Morphological field emission-SEM study of the effect of six phosphoric acid etching agents on human dentin

Er:YAG Laser Physical Etching and Ultra-High-Molecular-Weight Cross-Linked Sodium Polyacrylate Chemical Etching for a Reliable Dentin Dry Bonding

Dentin bond interface stability is the key issue of dental adhesion in present clinical dentistry. The concept of selective extrafibrillar demineralization has opened a new way to maintain intrafibrillar minerals to prevent interface degradation. Here, using ultra-high-molecular-weight sodium polyacrylate [Carbopol (Carbo) > 40 kDa] as a calcium chelator, we challenge this concept and propose a protocol for reliable dentin dry bonding. The results of high-resolution transmission electron microscopy revealed periodic bands of 67 nm dentin collagen fibrils after Carbo etching, and the hydroxyproline concentration increasing with prolonged chelating time denied the concept of extrafibrillar demineralization. The results that wet and dry bonding with Carbo-based demineralization produced a weaker bond strength than the traditional phosphoric acid wet adhesion suggested that the Carbo-based demineralization is an unreliable adhesion strategy. A novel protocol of Er:YAG laser physical etching followed by Carbo chemical etching for dentin adhesion revealed that a micro-/nano-level rough, rigid, and non-collagen exposed dentin surface was produced, the micro-tensile bond strength was maintained after aging under dry and wet bonding modes, and in situ zymography and nanoleakage within the hybrid layers presented lower signals after aging. Cell culture in vitro and a rabbit deep dentin adhesion model in vivo proved that this protocol is safe and biocompatible. Taken together, the concept of extrafibrillar demineralization is limited and insufficient to use in the clinic. The strategy of Er:YAG laser physical etching followed by Carbo chemical etching for dentin adhesion produces a bonding effect with reliability, durability, and safety.

Influence of the thickening agent contained in a phosphoric acid etchant on bonding between feldspar porcelain and resin cement with a silane coupling agent

Phosphoric acid (PA) etchants are widely used for the bonding pretreatment of teeth; however, their influences on the bonding between glass-ceramics and resin cement have not been clarified yet. This study investigated the effect of a thickening agent on the bonding strength between feldspar porcelain treated with a PA etchant and resin cement with a silane coupling agent. The experiments were performed using two PA etchants: commercial one and prepared one consisting a PA aqueous solution and poly(ethylene glycol) thickening agent. The samples were evaluated by shear bond strength testing, scanning electron microscopy, and Fourier-transform infrared spectroscopy. The obtained results revealed that the thickening agent adhered to the porcelain surface and inhibited cement bonding. Meanwhile, PA remained on the surface due to the presence of the thickening agent and activated the silane coupling agent. Overall, the PA etchant did not improve the bond durability.

Effect of phosphoric acid and sodium hydroxide on cleaning and bonding of saliva-contaminated feldspar porcelain

Purpose Hydrofluoric acid has been used to remove salivary contamination in dental glass-ceramics before bonding treatment. However, alternative methods are required because hydrofluoric acid is harmful. This study examined the cleaning effects of phosphoric acid and sodium hydroxide on glass-ceramics for bonding pre-treatment.Methods Feldspar porcelain was divided into four groups: (C) cleaned porcelain without any contamination, (S) porcelain contaminated with saliva, (SPA) porcelain cleaned with 37% phosphoric acid after saliva contamination, and (SSH) porcelain cleaned with 10% sodium hydroxide after saliva contamination. Each sample was bonded to the resin cement using a silane-containing primer. They were then subjected to a shear bond strength (SBS) test. Each surface was analyzed by scanning electron microscopy (SEM), contact angle measurements, and Fourier transform infrared spectroscopy (FT-IR).Results The SBS of group SSH was comparable to that of group C but significantly higher than that of groups S and SPA. SEM observations showed that saliva-like structures remained on the samples of groups S and SPA, but not on the SSH group. The contact angles of groups C and SSH were comparable and significantly smaller than those of groups S and SPA, respectively. FT-IR analysis also revealed saliva in groups S and SPA, which was absent in the SSH group.Conclusions The saliva remained on the porcelain even after cleaning with phosphoric acid, and SBS was not restored to the same level as before the contamination. In contrast, sodium hydroxide eliminated saliva and restored SBS to the same level as before contamination.

Effect of the Viscosity and Application Time of Different Phosphoric Acids on the Bond Strength and Nanoleakage of Fiber Posts to Root Dentin

PURPOSE

To evaluate the effect of application time and viscosity of meta-phosphoric acid (MPA) and ortho-phosphoric acid (OPA) on the push-out resin-dentin bond strength (PBS) and nanoleakage (NL) at the adhesive-root dentin interface.

METHODS AND MATERIALS

Ninety-six roots of premolars were endodontically prepared and randomly assigned into groups according to the (i) acid (OPA and MPA), (ii) viscosity (gel and liquid), and (iii) application time (7 and 15 seconds). Fiber posts were cemented to the roots, which were then transversally sectioned into serial slices. The slices (cervical, medium, and apical) were subjected to PBS or NL. Analysis of the dentin etching pattern was performed using scanning electron microscopy (SEM). The PBS (MPa) and NL (%) data were subjected to three-way repeated-measures analysis of variance (ANOVA) and Tukey's test (α=0.05).

RESULTS

The cross-product interaction was significant for both PBS and NL (p<0.001). No significant difference in the PBS was observed with the use of OPA compared to MPA (p>0.05). Higher PBS values were observed in the groups etched for 15 seconds compared to 7 seconds, regardless of the acid, viscosity, or root third (p<0.05). Lower NL was observed for MPA etching when compared to OPA etching (p<0.05), and these values were not affected by increasing the application time or acid viscosity (p>0.05). A more pronounced etching pattern was observed with OPA than MPA regardless of the acid viscosity.

CONCLUSION

The use of 40% meta-phosphoric acid promoted adequate bond strength without increasing dentin demineralization or void spaces in the hybrid layer.

