strength (BFS) and modulus of remineralising composites.

METHODS

Composites were prepared by adding poly(propylene glycol) dimethacrylate (24 wt%), camphorquinone (1 wt%) and MDP (0%, 5%, 10%, 15% and 20 wt%) or 4-META (3%) to urethane dimethacrylate. These were mixed with glass fillers containing 8 wt% monocalcium phosphate and 4 wt% polylysine (powder-liquid ratio of 3:1). Continuous spectral changes, following 20 s light exposure (37 °C), were assessed with an ATR-FTIR to monitor polymerisation kinetics (n = 3). Final extrapolated conversions (D_C,max) were employed to calculate polymerisation shrinkage. BFS and modulus of 24-h dry stored disc specimens (10 × 1 mm; n = 10) were determined using a ball-on-ring jig setup.

RESULTS

Maximum rate of polymerisation and D_C,max increased linearly from 2.5 to 3.5% s^-1 and 67 to 83%, respectively, upon increasing MDP from 0 to 20 wt%. Values with 3% 4-META were 2.6% s^-1 and 78%. Shrinkage was 3.8 ± 0.3% for all formulations. Raising 4-META or MDP from 0 to 3 versus 5%, respectively, increased strength from 106 to 145 versus 136 MPa. A decreasing trend with higher MDP concentrations was noted. Elastic modulus showed no specific trend upon MDP increase.

SIGNIFICANCE

Whilst final conversion levels were enhanced by 3% 4-META or >5% MDP, trends did not correlate with strength. Peak strengths with 3% 4-META or 5% MDP may therefore be due to acidic monomers providing linkage between the hydrophilic, non-silane treated particles and the polymer matrix.

Chemical interaction between 10-methacryloyloxydecyl dihydrogen phosphate and methacryloxypropyltrimethoxysilane in one-bottle dental primer and its effect on dentine bonding

In the present study, we investigated the chemical interaction between 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and methacryloxypropyltrimethoxysilane (gamma-MPS) in one-bottle primer solutions and its effect on dentine bonding performance. Solutions containing 10 wt% 10-MDP and/or gamma-MPS at 0, 1, 5, 10, or 15 wt% were prepared, providing 10 experimental groups (labeled MDP/MPSxx or MPSxx, where MDP indicates the presence of 10 wt% MDP and xx is the wt% of gamma-MPS in the solution). Phosphoric-acid-etched dentine blocks were prepared from human molars and conditioned in the solutions before being used to build resin-dentine-bonded specimens, which were subsequently subjected to microtensile bond strength (μTBS) testing after 24-h or six-months water storage. Interfacial nanoleakage was evaluated by SEM observation. All the primer-conditioned samples showed significantly higher initial μTBS values than that of the control group, and six-months water storage significantly lowered the μTBS for all the groups; however, the decreases for MDP/MPS10 and MDP/MPS15 were significantly greater than those for MDP/MPS1 and the control solution. Furthermore, MDP/MPS10 and MDP/MPS15 groups also showed more serious nanoleakage. Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, and X-ray diffraction analyses were used to investigate the chemical affinity between 10-MDP and hydroxyapatite (HAp). In XRD analysis, the intensities of peaks assigned to 10-MDP-calcium salts were lower for the solutions containing gamma-MPS. Overall, the results indicate that the copresence of gamma-MPS (above 10 wt%) and 10-MDP in one-bottle primer solutions inhibit the formation of 10-MDP-calcium salts, leading to increased long-term nanoleakage and decreased bonding durability.

The Effects of Amalgam Contamination and Different Surface Modifications on Dentin Shear Bond Strength When Using Different Adhesive Protocols

PURPOSE

To evaluate the effect of amalgam contamination, different surface treatments, and adhesive protocols on dentin shear bond strength (SBS) to bulk-fill composite resin material.

MATERIALS AND METHODS

Eighty teeth were fixed in molds, and the dentin was exposed and then polished. Sixty teeth were restored by amalgam and thermocycled to 10,000 cycles (5°C and 55°C, 30-second dwell time). The rest were restored with composite materials without amalgam predecessor. The samples were divided into G1 (with dentin pretreatment with 2% chlorhexidine gluconate), G2 (0.5 mm of dentin was removed), G3 (no surface modification), and G4 (samples were restored with bulk-fill composite). The bonded specimens were subdivided based on the adhesive protocol of the universal adhesive system used into etch-and-rinse and self-etch groups. Acid etching was done using 32% phosphoric acid. Composite resin was used for build-up using mold and glass. Specimens were cured and left for 24 h in distilled water at room temperature for polymerization reaction, underwent thermocycling for 5000 cycles, and were subjected to knife-edge shear bond testing. Descriptive statistics, independent t-tests, and one-way analysis of variance followed by pairwise comparisons were used to analyze the results.

