Measurement of dentin permeability and wetness by use of the Periotron device

The microtensile bond strength test: Its historical background and application to bond testing

Microtensile bond strength (μTBS) test was introduced in 1994. Since then, it has been utilized profoundly across many bond strength testing laboratories, making it currently one of the most standard and versatile bond strength test. Although it is a static and strength-based method, together with the morphological and spectroscopic investigations, it has been contributing immensely in the advancement of dentin adhesive systems. μTBS test has a greater discriminative capability than the traditional macro-shear bond test. During the early stage of its development, the authors predicted that this testing method would enable evaluation of the adhesive performances of resins to excavated carious or sclerotic dentin and the regional bond strengths of various portions of the cavity. In addition, they also stated the possibility of comparing the long-term stability of resin adhesion at various portions of the cavity walls on teeth extracted at various times after insertion of bonded restorations. In this review, we discussed the historical background, inception and the application of the μTBS test and proposed directions for further improvement of this testing method.

Influence of pulse repetition rate of Er:YAG laser and dentin depth on tensile bond strength of dentin-resin interface

The study evaluated the in vitro influence of pulse-repetition rate of Er:YAG laser and dentin depth on tensile bond strength of dentin-resin interface. Dentin surfaces of buccal or lingual surfaces from human third molars were submitted to tensile test in different depths (superficial, 1.0 and 1.5 mm) of the same dental area, using the same sample. Surface treatments were acid conditioning solely (control) and Er:YAG laser irradiation (80 mJ) followed by acid conditioning, with different pulse-repetition rates (1, 2, 3, or 4 Hz). Single bond/Z-250 system was used. The samples were stored in distilled water at 37 degrees C for 24 h, and then the first test (superficial dentine) was performed. The bond failures were analyzed. Following, the specimens were identified, grounded until 1.0- and 1.5-mm depths, submitted again to the treatments and to the second and, after that, to third-bond tests on a similar procedure and failure analysis. ANOVA and Tukey test demonstrated a significant difference (p < 0.001) for treatment and treatment x depth interaction (p < 0.05). The tested depths did not show influence (p > 0.05) on the bond strength of dentin-resin interface. It may be concluded that Er:YAG laser with 1, 2, 3, or 4 Hz combined with acid conditioning did not increase the resin tensile bond strength to dentin, regardless of dentin depth.

Polymerization kinetics of dental adhesives cured with LED: correlation between extent of conversion and permeability

OBJECTIVES

The aim of this study was to analyze the polymerization kinetics of different adhesive films in relation to their permeability after exposure to different LED curing units.

METHODS

One adhesive from each class was analyzed: a three-step etch-and-rinse (OptiBond FL; Sybron-Kerr), a two-step etch-and-rinse (One-Step, Bisco), a two-step self-etch (Clearfil Protect Bond, Kuraray) and a one-step self-etch adhesive (Xeno III; Dentsply DeTrey). Adhesive films were prepared and cured with SmartLite IQ (Dentsply) or L.E. Demetron I (Demetron Kerr) up to complete curing. Polymerization kinetic curves of the tested adhesives were obtained with differential scanning calorimetry (DSC). In particular, total reaction time and extent of polymerization (Ep) at 20, 40 or 60s were compared. Permeability of the adhesive films was evaluated on flat dentin surfaces of human extracted teeth connected to a permeability device and statistically analyzed.

RESULTS

Total reaction time differed among the adhesives tested: OptiBond FL<Clearfil Protect Bond<One-Step<Xeno III with both curing units (p<0.05). At 20s OptiBond FL showed the highest Ep, while the lowest values were obtained with One-Step and Xeno III (p<0.05). E(p) increased when curing time was prolonged (40 and 60s) for all adhesives tested (p<0.05), however, on simplified adhesives, incomplete polymerization took place even after prolonged exposure intervals. An inverse correlation was found between Ep of the adhesives and their permeability using LED curing units.

SIGNIFICANCE

This study supports the hypothesis that, longer curing times than those recommended by the respective manufacturer decrease permeability of the bonded interfaces.