Role of the smear layer in adhesive dentistry and the clinical applications to improve bonding performance

Currently, dental adhesives can be divided into two systems; a smear layer-removal approach with etch-and-rinse adhesives or a smear layer-modified approach with self-etching adhesives. After phosphoric acid etching, the smear layer is completely removed. More attention is, however, required when using self-etching adhesives. The smear layer is partially demineralized by the weak acidic monomer and subsequently incorporated into the hybrid layer. Therefore, the characteristics of the smear layer play an important role on the bonding performance of self-etching adhesives. Such characteristics, for instance, smear layer thickness and smear layer density, are influenced by many factors, e.g., instruments used for dentin surface preparation, cutting speed, and the abrasive particle size of the cutting instruments. This review discusses the contributing factors that affect the smear layer characteristics, and the influence of the smear layer on the bonding performance of dental adhesives. Also, the application techniques regarding how to improve the bonding performance of self-etching adhesives – the smear layer removal by using chemical agents, or the modification of the adhesive application procedures – are provided.

Functional signatures of ex-vivo dental caries onset

Background

The etiology of dental caries remains poorly understood. With the advent of next-generation sequencing, a number of studies have focused on the microbial ecology of the disease. However, taxonomic associations with caries have not been consistent. Researchers have also pursued function-centric studies of the caries microbial communities aiming to identify consistently conserved functional pathways. A major question is whether changes in microbiome are a cause or a consequence of the disease. Thus, there is a critical need to define conserved functional signatures at the onset of dental caries.

Methods

Since it is unethical to induce carious lesions clinically, we developed an innovative longitudinal ex-vivo model integrated with the advanced non-invasive multiphoton second harmonic generation bioimaging to spot the very early signs of dental caries, combined with 16S rRNA short amplicon sequencing and liquid chromatography-mass spectrometry-based targeted metabolomics.

Findings

For the first time, we induced longitudinally monitored caries lesions validated with the scanning electron microscope. Consequently, we spotted the caries onset and, associated with it, distinguished five differentiating metabolites - Lactate, Pyruvate, Dihydroxyacetone phosphate, Glyceraldehyde 3-phosphate (upregulated) and Fumarate (downregulated). Those metabolites co-occurred with certain bacterial taxa; Streptococcus, Veillonella, Actinomyces, Porphyromonas, Fusobacterium, and Granulicatella, regardless of the abundance of other taxa.

Interpretation

These findings are crucial for understanding the etiology and dynamics of dental caries, and devising targeted interventions to prevent disease progression.

Nanofiller Particles and Bonding Durability, Water Sorption, and Solubility of Universal Adhesives

The aim of this study was to evaluate the influence of nanofiller particles in simplified universal adhesive on the long-term microtensile bond strength and silver nitrate up-take, as well as water sorption and solubility. Commercial adhesives Ambar Universal (FGM) in nanofilled-containing version (filled) and same lot without fillers (unfilled) were donated and applied by means of etch-and-rinse strategy. Microtensile bond strength was surveyed after 24-hours or 1-year water storage. Silver nitrate uptake was assayed using scanning electron microscopy (SEM). Water sorption and solubility experiments were performed based on ISO 4049:2009. Statistical analysis was performed using two-way ANOVA and Tukey test (p<0.05). The bond strength of both the adhesives were statistically similar at 24 hours (p>0.05), but the filled group attained significant bond strength reduction after aging when compared to initial bond strength (p<0.001). Conversely, unfilled adhesive presented stable adhesion after 1-year storage (p=0.262). Silver nitrate uptake was similar for both adhesives, with little silver impregnation at the hybrid and adhesive layers. Water sorption was higher with filled adhesive compared to the unfilled one (p=0.01). Conversely, solubility was higher in unfilled in comparison to filled one (p=0.008). The presence of nanofillers in universal adhesive achieves higher water sorption and dentin bond degradation, which did not occur in the unfilled adhesive.

Advanced imaging of dentin microstructure

This study aimed to demonstrate the feasibility of using optical coherence tomography (OCT) for locating the sectioning site of a specimen before characterizing the ultrastructural features of dentin surfaces as well as the inner wall of the dentinal tubules (DT) using a field emission scanning electron microscope (FESEM). Eight sound human molar teeth were extracted, examined via cross-polarization optical coherence tomography (CP-OCT), embedded, and hemisectioned using a low-speed diamond sawing machine. Next, each sectioned surface was further trimmed, polished, and examined under a confocal laser scanning microscope (CLSM) to locate the target area on the superficial dentin. Subsequently, each section was gold-coated and examined using FESEM. Backscattered reflection from the dentin layer was less than that from the enamel under CP-OCT. Distinct reflections from certain enamel and dentin microstructures were observed before sectioning the specimens. Areas with enamel cracks and dentin defects were identified and avoided during sectioning. At the micron level, the CLSM images exhibited a homogenous distribution of the DT orifices. Low magnification FESEM images showed intertubular dentin as a loosely condensed globular layer with shallow grooves in between, whereas peritubular dentin exhibited more organized condensation of apatite crystals surrounding the DT orifices. High magnification of the DT revealed a cross-linking layer of mineralized collagen network extending in the peri-intratubular lumen, with scattered globules of matrix vesicles. CP-OCT enabled the realization of rapid initial scanning and image acquisition with high contrast at the micron scale before profound insights into dentin ultrastructures at the nano scale were provided by FESEM. The variations in structural densities of the dental tissues significantly affected the image contrast and helped identify underlying structures.

Clinical Performance of Filled/Nanofilled Versus Nonfilled Adhesive Systems in Noncarious Cervical Lesions: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions.