RESULTS

The highest mean SBS values were found in the control group where acid etching was used (24.46±2.24 MPa), followed by self-etching in the same group (21.92±2.54 MPa). Lower SBS values were associated with the amalgam-contaminated group. The lowest values were found in the dentin refreshment group when the self-etching mode was used (13.59±1.73 MPa). Chlorhexidine treatment improved the mean SBS value compared with the no treatment or dentin refreshment groups for both adhesive protocols.

CONCLUSION

Amalgam contamination may affect SBS values. Acid etching improved SBS for non-contaminated dentin. Chlorhexidine improved SBS for amalgam-contaminated dentin as a surface treatment but had no significant effect.

Development of self-adhesive pulp-capping agents containing a novel hydrophilic and highly polymerizable acrylamide monomer

Several studies have shown the clinical success of hydraulic calcium-silicate cements (hCSCs) for direct and indirect pulp capping and root repair. However, hCSCs have various drawbacks, including long setting time, poor mechanical properties, low bond strength to dentin, and relatively poor handling characteristics. To overcome these limitations, a light-curable, resin-based hCSC (Theracal LC, Bisco) was commercially introduced; however, it did not exhibit much improvement in bond strength. We developed a light-curable self-adhesive pulp-capping material that contains the novel acrylamide monomer N,N'-{[(2-acrylamido-2-[(3-acrylamidopropoxy)methyl]propane-1,3-diyl)bis(oxy)]bis(propane-1,3-diyl)}diacrylamide (FAM-401) and the functional monomer 4-methacryloxyethyl trimellitate anhydride (4-MET). Two experimental resin-based hCSCs containing different calcium sources (portlandite: Exp_Pl; tricalcium silicate cement: Exp_TCS) were prepared, and the commercial hCSCs Theracal LC and resin-free hCSC Biodentine served as controls. The performance of each cement was evaluated based on parameters relevant for vital pulp therapy, such as curing degree on a wet surface, mechanical strength, as determined using a three-point bending test, shear bond strength to dentin, cytotoxicity, as determined using an MTT assay, and the amount of calcium released, as determined using inductively coupled plasma atomic emission spectrometry. Both experimental cements cured on wet surfaces and showed relatively low cytotoxicity. Furthermore, their flexural and shear bond strength to dentin were significantly higher than those of the commercial references. High calcium release was observed for both Exp_Pl and Biodentine. Thus, Exp_Pl as a new self-adhesive pulp-capping agent performed better than the commercial resin-based pulp-capping agent in terms of mechanical strength, bond strength, and calcium release.

Touch-Cure Polymerization at the Composite Cement-Dentin Interface

Ceramic restorations are often adhesively luted onto the tooth prep. The so-called touch-cure concept was developed to yield optimum polymerization of composite cement at the restoration-cement-tooth interface for immediate bond stabilization. Although this touch cure is theorized to initiate polymerization at the interface when the accelerator in the primer makes contact with the cement, this process has not yet been proven. This study aimed to elucidate the mechanism of touch cure by measuring the degree of conversion (DC) of composite cement applied with or without an accelerator-containing tooth primer (TP) versus an accelerator-free primer using real-time Fourier-transform infrared spectroscopy (RT-FTIR) and attenuated total reflection (ATR)-FTIR. Interfacial bond strength was measured in shear mode, the accelerator composition confirmed by X-ray fluorescence analysis (XRF), and the interfacial interaction of TP and composite cement with dentin investigated by X-ray diffraction (XRD), focused-ion-beam scanning electron microscopy (FIB-SEM) with 3-dimensional interface reconstruction, and transmission electron microscopy (TEM). RT/ATR-FTIR revealed the significantly highest DC when the composite cement was applied with the accelerator-containing primer. XRF disclosed a vanadium compound as a novel chemical accelerator within TP, instead of a classic chemical curing initiator system, to set off touch cure as soon the cement contacts the previously applied primer. Although the TP contains the acidic functional monomer 10-MDP for adhesion to tooth tissue, touch cure using the accelerator-containing TP combined the fastest/highest DC with the highest bond strength. FIB-SEM and TEM confirmed the tight interfacial interaction at dentin with submicron hybridization along with stable 10-MDP also Ca-salt nanolayering.