Effect of Resin Coating on Adhesion of Composite Crown Restoration

The purpose of this study was to evaluate the effect of a resin coating technique on the microtensile bond strength (microTBS) of resin cement to dentin in composite crown restorations. Crown preparations were done on human molars. A resin coating material, Hybrid Bond, was immediately applied to the prepared dentin and light-cured, while the tooth without resin coating acted as the control. An impression of the resin-coated tooth was taken, and a composite crown fabricated on the working cast. The composite crown was then bonded with a resin cement, Chemiace II. MicroTBSs were measured at a crosshead speed of 1 mm/min, and the resin-coated group yielded significantly higher microTBSs than the non-coated group (p < 0.05). In terms of microTBS values between the axial and occlusal surfaces, no regional differences in resin-dentin bond strength were detected (p < 0.05). It was concluded that resin coating with Hybrid Bond significantly improved the microTBS of resin cement to dentin in composite crown restorations.

Degree of conversion and permeability of dental adhesives

The aim of this study was to analyse the extent of polymerization of different adhesive films in relation to their permeability. One adhesive of each class was investigated: OptiBond FL; One-Step; Clearfil Protect Bond; and Xeno III. Adhesive films were prepared and cured with XL-2500 (3M ESPE) for 20, 40 or 60 s. Polymerization kinetic curves of the adhesives tested were obtained with differential scanning calorimetry (DSC) and data were correlated with microhardness. The permeability of the adhesives under the same experimental conditions was evaluated on human extracted teeth connected to a permeability device and analysed statistically. The results showed that the extent of polymerization obtained from DSC exotherms was directly correlated with microhardness. An increased level of polymerization after prolonged light-curing was confirmed for all adhesives. Simplified adhesives exhibited a lower extent of polymerization and showed incomplete polymerization, even after 60 s. An inverse correlation was found between the degree of cure and the permeability. This study supports the hypothesis that the permeability of simplified adhesives is correlated with incomplete polymerization of resin monomers and the extent of light exposure. These adhesives may be rendered less permeable by using longer curing times than those recommended by the respective manufacturer.

The effect of simulated intrapulpal pressure on bond strength to enamel and dentine

The purpose of this study was to evaluate the effect of simulated intrapulpal pressure on the shear bond strength (SBS) of a self-etching bonding system (Clearfil Liner Bond II) to both enamel and dentine surfaces. Forty-two caries-free human molar teeth were randomly assigned to two equal groups (n=21). One group of 21 teeth was connected to a special pulpal pressure machine, which is developed to simulate in vivo conditions. The buccal and lingual surfaces of the teeth were prepared with a diamond wheel to create flat dentine and enamel surfaces. A self-etching bonding system was then applied under pulpal pressure and 2.5 mm diameter composite cylinders were bonded to the prepared surfaces. The samples were then stored in distilled water at room temperature for 24 h under pulpal pressure before SBS was tested. The second restored group was used as a control and the teeth were not connected to the pulpal pressure apparatus during material application and test procedures. They were stored for 24 h in distilled water at room temperature before the SBS test. Fracture analysis of the enamel and dentinal surfaces was performed using a stereomicroscope. Shear bond strength values to dentine was significantly reduced with pulpal pressure (P < 0.001). However, in the enamel, SBS was increased (P < 0.001). In the control group, the SBS values to dentine and enamel did not show any significant difference (P > 0.05). Based on these results, it can be concluded that further analysis of enamel histology and bonding mechanisms are needed.

Effect of region and dentin perfusion on bond strengths of resin-modified glass ionomer cements

OBJECTIVES

The purpose of this study was to evaluate the hypothesis that regional differences and pulpal pressure would significantly affect bond strengths of resin-modified glass ionomer cements to dentin.