SUMMARY

Ultrasonic Monitoring of Dentin Demineralization

Demineralization is a process of loss of minerals in the dental hard tissue that affects seriously the health of the patients, as it diminishes the tooth resistance, generating chewing problems by altering the occlusal structure, hypersensitivity, and pulpal problems. Demineralization can be produced by pathological processes as erosion or caries, or by surgical processes as etching. Due to the complexity of natural demineralization processes, it is mandatory to provide quantitative and standardized tests to allow their study in controlled laboratory conditions. Ultrasonic techniques are suitable for this purpose as they are nondestructive, quick, and provide localized mechanical information about the tissue, which is related with its degree of demineralization. In the present work, we evaluate the complete process of demineralization of the human dentin under controlled laboratory conditions using a pulse-echo ultrasonic technique. Up to 15 human dentin teeth have been demineralized with phosphoric acid at 10%. The time-of-flight measurements using the pulse-echo system allows to obtain the speed of sound in healthy (3415 m/s) and demineralized dentin tissue (1710 m/s), as well as to characterize the dynamical process of the acid penetration, which generates well-defined boundaries between two media (demineralized and mineralized dentin), showing very different mechanical properties. These boundaries advance in depth at an initial rate of [Formula: see text]/min, decelerating at -9.3 nm/min² until the whole demineralization of the sample is achieved. In addition, the technique allows to measure the relevance of the demineralization produced by the acid residues inside the tooth once it has been removed from the acidic solution. Beyond the assessment of artificial demineralization lesions under laboratory conditions, as demonstrated in this article, the proposed technique opens new approaches to the assessment of demineralization caused by natural caries in vivo.

Current perspectives on dental adhesion: (3) Adhesion to intraradicular dentin: Concepts and applications

Adhesion science is one of the greatest contributions to restorative dentistry. Adhesion not only established the current principles of tissue preservation, but also allowed for the production of more hermetic and long-lasting restorations. Although adhesive strategies are routinely used in most clinical situations, adhesion to root dentin is still a major challenge. The presence of humidity together with less intertubular dentin are factors that limit the adhesive potential of root dentin. This situation is more unfavorable in endodontically treated teeth prepared for prefabricated or custom-made intraradicular posts; these procedures may alter the mechanical properties of teeth by modifying the viable dentin surface for adhesion. Also, contaminants deposited on the dentin surface are difficult to remove through conventional techniques. Moreover, root canal morphology has a very unfavorable C-factor, bringing undesirable effects resulting from polymerization contraction of resin-based materials. However, the differences between coronal and root dentin are not a barrier for dentin adhesion. Standardization of procedures and care during clinical steps are fundamental to the success of adhesion to coronal or intraradicular dentin. Thus, it is essential to know the anatomy of the root structure, the factors that interfere with intraradicular adhesion, as well as the current adhesive materials and techniques.

The Effect of Viscosity and Application Mode of Phosphoric Acid on Bond Strength of GlassFiber Post

Background

When a phosphoric acid is used, before applying an adhesive system, it is known that obtaining an effective adhesion to the root canal walls is a challenge. The aim of the present study was to evaluate the influence of phosphoric acid viscosity and application mode on the push-out bond strength (BS) values of fiberglass post to root dentin. The conditioning pattern on the root dentin was also evaluated.

Materials and Methods

The roots of 44 endodontically treated premolars were divided into 4 groups, of eleven teeth each, according to the combination of the main factors: phosphoric acid viscosity (liquid or gel) and application mode (passive or sonic). After application of the two-step etch-and-rinse adhesive system, the fiberglass posts were cemented with a dual-cure resin-cement. Roots were sectioned transversely into six 1-mm slices for push-out BS test at 0.5 mm/min. Some roots of each group were selected for evaluation of the conditioning pattern by scanning electron microscopy. BS results (three-way ANOVA and Tukey’s test) and the conditioning pattern (Kruskal–Wallis test and Mann–Whitney test) were statistically evaluated (α= 0.05).

Results

The highest BS value was observed with a liquid phosphoric acid under sonic application mode (p < 0.05), being all other groups similar to one another (p < 0.05). Also, the highest BS value was observed in the cervical third, followed by the medium and the apical thirds (p < 0.05). The sonic application produced better smear layer removal and opening of dentinal tubules for both viscosities (p = 0.015).

Conclusion

A better bonding of fiberglass posts to root canals can be achieved when the post spaces are conditioned with a liquid phosphoric acid under sonic application.

Effect of grape seed extract-containing phosphoric acid formulations on bonding to enamel and dentin

The aim was to evaluate the effect of 2% grape seed extract (GSE) containing phosphoric acid (PhA) on the bond strength to enamel and dentin. The control group was 37% PhA. The following three PhA formulations with 2% GSE and 20% ethanol were obtained: GSE5 = 5% PhA; GSE10 = 10% PhA; and GSE20 = 20% PhA. The enamel and dentin surfaces of molars were etched with the acid solutions, followed by Scotchbond Multi-Purpose adhesive and composite resin application. The tensile bond strength (TBS) test evaluated the bond to enamel after 24 h, and the microtensile bond strength (μTBS) test evaluated the bond to dentin after 24 h and 12-month water storage. Etched enamel and dentin were observed by scanning electron microscopy (SEM) and atomic force microscopy (AFM), respectively. The TBS data were submitted to one-way ANOVA, while µTBS data were submitted to two-way ANOVA and Tukey's test (α = 0.05). The TBS (MPa) to enamel did not significantly differ among the control (48.1 ± 15.7), GSE5 (46.1 ± 9.6), GSE10 (49.8 ± 13.6) and GSE20 (44.1 ± 11.9) groups (p = 0.537). The µTBS (MPa) to dentin of the control (28.4 ± 14.4) and GSE20 (24.1 ± 8.1) groups were significantly higher than those of the GSE5 (16.8 ± 7.4) and GSE10 (17.5 ± 6.6) groups at 24 h (p < 0.006). After 12-month storage, only GSE5 (21.0 ± 7.8) and GSE10 (17.6 ± 8.0) did not show significantly decreased μTBS (p > 0.145). SEM micrographs showed a shallower enamel etching pattern for GSE5. AFM images showed the formation of collagenous globular structures for GSE5 and GSE10. The different acid solutions did not influence the TBS to enamel, and the µTBS to dentin was stable over time when dentin was etched with GSE5 and GSE10.