High-resolution mechanical mapping of the adhesive-dentin interface: The effect of co-monomers in 10-methacryloyloxydecyl dihydrogen phosphate

The presence of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) at the adhesive-dentin interface enables ionic binding to calcium salts, which results in rigid nano-layering within the submicron scale resin-dentin interdiffusion zone. MDP has been used with additional co-monomers, such as hydroxyethyl methacrylate (HEMA) and/or 4-methacryloyloxyethyl-trimellitic acid (4-MET), mainly to enhance the chemical bonding properties. However, the use of co-monomers may compromise the rigidity of the adhesive-dentin interface. In this study, we use high-resolution mechanical mapping across the interface to discern the in situ mechanical properties of each target region at the nanoscale. Visualization by modulus mapping demonstrated that HEMA increases the diffusion properties of MDP into dentin structures. However, the rigidity of the adhesive-dentin interface indicated by the storage modulus was markedly lower in MDP containing HEMA than in MDP containing 4-MET. Dynamic indentation testing revealed that the bonding layer was more deformable in the presence of HEMA. Moreover, the presence of MDP in the bonding layer might also increase the deformability because the polymerization linearity allows a large degree of viscoelasticity. These factors also diminish the rigidity of the adhesive-dentin interface. Within the limitations of this study, our findings demonstrated that 4-MET is a better co-monomer than HEMA in MDP-based dental adhesives. Modulus mapping and nanoindentation are introduced as new tests for the adhesive-dentin interface to address queries about the effectiveness of dental adhesives.

Biomimetic fabrication and application of fibrous-like nanotubes

AIMS

To investigate the biomimetic fabrication of fibrous-like organic-inorganic hybrid structures via a simple bottom-up approach, viz. self-assembly of simple molecules, and apply fibrous-like composites as a novel primer to improve dentin bond strengths of self-etch adhesives.

MATERIALS AND METHODS

The resultants of commercial amorphous calcium phosphate (ACP) nanoparticles and 10-methacryloyloxydecyl dihydrogen phosphate (MDP) ethanol-aqueous solution were analyzed by TEM, SEM, XRD, DLS and AFM. The acid and alkali resistance of abovementioned self-assembled composites were analyzed with TEM. Micro-tensile bond strengths (MTBS) tests were performed after polished dentin surfaces were pretreated with self-assembled composites. The pretreated dentin surfaces and dentin-resin interfaces were characterized by SEM/TEM.

KEY FINDINGS

ACP nanoparticles in MDP solution could self-assemble into fibrous-like nanotube structures in 8 nm diameter. Self-assembly and self-proliferation process went from ACP nanoparticles, dissolved ACP nanoparticles (less than 50 nm), twig-like structures and fibrous-like nanotubes to cellular networks. The fibrous-like nanotubes were only detected when the amount of ACP in reaction system were more than 0.01 g. The more ACP interacted with MDP, the more fibrous-like nanotubes were formed. After the dentin surfaces were treated with fibrous-like nanotube composites, MTBS could be significantly improved. Moreover, the fibrous-like nanotube structures could be resistant to acidic challenge, and were stable at least for 3 months.

SIGNIFICANCE

The fibrous-like nanotube structures could be self-assembled via a bottom-up approach at certain ratio of MDP and commercial ACP nanoparticles. The application of fibrous-like nanotube composites as a novel primer prior to self-etch adhesives greatly improved dentin bond strengths.

Nano-Layering Adds Strength to the Adhesive Interface

X-ray diffraction (XRD) surface analysis and ultrastructural interfacial characterization using transmission electron microscopy (TEM) confirmed that the functional monomer 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) self-assembles into nano-layers at adhesive-tooth interfaces. Self-assembled nano-layering is thought to contribute to the durability of bonding to tooth dentin, although this has not been proven yet. In order to disclose this potential bond-durability contribution of nano-layering, we observed the 3-dimensional (3D) spreading of nano-layering by a series of focused-ion-beam (FIB) milled cross sections by scanning electron microscopy (FIB-SEM) and examined the mechanical properties of self-assembled nano-layering using scanning probe microscopy (SPM). A commercial 10-MDP-containing 3-step self-etch adhesive partially demineralized dentin up to submicron depth, forming a submicron hydroxyapatite-rich hybrid layer. TEM chemically and ultrastructurally confirmed the formation of interfacial nano-layering. FIB-SEM 3D reconstructions disclosed a 3D network of self-assembled nano-layering extending from the hybrid layer up to within the adjacent adhesive-resin layer. SPM revealed that nano-layering within the adhesive-resin layer possessed a higher elastic modulus than that of the surrounding adhesive resin, hereby suggesting that nano-layering contributes to the mechanical strength of adhesives like filler particles do. Nano-layering's 3D expanded structure is expected to strengthen the surrounding resin, as well to better interconnect the adhesive-resin layer to the hybrid layer. In conclusion, this exploratory study demonstrated that nano-layering constitutes a strong phase at the adhesive interface, which may contribute to the clinical longevity of the 10-MDP-based bond to dentin.

