Hybridization quality in cervical cementum and superficial dentin using current adhesives

Navigating the practical-knowledge gap in deep margin elevation: A step towards a structured case selection - a review

The deep margin elevation (DME) technique has gained popularity because of numerous supporting case reports. However, some clinicians are cautious regarding using this technique owing to the lack of clear case selection criteria for DME application. This review aimed to analyze case reports and a series of DME cases to determine pre-/post-operative evaluation methods that could be used to suggest a pre-operative case selection checklist for DME. An electronic database search was conducted in June 2021 and updated by June 2023 using selected terms from PubMed, Cochrane Library, Google Scholar, EBSCO, and Scopus. The search was limited to English-language publications and was not restricted to the date. The inclusion criteria were case reports/series addressing periodontal and restorative outcomes of DME. The search identified 217 articles, 76 of which were pertinent. However, only six case reports and one case series satisfied the inclusion criteria. None of the selected studies followed any reporting guidelines, which led to significant information gaps. While the reviewed studies reported favorable outcomes, standardized protocols for evaluating pre-/post-operative restorative and periodontal status were lacking. The post-operative follow-up period varied from 3 months to 6 years. Designing and implementing pre-/post-operative guidelines hold the potential for ensuring the safe application of the DME technique. This may enhance our understanding of the suitability and efficacy of such non-invasive technique in future clinical trials.

Clinical significance

Handling deep cavities and preparing crowns are challenging. However, a lack of understanding of when to perform DME can lead to missed opportunities for conservative treatment, thereby a disservice to the patient. Provision of safe guidelines should be employed by clinicians until further evidence either supports or contradicts this treatment method.

Hybridization quality and bond strength of adhesive systems according to interaction with dentin

Objective:

To evaluate the hybridization quality and bond strength of adhesives to dentin.

Materials and Methods:

Ten human molars were ground to expose the dentin and then sectioned in four tooth-quarters. They were randomly divided into 5 groups according to the adhesive used: Two single-step self-etch adhesives – Adper Prompt (ADP) and Xeno III (XE), two two-step self-etching primer systems – Clearfil SE Bond (SE) and Adhe SE (ADSE), and one one-step etch-and-rinse system – Adper Single Bond (SB). Resin composite (Filtek Z250) crown buildups were made on the bonded surfaces and incrementally light-cured for 20 s. The restored tooth-quarters were stored in water at 37°C for 24 h and then sectioned into beams (0.8 mm² in cross-section). Maximal microtensile bond strength (μ-TBS) was recorded (0.5 mm/min in crosshead speed). The results were submitted to one-way ANOVA and Tukey's test (α = 0.05). Thirty additional teeth were used to investigate the hybridization quality by SEM using silver methenamine or ammoniacal silver nitrate dyes.

Results:

SE reached significantly higher μ-TBS (P < 0.05); no significance was found between ADSE and XE (P > 0.05), and between SB and ADP (P > 0.05); ADSE and XE were significantly higher than SB and ADP (P < 0.05). The bonding interface of SB showed the most intense silver uptake. SE and ADSE showed more favorable hybridization quality than that observed for ADP and XE.

Conclusions:

The bond strength and hybridization quality were affected by the interaction form of the adhesives with dentin. The hybridization quality was essential to improve the immediate μ-TBS to dentin.

Interfacial Nanoleakage and Bonding of Self-Adhesive Systems Cured with a Modified-Layering Technique to Dentin of Weakened Roots

Objective

The purpose of the study was to evaluate the nanoleakage and bond strength of different self adhesive systems cured with a modified-layering technique (MLT) to dentin of weakened roots.

Methods

Twenty-one maxillary incisors were decoronated and then root canals were instrumented and obturated with the cold lateral compaction technique. Weakened roots were simulated by flaring root canals until only 1 mm dentin thickness remained. Teeth were distributed into three groups. The canals were backfilled with Vertise Flow (VF group), a self-adhering system, following a modified-layering technique using two light-transmitting posts, sizes 6 and 3. DT Light Post size 2 was cemented using the same material. Remaining roots were prepared and cured in the same way as the VF group. However, in the TS/MF group, Clearfil Tri-S Bond (TS) adhesive and Clearfil Majesty Flow (MF) composite were used, while in the ED/PF group, ED primer II (ED)/Panavia F2.0 (PF) were used. After one week of storage, each root was sectioned to obtain six slices (two slices from each root third: coronal, middle and apical) of 0.9 ± 0.1 mm thickness. Interfacial nanoleakage expression was analyzed using a field emission scanning electron microscope (FEG-SEM), and the micro push-out bond strength (μPOBS) was measured at different root regions. Modes of failure were also determined using SEM. Data were statistically analyzed using two-way analysis of variance with repeated measures and Tukey post hoc test (p≤0.05).