Influence of the depth of intraradicular dentin on the pushout bond strength of resin materials

AIM

The aim of the present study was to evaluate the pushout bond strength between glass-fiber posts to different regions of intraradicular dentin with different materials for adhesive cementation.

METHODS

After endodontic filling, 40 teeth were divided into five groups according to adhesive cementation: Adper Single Bond 2 + RelyX ARC, Excite DSC + RelyX ARC (EXC), Adper SE Plus + RelyX ARC (SEP), RelyX Unicem, and Set. After the bonding process, roots were sectioned obtaining slices to be analyzed from each third. The bond strength was measured using the pushout test in a universal testing machine (Emic DL 3000) at a cross-head speed of .5 mm/minutes in different areas of the post space (cervical, middle, and apical). Data were subjected to analysis of variance and Fisher's test (α = .05).

RESULTS

The highest values for the pushout bond strength were found for the SEP group in all experimental conditions, without a significant difference for the EXC group in the middle and apical regions. There was a decrease in pushout bond strength in the cervical-apical direction for all groups, except the EXC group, which did not show a difference among the different regions.

CONCLUSIONS

The different interactions of the resin materials and the intraradicular depth influenced the bond strength of adhesives materials to dentin substrate.

Effects of caffeic acid phenethyl ester application on dentin MMP-2, stability of bond strength and failure mode of total-etch and self-etch adhesive systems

OBJECTIVE

Investigate the long-term effect of dentin pretreatment with 0.05 or 0.1% caffeic acid phenethyl ester (CAPE) on (1) bond strength of resin composite to dentin by a three-step etch-and-rinse (Adper Scotchbond Multipurpose/ ASB) or a two-step self-etch adhesive system (Clearfil SE Bond/ CSE), (2) their fracture mode, (3) the micromorphological features of the hybrid layer formed; and (4) the level of MMP-2 in dentin (after application, using a correlative immunoexpression/quantification approach).

DESIGN

Composite resin blocks were fabricated on 48 third molars (n = 6), according to the type of adhesive and treatment (control, CAPE 0.05% and CAPE 0.1%). Slices were obtained for scanning electron microscopy (SEM) evaluation, and sticks were fabricated for microtensile tests (24 h and 1 year). Aliquots of dentin powder were distributed (n = 12) according to the treatment and the MMP-2 concentration was determined by ELISA.

RESULTS

Tukey test showed that ASB groups presented higher BS in 24 h than CSE groups. ASB presented a reduction in BS values after 1-year. ASB and CSE presented no significant differences in BS after 1-year. CAPE had no effect on BS for both adhesive systems. The predominant failure mode for the ASB groups were adhesive; when 0.1% CAPE was applied there was a predominance of mixed fractures. Regarding the CSE group, 0.05% CAPE led to more adhesive failures, and the 0.1% concentration resulted in a higher number of cohesive failures in dentin. Higher MMP-2 concentrations were detected for the groups that did not undergo demineralization treatment, and the lowest values for the ASB groups treated with CAPE. SEM analysis showed no influence of pretreatment with CAPE.

CONCLUSIONS

CAPE did not influence the BS of the adhesives tested, or the micromorphology of the hybrid layer, irrespective of concentration or storage time. CAPE affected the fracture pattern at 24 h, depending on the concentration and the adhesive system used. Immunoassay analysis showed that CAPE 0.1% reduced the MMP-2 concentration in the ASB adhesive without affecting bond strength to dentin.

Evaluation of sub-surface penetration and bonding durability of self-etching primer systems to Er:YAG laser treated cervical dentin

This study aimed to investigate self-etching bonding systems penetrating in sub-surface dentin layer after Er:YAG laser irradiation and micro-shear bonding durability over a period of 1 year. Dentin slices obtained from extracted human third molars were prepared. Two self-etching adhesive systems were evaluated: Clearfil SE Bond and Clearfil Tri-S Bond. Specimens were tested for micro-shear bond strength with one of the following treatments: Er:YAG laser irradiation and 600-grit silicon paper polishing at 24 h, 7 days, 6 months and 1 year. The adhesive interfaces between bonding agents and lased cervical dentin were studied. No hybrid layer could be observed for lased dentin. The slim resin tags could be seen penetrating through the lased subsurface layer. Bond strength to lased dentin after 6 months and 1 year were significantly decreased (p<0.05).

The effect of saliva decontamination procedures on dentin bond strength after universal adhesive curing

Objectives

The purpose of this study was to investigate the effectiveness of multiple decontamination procedures for salivary contamination after curing of a universal adhesive on dentin bond strength according to its etch modes.

Materials and Methods

Forty-two extracted bovine incisors were trimmed by exposing the labial dentin surfaces and embedded in cylindrical molds. A universal adhesive (All-Bond Universal, Bisco) was used. The teeth were randomly divided into groups according to etch mode and decontamination procedure. The adhesive was applied according to the manufacturer's instructions for a given etch mode. With the exception of the control groups, the cured adhesive was contaminated with saliva for 20 sec. In the self-etch group, the teeth were divided into three groups: control, decontamination with rinsing and drying, and decontamination with rinsing, drying, and adhesive. In the etch-and-rinse group, the teeth were divided into four groups: control, decontamination with rinsing and drying, decontamination with rinsing, drying, and adhesive, and decontamination with rinsing, drying, re-etching, and reapplication of adhesive. A composite resin (Filtek Z350XT, 3M ESPE) was used for filling and was cured on the treated surfaces. Shear bond strength was measured, and failure modes were evaluated. The data were subjected to one-way analysis of variation and Tukey's HSD test.

Results

The etch-and-rinse subgroup that was decontaminated by rinse, drying, re-etching, and reapplication of adhesive showed a significantly higher bond strength.

Conclusions

When salivary contamination occurs after curing of the universal adhesive, additional etching improves the bond strength to dentin.