Effects of remaining dentin thickness, smear layer and aging on the bond strengths of self-etch adhesives to dentin

This study evaluated the effects of remaining dentin thickness (RDT), different smear layers, and aging on the microtensile bond strength (µTBS) of universal adhesives to dentin when applied in self-etch mode. Ninety-six human third molars were randomly allocated to 12 groups (n=8) based on adhesives: Clearfil^TM SE Bond 2 (SE, control), Clearfil^TM Universal Bond (CU) and ScotchBond^TM Universal Adhesive (SB); smear layers: prepared either with 600-grit SiC paper (P) or regular diamond bur (B); and aging: stored in distilled water at 37ºC for 24 hours (24h) or 1 year (1y). µTBS was significantly affected by the type of adhesives, smear layers, and aging (p<0.001). A statistically significant and positive linear relationship was also observed between µTBS and RDT (p<0.05) in all the tested groups, except for SEB1y and CUB24h (p>0.05). RDT, smear layer types, and aging can influence the bonding performances of universal adhesives when applied in self-etch mode.

Effect of different adhesive strategies on the microtensile bond strength of dentin to indirect resin-based composite

Background

To evaluate the microtensile bond strength of indirect resin composite bonded to dentin using five different adhesives strategies.

Material and Methods

Forty specimens (Solidex) were produced and randomly into five groups with different adhesives strategies: (G1)- Single Bond Universal + etch + silane + RelyX Ultimate, (G2)- Single Bond Universal + silane + RelyX Ultimate, (G3)- Single Bond Universal + etch + RelyX Ultimate, (G4)- Single Bond Universal + RelyX Ultimate, and (G5)-Scotchbond Multi-purpose + RelyX ARC. After cementation the specimens were stored in 100% humidity for 24hours at 37°C. The specimens were sectioned perpendicular to the adhesive interface to obtain beams and submitted to microtensile test. Microtensile values were expressed in MPa and analyzed by one-way ANOVA and multiple comparison Tukey tests (α=0.05).

Results

The mean bond strength in MPa groups were: G1=11,48, G2=14,15, G3=16,95, G4=17,03 and G5=16,80. Statistical analysis showed that the bond strength values were not significantly affected by the different adhesive strategies.

Conclusions

Cementation of dentin to indirect resin composite cannot be significantly affected by different adhesive strategies used. The specimens treated with silane, etch associated with Single bond universal did not increase bond strength values. Key words:Adhesives, dental cements, dentin.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Current perspectives on dental adhesion: (1) Dentin adhesion - not there yet

The essential goal of any adhesive restoration is to achieve a tight and long-lasting adaptation of the restorative material to enamel and dentin. The key challenge for new dental adhesives is to be simultaneously effective on two dental substrates of conflicting nature. Some barriers must be overcome to accomplish this objective. While bonding to enamel by micromechanical interlocking of resin tags within the array of microporosities in acid-etched enamel can be reliably achieved and can effectively seal the restoration margins against leakage, bonding effectively and durably to organic and humid dentin is the most puzzling task in adhesive dentistry.

Much of the research and development of dental adhesives has focused on making the clinical procedure more user-friendly by reducing the number of bottles and/or steps. Although clinicians certainly prefer less complicated and more versatile adhesive materials, there is a trade-off between simplification of dental adhesives and clinical outcomes. Likewise, new materials are launched with claims of being novel and having special properties without much supporting evidence.

This review article discusses dental adhesion acknowledging pioneer work in the field, highlights the substrate as a major challenge to obtain durable adhesive restorations, as well as analyzes the three adhesion strategies and their shortcomings. It also reviews the potential of chemical/ionic dental adhesion, discusses the issue of extensively published laboratory research that does not translate to clinical relevance, and leaves a few thoughts in regard to recent research that may have implications for future adhesive materials.

Influence of acidic monomer concentration and application mode on the bond strength of experimental adhesives

The aim of this research was to evaluate the influence of MDP (10-methacryloyloxydecyl dihydrogen phosphate) concentration and application mode of experimental adhesives on microshear bond strength (μSBS) to dentin after storage in distilled water at 37°C for 24h and 6 months. Five experimental adhesives were prepared with: CQ, DABE, BHT, ethanol, HEMA, TEGDMA, Bis-EMA, UDMA, and Bis-GMA. Concentrations of 0 wt%, 3 wt%, 9 wt%, 12 wt% or 15 wt% of MDP were added to their composition. The adhesives were applied to flat dentin surfaces in etch-and-rinse or self-etching modes. Cylindrical molds filled with light-cured composite resin were placed above the dentin. The specimens were stored in distilled water at 37oC for 24h or 6 months and submitted to μSBS testing. The adhesives were also submitted to pH analysis. The data were analyzed by one-way ANOVA, three-way ANOVA and Tukey's test (α = 5%). All the adhesives used in the etch-and-rinse mode showed significantly higher bond strength than the adhesives applied in the self-etching approach. The 9 wt% adhesive showed the highest bond strength values, and 3 wt% was most stable after storage. A strong negative correlation between MDP concentration and pH was observed. It was concluded that the formulations with low concentrations of MDP (up to 9 wt%) showed better results for bond strength and bond strength degradation over time.