METHODS

Twenty-six extracted caries-free human third molars were ground to expose middle dentin and were randomly divided into two groups for bonding: no pulpal pressure and pulpal pressure of 15cm H(2)O. Fuji II LC, Vitremer, or Photac-Fil Quick were applied to the previously pre-treated surfaces and light-cured as recommended by the manufacturers. After immersion in water at 37 degrees C for 24h, the teeth were sectioned to 0.7mm thick slabs, divided into pulp horn, center, and peripheral regions according to visual criteria, and trimmed along the bonded interface for microtensile bond test to a cross-sectional area of 1mm(2). The slabs were subjected to tensile forces and the data analyzed using ANOVA and Fisher's PLSD at the 95% level of confidence.

RESULTS

For Fuji II LC, bond strengths to the pulp horn regions were significantly lower than those to the other regions independent of pulpal pressure (p<0.05). On the other hand, regional bond strengths were not observed for Vitremer and Photac-fil Quick 0.05).

CONCLUSIONS

Pulpal pressure had a stronger influence on bond strengths and failure modes of resin-modified glass ionomers than regional differences of the substrate.

Dentine permeability and tracer tests

OBJECTIVES

This paper reviews the evidence for dentine's permeability in order to clarify and emphasize its confounding effect on leakage test measurements, and hence the need to use special test designs to avoid its effects.

METHODS

The literature on the subject between 1887 and 1997, including 249 articles.

CONCLUSIONS

The prerequisite condition for any tracer penetration test is that unflawed specimens are themselves impermeable to tracer. Entry of tracer then can be used to indicate correctly the location or severity of flaws. The relative impermeability of intact dental enamel permits such testing of the enamel-restoration interface seal, but the same is not true when using dentine, which is usually frankly porous to most tracers through its tubules. False positive results are very likely. Recent intense interest in dentine bonding agents has increased the need and frequency of these tests with dentine, but this serious confounding factor has so far generally remained unstated, and has only been controlled adequately in one study. If tracer penetration test results are to be meaningful, then adequate control is required.

Effect of intrinsic wetness and regional difference on dentin bond strength

OBJECTIVES

The aim of this investigation was to determine the influence of intrinsic wetness on regional bond strengths of adhesive resins to dentin.

METHODS

Human caries-free third molars were randomly divided into three groups for bonding: Group 1--no pulpal pressure; Group 2--pulpal pressure of 15 cm H2O; and Group 3--dentin dried overnight in a desiccator. Clearfil Liner Bond II (Kuraray) or One Step (Bisco) adhesive resins systems were applied to the flat dentin surfaces and the teeth were restored with APX resin composite (Kuraray). After 24 h in water at 37 degrees C, the specimens were sectioned into 0.7 mm thick slabs and divided into three regional subgroups according to the remaining dentin thickness and visual criteria: pulp horn, center, and periphery. The slabs were then trimmed for the micro-tensile bond test and subjected to a tensile force and crosshead of 1 mm/min. The data were analyzed with ANOVA and Fisher's PLSD test at a confidence level of 95%. The fracture modes were determined under a scanning electron microscope (JXA-840, JEOL, Japan).

RESULTS

No significant regional difference was observed for the Group 1 and 2 specimens restored with Clearfil Liner Bond II (p > 0.05). However, bond strengths significantly decreased at the pulp horn region of the Group 1 and 2 specimens restored with One Step (p > 0.01). All bond strengths of Group 3 decreased significantly and regional differences were not evident (p > 0.05).

SIGNIFICANCE

The dentin adhesive system should be chosen according to the substrate and region to be bonded, since bond strengths can vary according to the intrinsic wetness, region, and the adhesive system.

Dentine permeability and dentine adhesion

OBJECTIVES

The objectives of this paper are to review the structure of dentine as it pertains to adhesive bonding and to describe the importance of resin permeation into dentinal tubules and into spaces created between collagen fibrils by acid-etching during resin bonding. The advantages and disadvantages of separate acid-etching, priming and adhesive applications are discussed.

DATA SOURCES

Although not an exhaustive review, the concepts included in the review were obtained from the dentine bonding literature.

STUDY SELECTION

Attempts were made to critically evaluate what is known about dentine permeability and adhesion and what remains to be discovered. Speculations were made on a number of controversial issues that are not yet resolved.

CONCLUSIONS

Acid-etching of dentine produces profound changes in the chemical composition and physical properties of the matrix which can influence the quality of resin-dentine bonds, their strength and perhaps their durability.