Effect of low-concentration bleaching products on enamel bond strength at different elapsed times after bleaching treatment

This study evaluated the effects of several low-concentration bleaching products on microtensile bond strength (µTBS) to enamel at different elapsed times after the bleaching treatment. One hundred and fifty bovine incisors were divided into five groups: No treatment, 10% carbamide peroxide (Opalescence), 10% hydrogen peroxide (Opalescence Treswhite Supreme), 3% carbamide peroxide plus lactoperoxidase (WhiteKin), or 3% carbamide peroxide plus 2.7% carbamide peroxide (Clysiden Kit Express). All treatments lasted 4 weeks. After bleaching treatment or non-treatment, teeth were restored immediately, at 1, 3, 7, or 14 days after bleaching and submitted to µTBS test. Data were analyzed by ANOVA and Tukey's test (p<0.05). For WhiteKin and Clysiden, µTBS to enamel was significantly reduced immediately, at 1, 3 and 7 days after bleaching. At 14 days after bleaching, similar µTBS values were obtained regardless of bleaching product. Therefore, while over-the-counter (OTC) products might affect bond strength to enamel, this effect was no longer observed after 14 days.

Mechanical properties of components of the bonding interface in different regions of radicular dentin surfaces

STATEMENT OF PROBLEM

The mechanical properties of the adhesive materials used in intraradicular treatments could vary according to the interaction between the restorative material and dentin substrate. An evaluation of these properties is essential to determine the success of the luting procedures performed on glass-fiber posts.

PURPOSE

The purpose of this study was to evaluate the mechanical properties of dentin adhesives, resin cements, and the dentin that underlies the bonding interface in different thirds of intraradicular dentin.

MATERIAL AND METHODS

Forty extracted, single-rooted human teeth were used in this study. After the endodontic treatment of the post spaces, the teeth were divided into 5 groups (n=8): Adper Single Bond 2 + RelyX ARC, Excite DSC + RelyX ARC, Adper SE Plus + RelyX ARC, RelyX Unicem, and Set. The hardness and elastic modulus values were measured at the adhesive interface in different thirds of the radicular dentin by using an ultramicrohardness tester. The data were subjected to 2-way ANOVA and the Fisher protected least significant difference test (α=.05).

RESULTS

In the underlying dentin, the highest Martens hardness values were found in the apical region for all groups; the exceptions were the groups with the self-etching adhesive. In the adhesive layer, the highest Martens hardness values were obtained for the Adper SE Plus + RelyX ARC group; further, no statistical differences were found among the different regions for this group. RelyX ARC had the lowest Martens hardness and elastic modulus values in the apical regions when used with Adper Single Bond 2 and Adper SE Plus. No differences were found in the Martens hardness and elastic modulus values for the self-adhesive resin cement in the regions investigated.

CONCLUSION

The mechanical properties of adhesive materials and the underlying dentin are influenced by the interaction between the two as well as by the depth of the analyzed intraradicular area.

The dentin organic matrix - limitations of restorative dentistry hidden on the nanometer scale

The prevention and treatment of dental caries are major challenges occurring in dentistry. The foundations for modern management of this dental disease, estimated to affect 90% of adults in Western countries, rest upon the dependence of ultrafine interactions between synthetic polymeric biomaterials and nanostructured supramolecular assemblies that compose the tooth organic substrate. Research has shown, however, that this interaction imposes less than desirable long-term prospects for current resin-based dental restorations. Here we review progress in the identification of the nanostructural organization of the organic matrix of dentin, the largest component of the tooth structure, and highlight aspects relevant to understating the interaction of restorative biomaterials with the dentin substrate. We offer novel insights into the influence of the hierarchically assembled supramolecular structure of dentin collagen fibrils and their structural dependence on water molecules. Secondly, we review recent evidence for the participation of proteoglycans in composing the dentin organic network. Finally, we discuss the relation of these complexly assembled nanostructures with the protease degradative processes driving the low durability of current resin-based dental restorations. We argue in favour of the structural limitations that these complexly organized and inherently hydrated organic structures may impose on the clinical prospects of current hydrophobic and hydrolyzable dental polymers that establish ultrafine contact with the tooth substrate.

Assay of in vitro osteoclast activity on dentine, and synthetic calcium phosphate bone substitutes

Resorption of synthetic bone substitute materials is essential for the integration of these materials into the natural bone remodeling process. Osteoclast behavior in the presence of calcium phosphate bioceramics (CaPB) is partially understood, and a better understanding of the underlying mechanisms is expected to facilitate the development of new synthetic bone substitutes to improve bone regeneration. In the present study, our aim was to investigate osteoclastic resorption of various synthetic CaPB. We used neonatal total rabbit bone cells to generate osteoclasts. Osteoclast-generated resorption on dentine and multiple CaPB was investigated by quantifying the surface resorbed and measuring tartrate resistant acid phosphatase (TRAP) enzyme activity. In this study, we observed that osteoclastic cells responded in a different way to each substrate. Both dentine and CaPB were resorbed but the quantitative results for the surface resorbed and TRAP activity showed a specific response to each substrate and that increased mineral density seemed to inhibit osteoclast activity.

Morphology of the dentin on primary molars after the application of phosphoric acid under different conditions

The aim of this study was to evaluate changes in the superficial dentin pattern of primary teeth after applying different phosphoric acid concentrations and conditioning times. Twenty-four dentin surfaces were divided in 4 groups with 10 teeth each: GI -no treatment; GII to GIV -phosphoric acid at 37%, 32%, and 10% respectively. The samples were divided into two halves: one treated for 7 seconds (T1) and the other one for 15 seconds (T2). They were submitted to scanning electronic microscopy (SEM). A reticule was superimposed upon the images to randomly select dentinal tubules measured in µm². The conditioning times did not cause significant differences in the mean diameter values of the dentin tubules within each test group: GII (T1= 4.86; T2= 4.70); GIII (T1 = 3.83; T2= 3.08); GIV (T1= 5.04; T2= 5.23). Comparing different groups, there were no differences in T1. The same results were observed in T2, except for GIV which presented higher mean diameter values than GIII. The extent of acid conditioning did not influence tubule opening within groups. When different types of acids where compared, only the 10% phosphoric acid showed upper tubule opening than 32% phosphoric acid. The dentin pattern varied according to the type of acid used for conditioning.