Results

With MLT, all adhesive systems showed nanoleakage. For μPOBS, there was a statistically significant effect for adhesive systems (p&lt;0.001) but not for root region (p&lt;0.64) or for their interaction (p=0.99). Tukey post hoc test revealed that the bond strength of the VF group was significantly higher than the TS/MF and ED/PF groups for all root regions.

Conclusion

All of the tested self-adhesive systems cured using MLT had slight nanoleakage and were not sensitive to root regional differences. Self-adhering systems had higher bond strength than self-etch adhesives.

Bond strength and nanoroughness assessment on human pretreated cementum surfaces

OBJECTIVES

To determine the bond strength of seven adhesive systems to human cementum, and to assess the promoted surface roughness.

METHODS

Extracted human canines were used for the present study. The mesial surface from the cervical third of the roots were ground flat with wet 600-grit silicon carbide paper and bonded. Seven adhesive systems were employed: an etch-and-rinse adhesive (Single Bond), two two-step self-etching (Clearfil SE Bond and Resulcin Aquaprime) and four one-step self-etching (One-up Bond F, Prompt-L-Pop, Etch and Prime 3.0 and NRC+Prime&Bond NT). Composite build-ups were constructed and stored in a humid environment for 24h at 37 degrees C. Specimens were sectioned into 1mm(2) beams and tested for microtensile bond strength (MTBS). Additional surfaces were conditioned for atomic force microscopy (AFM) analysis. Results were analyzed with ANOVA and Student-Newman-Keuls tests (P<0.05).

RESULTS

Single Bond showed the highest MTBS values. No differences were found between Resulcin Aquaprime, One-up Bond and Prompt-L-Pop. Clearfil SE Bond, Etch and Prime and NRC+Prime&Bond NT obtained the lowest bond strength values. H(3)PO(4) acid treatment of cementum and Resulcin Aquaprime showed the highest nanoroughness parameters and One-up Bond the lowest.

CONCLUSION

The etch-and-rinse adhesive and the two-step self-etching adhesive with the lowest pH value promoted the highest bond strength to human cementum surfaces.

Comparison of microleakage of three adhesive systems in class V composite restorations prepared with Er,Cr:YSGG laser

OBJECTIVE

This study compared microleakage of three adhesives in class V (CI V) composite restorations prepared with Er,Cr:YSGG laser.

BACKGROUND DATA

Changes produced on enamel and dentin surfaces subsequent to laser irradiation influence microleakage of composite restorations.

MATERIALS AND METHODS

CI V cavities were prepared in 80 sound extracted human premolars with Er,Cr:YSGG laser. The teeth were randomly divided into 4 groups (n = 20). In group 1, a total-etch adhesive was used, and two-step and one-step self-etch adhesives were used in groups 2 and 3, respectively. Group 4 was the control group with no adhesives. Following restoration and thermocycling, microleakage was evaluated. To compare microleakage in occlusal and gingival margins in each group, the Wilcoxon test was used. Kruskal-Wallis analysis was used for comparison of occlusal and gingival microleakage, and two-by-two comparisons were made using the Mann-Whitney U test.

RESULTS

There were significant differences in microleakage between occlusal and gingival margins in each group except for the control group. Significant differences were observed in occlusal and gingival microleakage among all the groups. Two-by-two comparisons revealed significant differences in occlusal microleakage between the control group and the other groups. There were significant differences in gingival microleakage between groups 1 and 2 and groups 1 and 3; however, differences in gingival microleakage between groups 2 and 3 were not significant.

CONCLUSION

With all the adhesives, microleakage was significantly higher in gingival margins compared with occlusal margins. In occlusal margins, there were no significant differences in microleakage among the three adhesives. In gingival margins, self-etch adhesives revealed less microleakage than the total-etch adhesive.