Current concepts on adhesion to dentin

This review examines fundamental concepts in bonding to dentin. Emphasis is placed on the structure and permeability characteristics of dentin and how they may influence its interaction with adhesive resin. Several new techniques to examine the interfaces between resin and dentin are reviewed along with some of their limitations. The advantages and disadvantages of acid etchants/conditioners vs. self-etching conditioners/primers are discussed. The problems of matching the surface tension of resin-bonding systems to the surface energy of the substrate are reviewed in terms of wetting the various components of dentin. The problems associated with matching the permeability of intertubular dentin to the diffusibility of bonding reagents are explored. Speculation is advanced on how to ensure polymerization and wetting of dentinal collagen. Theoretical problems associated with dentin bonding and with bond testing are reviewed to encourage future research in this rapidly developing area.

Dynamics of the pulpo-dentin complex

Dentin has a relatively high water content due to its tubular structure. Once dentin is exposed, this intratubular water is free to move in response to thermal, osmotic, evaporative, or tactile stimuli. Fluid shifts across dentin are thought to cause sufficient shear forces on odontoblasts, nerve endings, nearby fibroblasts, and blood vessels to cause significant mechanical irritation, disruption, or damage, depending on the magnitude of the fluid shift. Even in the absence of fluid shifts, the water-filled tubules provide diffusion channels for noxious (i.e., bacterial products) substances which diffuse inward toward the pulp, where they can activate the immune system, provide chemotactic stimuli, cytokine production, and produce pain and pulpal inflammation. Viewed from this perspective, dentin is a poor barrier to external irritants. However, pulpal tissues react to these challenges by increasing the activity of nerves, blood vessels, the immune system, and interstitial fluid turnover, to make the exposed dentin less permeable either physiologically, via increased outward fluid flow, or microscopically, by lining tubules with proteins, mineral deposits, or tertiary dentin, thereby enhancing the barrier properties of dentin, and providing additional protection to pulpal tissues. These reactions involve dentin and pulp, both in the initiation of the processes and in their resolution. These responses of the dental pulp to irritation of dentin demonstrate the dynamic nature of the pulpo-dentin complex.

Adaptation of a resin composite in vivo

OBJECTIVE

The adaptation of experimental dentine bonding systems has been evaluated in vivo.

METHODS

A cylindrical cavity which extended into dentine was prepared in the facial surface of vital teeth that were to be extracted for orthodontic reasons. The preparations were restored with a commercial light-activated resin composite that was mediated by experimental dentine bonding systems. The restored teeth were extracted as soon as possible following polymerization of the composite. The marginal and internal adaptation of the resin composite restoration was observed under a light microscope in both horizontal and longitudinal sections of the teeth immediately after extraction.

RESULTS

Of the experimental dentine bonding systems investigated, those including a primer of glyceryl methacrylate showed complete adaptation whereas those with primers of 2-HEMA showed a contraction gap in three out of 10 specimens.

Dentine permeability and bond quality as affected by new bonding systems

OBJECTIVES AND METHODS

The relationship between dentine bonding and the condition of dentine for four dentine bonding systems (All Bond 2, Clearfil Liner Bond, Scotchbond MP and XR Bond) has been examined. Different dentine conditions were evaluated and correlated with adhesion values. Dentine permeability was calculated using a hydraulic pressure apparatus working under physiological pulpal pressure (6.9 kPa), while remaining dentine thickness (RDT) was measured using pincer calipers. Scanning electron microscopic (SEM) examinations were effected to analyse dentine morphology. These evaluations were considered as an index of the condition of dentine. Shear bond strength tests were used to evaluate adhesion. Dentine samples after the bonding systems application were stored for 24 h under pulpal pressure before bond strength was tested.

RESULTS

Scanning electron microscopy examinations indicated that the application of bonding system conditioners caused the removal of smear layer, the demineralization of dentine and the formation of a layer of collapsed collagen fibrils in the intertubular and peritubular dentine. Primers were able to infiltrate the collagen fibrils. A layer of resin infiltrated/reinforced dentine (the so-called 'hybrid layer') was observed for All Bond 2, Clearfil Linear Bond and Schotchbond MP.