Microleakage in conservative cavities varying the preparation method and surface treatment

Objective

To assess microleakage in conservative class V cavities prepared with aluminum-oxide air abrasion or turbine and restored with self-etching or etch-and-rinse adhesive systems.

Material and Methods

Forty premolars were randomly assigned to 4 groups (I and II: air abrasion; III and IV: turbine) and class V cavities were prepared on the buccal surfaces. Conditioning approaches were: groups I/III - 37% phosphoric acid; groups II/IV -self-priming etchant (Tyrian-SPe). Cavities were restored with One Step Plus/Filtek Z250. After finishing, specimens were thermocycled, immersed in 50% silver nitrate, and serially sectioned. Microleakage at the occlusal and cervical interfaces was measured in mm and calculated by a software. Data were subjected to ANOVA and Tukey’s test (α=0.05).

Results

Forty premolars were randomly assigned to 4 groups (I and II: air abrasion; III and IV: turbine) and class V cavities were prepared on the buccal surfaces. Conditioning approaches were: groups I/III - 37% phosphoric acid; groups II/IV -self-priming etchant (Tyrian-SPe). Cavities were restored with One Step Plus/Filtek Z250. After finishing, specimens were thermocycled, immersed in 50% silver nitrate, and serially sectioned. Microleakage at the occlusal and cervical interfaces was measured in mm and calculated by a software. Data were subjected to ANOVA and Tukey’s test (α=0.05).

Conclusion

Marginal seal of cavities prepared with aluminum-oxide air abrasion was different from that of conventionally prepared cavities, and the etch-and-rinse system promoted higher marginal seal at both enamel and dentin margins.

Young's modulus of peritubular and intertubular human dentin by nano-indentation tests

The local Young modulus of dry dentin viewed as a hierarchical composite was measured by nano-indentation using two types of experiments, both in a continuous stiffness measurement mode. First, tests were performed radially along straight lines running across highly mineralized peritubular dentin sections and through less mineralized intertubular dentin areas. These tests revealed a gradual decrease in Young's modulus from the bulk of the peritubular dentin region where modulus values of up to ∼40-42GPa were observed, down to approximately constant values of ∼17GPa in the intertubular dentin region. A second set of nano-indentation experiments was performed on the facets of an irregular polyhedron specimen cut from the intertubular dentin region, so as to probe the modulus of intertubular dentin specimens at different orientations relative to the tubular direction. The results demonstrated that the intertubular dentin region may be considered to be quasi-isotropic, with a slightly higher modulus value (∼22GPa) when the indenting tip axis is parallel to the tubular direction, compared to the values (∼18GPa) obtained when the indenting tip axis is perpendicular to the tubule direction.

Morphological/chemical imaging of demineralized dentin layer in its natural, wet state

OBJECTIVE

Measuring the structure, composition or suitability for bonding of the acid-etched dentin substrate, especially in its hydrated state, has been a formidable problem. The purpose of this study was to determine the morphological and structural profiles of the dentin demineralized layer measured in its natural wet state using environmental scanning electron microscopy (ESEM) and micro-Raman imaging.

MATERIALS AND METHODS

The occlusal 1/3 of the crown was removed from nine extracted, unerupted human third molars. Dentin surfaces were abraded with 600-grit SiC sandpaper under water to create smear layers. The prepared dentin surfaces were randomly selected for treatment with the self-etching agent (Adper Prompt L-Pop) or the total-etching agent 35% H(3)PO(4) gel (with/without agitation). Micro-Raman spectra and imaging were acquired at 1-1.5microm spatial resolution at positions perpendicular to the treated surfaces; since this technique is non-destructive, the same specimens were also imaged with ESEM. Specimens were kept wet throughout spectral acquisition and ESEM observations.

RESULTS

ESEM could be used to reveal demineralized layers in acid-etched dentin, but the resolution was low and no collagen fibrils were disclosed. The detailed chemical maps/profiles of demineralized dentin layers under wet conditions could be obtained using Raman imaging. It was shown that the mineral existed in the superficial layer of all etched dentin covered with smear layers. The mineral was much easier to be removed underneath the superficial layer. The depth, degree, and profile of dentin demineralization were dependent on the types of acids (self-etching vs. total etching) and application procedures (with vs. without agitation).

SIGNIFICANCE

Most current adhesives are applied using wet bonding techniques in which the dentin is kept fully hydrated throughout the bonding. Our ability to fully characterize the hydrated, etched dentin substrates is very important for understanding bonding under in vivo conditions.

SEM analysis of the acid-etched enamel patterns promoted by acidic monomers and phosphoric acids

Objective:

Although self-etching bonding systems (SES) are indicated to prepare dental enamel for bonding, concerns have been expressed regarding their effectiveness. The aim of this study was to analyze the etching pattern (EP) of nine SES in comparison with 35% and 34% phosphoric acid etchants (FA) on intact (IN) and ground (GR) enamel surface.

Materials and Methods:

Twenty-two human third molars were sectioned in mesial-distal and buccal-lingual directions, and four dental fragments were obtained from each tooth. Half of the fragments were ground using 600-grit SiC paper and the other half remained intact. The fragments were randomly assigned into 22 groups, according to the texture of enamel surface (IN and GR) and the technique to etch the enamel (34% FA, 35% FA, AdheSE primer; Brush & Bond; Clearfil Protect Bond primer; iBond; One-up Bond F; OptiBond Solo Plus primer; Tyrian SPE primer; Unifil Bond primer and Xeno III). Conditioners were applied to IN and GR enamel surfaces, according to the manufacturer's instructions. Specimens etched with phosphoric acids were washed with water, while the surfaces treated with SES were submitted to alternate rinsing with alcohol and acetone. The specimens were dried, sputter-coated and examined under a scanning electron microscope.

Results:

For both IN and GR enamel surfaces, the EP of 34 and 35% FA was deeper and more homogeneous in comparison to EP of SES, except for Tyrian SPE. The acidic monomer action of self-etching systems was more effective on GR enamel.

Conclusion:

Most of the SES are less aggressive than phosphoric acid etchants and their etching effects were reduced on intact enamel surfaces. Uniterms: Dental acid etching; Dental enamel; Electron microscopy.

Effect of placement agitation and drying time on dentin shear bond strength: an in vivo study

The current study measured the bond strength of a self-etch system to dentin with and without agitation and with varying drying times of primer in vital dentin. The null hypotheses tested were that primer agitation and primer drying time did not affect the dentin shear bond strength. Sixty human maxillary and mandibular premolars scheduled to be extracted for orthodontic reasons were selected. The adhesive/resin combination used was Clearfil SE (Kuraray, Osaka, Japan)/TPH Spectrum (Dentsply DeTrey, Konstanz, Germany). The occlusal surfaces of the teeth were flattened using straight fissure diamond abrasive points ISO-012. Samples were divided into six groups of 10 teeth each. Primer was applied following the manufacturer's instructions with and without agitation followed by air-drying time of 0 (without air drying), five and 10 seconds. Clearfil SE Bond was applied and cured for 10 seconds. TPH Spectrum composite, shade A2 (Dentsply DeTrey), was placed over cured adhesive and was cured for 40 seconds. The teeth were restored to their original anatomy. The teeth were extracted after one week and the samples were kept in distilled water until testing at room temperature. The samples were tested in shear at a 1 mm/minute crosshead speed using an LR100 Universal Testing Machine. The data was analyzed using ANOVA and Tukey post-hoc tests (p < 0.05). Varying the drying time of the primer from zero (0) to 10 seconds did not significantly affect the bond strength values in vivo. At five seconds drying time, agitation significantly improved the shear bond strength to dentin. Agitation showed no effect when primer was not dried or it was dried for 10 seconds.

Dentinal tubules driven wetting of dentin: Cassie-Baxter modelling

We investigate the wetting properties of dentin surfaces submitted to a phosphoric acid etching followed by an air drying procedure, as in clinical situations of adhesive dentistry. The surface topography of the etched surfaces was characterized by AFM, and the wetting properties of water on these rough and heterogeneous surfaces were studied, by contact angle measurements. We showed that the contact angle increases with the acid exposure time and consequently with both surface roughness and the organicmineral ratio of the dentin components. From the whole results, obtained on dentin and also on synthesized hydroxyapatites samples, we inferred a water contact angle of ~133° on the dentinal tubule. These experimental results may be described by the Cassie-Baxter approach, and it is suggested that small air pockets could be formed inside the dentinal tubules.

Effect of the C-factor and Dentin Preparation Method in the Bond Strength of a Mild Self-etch Adhesive

A course cut carbide bur should be avoided prior to a mild self-etch adhesive, because it adversely affected bond strength. In contrast, a fine cut carbide bur provided the best combination: high bond strength with low variability, which suggests more reliable bond strength performance.

Effect of acid etching time on bond strength of an etch-and-rinse adhesive to primary tooth dentine affected by amelogenesis imperfecta

BACKGROUND

Dentine affected by amelogenesis imperfecta (AI) is histologically altered following loss of the hypoplastic enamel and becomes hypermineralized, which would make bonding less predictable.

AIM

This study examined the effect of etching time on the microtensile bond strength (microTBS) to AI-affected primary dentine.

DESIGN

Flat coronal dentine surface was obtained from extracted AI-affected and noncarious primary molars. Teeth were etched either for 15 or for 30 s using 34% phosphoric acid. Prime & Bond NT (Dentsply De Trey), an etch-and-rinse adhesive, was applied to dentine surfaces, air-dried and light-cured, followed by composite build-ups. The bonded teeth were sectioned into beams of 0.8 mm(2) and stressed to failure under tension. Representative fractured beams from each group were examined under scanning electron microscopy.

RESULTS

The extended etching time had an adverse effect on the microTBS for the normal dentine, while no significant difference was found for AI-affected dentine. When the AI-affected dentine was etched for 30 s, the fracture occurred in the demineralized dentine at the base of the hybrid layer.

CONCLUSION

Bonding to AI-affected dentine compromised the bonding of the etch-and-rinse adhesive. The bonding could not be improved by increasing etching time.

Effect of acid etching on dentin wettability and roughness: self-etching primers versus phosphoric acid

OBJECTIVE

To compare the effect of self-etching primers and phosphoric acid on the wettability and roughness of smear layer-covered and smear layer-free dentin.

MATERIALS AND METHOD

Three self-etching primers (Clearfil SE Bond, AdheSE, and Xeno III) and 10% (w/w) phosphoric acid (H(3)PO(4)) solution were evaluated. The substrates were midcoronal dentin with and without smear layer. For each liquid, pH, density, and surface tension were determined. Water wettability of dentin and roughness were measured before and after each etching. Wettability of self-etching primers and phosphoric acid was measured on untreated dentin.

RESULTS

Water wettability increased after acid conditioning similarly for all the liquids used. On smear layer-covered surfaces, self-etching primers achieved a comparable wetting but with greater contact angles than phosphoric acid. However, on smear layer-free surfaces, the increasing sequence of contact angle was Clearfil SE < AdheSE < Xeno III < Phosphoric acid. The treatment with phosphoric acid (lowest pH) produced the highest roughness increase on both dentin substrates. The roughening effect of the self-etching adhesives was more evident for AdheSE and Xeno III.

CONCLUSIONS

Self-etching primers and phosphoric acid promote similar water wettability increase. However, self-etching primers provided lower dentin roughness increase than pretreatment with phosphoric acid. The presence of smear layer did not affect the results of self-etching and phosphoric acid treatments.