CONCLUSIONS

Significant correlations were observed only for XR Bond, which proved very sensitive to RDT and dentine permeability despite the presence of smear layer. The other three materials did not show any correlation with dentine conditions. By contrast they showed the highest bond values.

Clinical relevance of the formulation and testing of dentine bonding systems

The formulation of a dentine bonding system requires several properties which control the performance of the adhesive film. Numerous tests have been introduced for material screening purposes. Understanding the clinical relevance of the formulation principles and laboratory testing pertinence to in vivo conditions are of great importance in order to establish meaningful criteria for product development and evaluation.

What is the clinical relevance of in vitro dentine permeability tests?

This paper reviews the effect of dentine permeability on the bond strength of dentinal bonding systems and its relationship with the morphology of dentine. Deep dentine is more permeable than superficial dentine. Demineralization of dentine surfaces with acidic conditioners significantly increases permeability with respect to dentine covered by a smear layer. Several primers apparently leave intact smear layers as seen by scanning electron microscopy, but greatly increase the fluid filtration towards the dentine suggesting several modifications in the smear layer. Previous generations of dentinal bonding systems have been shown to be extremely sensitive to dentine humidity and permeability. By contrast, contemporary dentine bonding systems are not influenced by wet dentine. According to the Poiseuille-Hagen equation, small changes in the functional diameter of dentinal tubules can greatly modify permeability. Restorative materials are able to reduce the permeability of prepared dentine subject to location.

Inhibition of serum albumin flux across exposed dentine following conditioning with GLUMA primer, glutaraldehyde or potassium oxalates

A variety of medicaments used on dentine in various treatment procedures may cause a reduction in dentine permeability. By observing the flow of endogenous serum albumin across exposed dentine, agents known to promote dentine bonding of restorative resins or retard dentine sensitivity were assessed regarding their capacity to arrest dentinal fluid flow. Experiments were conducted in young adult macaque monkeys employing Class V cavity preparations in incisors and canines. A diffusion-in-gel-enzyme-linked-immunosorbent-assay (DIG-ELISA) was used to quantitate serum albumin in effluents from these cavities at various time periods following either no treatment or topical application with GLUMA primer, glutaraldehyde or potassium oxalates. While in untreated cavities serum albumin continued to flow even after a period of 1 week, a substantial reduction or complete cessation of serum albumin flux was seen following topical application of the agents tested, suggesting a durable effect on dentinal fluid flow. No difference between agents was observed. Further cutting of the cavity bottom a few tenths of a millimetre resulted in renewed flow of serum albumin. Data suggest that the solutions tested are capable of reducing dentinal fluid flow onto exposed dentine surfaces.

Effects of high-speed cutting on dentin permeability and bonding

The effects of high-speed cutting by use of a diamond bur with or without water coolant or sanding by 80-grit SiC paper on dentin permeability, before and after surface treatment, and dentin bonding of adhesive resins were compared. Three different bonding systems were used: Scotchbond DC, which requires no removal of smear layers, and two others, Clearfil Photobond and Superbond C&B, both of which remove smear layers (phosphoric acid gel or 10% citric acid containing 3% ferric chloride, respectively). Creation of smear layers by bur cutting or sanding reduced dentin permeability to levels that were only 1-3% of the maximum permeability values. Scotchbond DC gave low but consistent bond strengths (3.7-6.1 MPa) to dentin covered with smear layers. Clearfil PHotobond also produced consistent bond strengths (8.6-9.4 MPa). The increase in the permeability of dentin after phosphoric acid treatment was higher when the SiC paper was used (146%) than when the high-speed bur was used (87-90%). The smear layer and smear plugs produced by the diamond bur were more resistant to 10-3 treatment than were the SiC-created smear layers. The bond strengths of Superbond showed the highest bond strengths to the conditioned dentin when the high-speed cutting was used with water coolant (16.3 MPa), compared with the other two groups (12.2-12.5 MPa).