Dental adhesion review: Aging and stability of the bonded interface

OBJECTIVE

Most of current dental adhesive systems show favorable immediate results in terms of retention and sealing of bonded interface, thereby counteracting polymerization shrinkage that affects resin-based restorative materials. Despite immediate efficacy, there are major concerns when dentin bonded interfaces are tested after aging even for short time period, i.e. 6 months.

METHODS

This study critically discusses the latest peer-reviewed reports related to formation, aging and stability of resin bonding, focusing on the micro and nano-phenomena related to adhesive interface degradation.

RESULTS

Most simplified one-step adhesives were shown to be the least durable, while three-step etch-and-rinse and two-step self-etch adhesives continue to show the highest performances, as reported in the overwhelming majority of studies. In other words, a simplification of clinical application procedures is done to the detriment of bonding efficacy. Among the different aging phenomena occurring at the dentin bonded interfaces, some are considered pivotal in degrading the hybrid layer, particularly if simplified adhesives are used. Insufficient resin impregnation of dentin, high permeability of the bonded interface, sub-optimal polymerization, phase separation and activation of endogenous collagenolytic enzymes are some of the recently reported factors that reduce the longevity of the bonded interface.

SIGNIFICANCE

In order to overcome these problems, recent studies indicated that (1) resin impregnation techniques should be improved, particularly for two-step etch-and-rinse adhesives; (2) the use of conventional multi-step adhesives is recommended, since they involve the use of a hydrophobic coating of nonsolvated resin; (3) extended curing time should be considered to reduce permeability and allow a better polymerization of the adhesive film; (4) proteases inhibitors as additional primer should be used to increase the stability of the collagens fibrils within the hybrid layer inhibiting the intrinsic collagenolytic activity of human dentin.

Analysis of Er:YAG lased dentin using attenuated total reflectance Fourier transform infrared and X-ray diffraction techniques

The purpose of this study was to investigate the chemical characteristics of dentin after Er:YAG laser irradiation using various output energies with or without water irrigation. Analysis was carried out by means of attenuated total reflectance Fourier transform infrared spectroscopy (FT-IR/ATR) and X-ray diffraction (XRD). Furthermore, the relative infrared peak intensities of dentin specimens were compared statistically. Results showed that Er:YAG laser with an output energy of 100 mJ/pulse with water irrigation did not cause any detectable change in dentin. However, a higher energy output or the absence of water irrigation affected the organic portion of dentin. With XRD, no obvious phase changes were observed between the XRD pattern of the control (non-irradiated) dentin powder and those after Er:YAG irradiation - regardless of Er:YAG laser output energy or dehydration condition. It was suggested that the intrinsic water content of dentin - together with extrinsic water irrigation - were important factors to achieving the desired outcome of dentin ablation by Er:YAG laser.

Effect of cavity preparation method on microtensile bond strength of a self-etching primer vs phosphoric acid etchant to enamel

This study evaluated the effect of cavity preparation using air abrasion or carbide bur on bond strength to enamel treated with a self-etching primer (Tyrian SPE) or a phosphoric acid etchant. Twenty-four molars were divided into three groups: high-speed; standard handpiece (ST air abrasion) or supersonic handpiece (SP air abrasion) of the same air-abrasive system. The enamel surfaces were treated with one of the two etchants and the same adhesive agent One Step Plus, and then composite buildups were done with Filtek Z250. After 24 h at 37 degrees C, beams (0.8 mm2) were obtained and subjected to tensile stress in a universal testing machine (0.5 mm/min). The data were submitted to analysis of variance and Tukey's test (P < 0.05). For the conditioning agents, it was observed that the specimens conditioned with phosphoric acid presented superior results than the specimens that used Tyrian SPE. For the preparation techniques, it was verified that the SP air abrasion groups showed the highest bond strengths and carbide-bur groups presented the lowest bond strengths when the specimens were conditioned with Tyrian SPE. It can be concluded that the influence of the cavity preparation method was dependent on the conditioning system used, only when using carbide-bur preparation technique.

Smear layer and surface state affect dentin fluoride uptake

OBJECTIVES

Polishing generates a smear layer (SL) on in vitro dentin samples that may influence fluoride uptake. We tested two hypotheses: SL increases fluoride uptake in superficial dentin (H1) and decreases fluoride uptake in deeper layers (H2) irrespectively of the amount of fluoride administered.

METHODS

Polished bovine dentin with SL present and removed by four methods (5% tannic acid, 20s [TA]; 17% EDTA, 120 s; 38% phosphoric acid, 60s [PA]; and 10s air polishing) was fluoridated with 1200 or 12000 ppm F (NaF) solution (pH 4.0).

RESULTS

Scanning electron microscopy (SEM) revealed that aggressiveness of SL removal varied by method from leaving SL patches behind (TA) to collagen exposure (PA). SL increased KOH-soluble and structurally bound fluoride uptake into superficial and deeper layers compared to SL free surfaces (except PA) following 1200 ppm, but not 12000 ppm fluoridation.

CONCLUSION

Presence of SL and surface conditions influence dentin fluoride uptake depending on fluoride concentration administered.

Micro-shear bond strength of Er:YAG-laser-treated dentin

This study tested if dentin adhesion is affected by Er:YAG laser. Ninety dentin disks were divided in groups (n = 10): G1, control; G2, Er:YAG laser 150 mJ, 90 degrees contact, 38.8 J/cm(2); G3, Er:YAG laser 70 mJ, 90 degrees contact, 18.1 J/cm(2); G4, Er:YAG laser 150 mJ, 90 degrees non-contact, 1.44 J/cm(2); G5, Er:YAG laser 70 mJ, 90 degrees non-contact, 0.67 J/cm(2); G6, Er:YAG laser 150 mJ, 45 degrees contact, 37.5 J/cm(2); G7, Er:YAG laser 70 mJ, 45 degrees contact, 17.5 J/cm(2); G8, Er:YAG laser 150 mJ, 45 degrees non-contact, 1.55 J/cm(2); and G9, Er:YAG laser 70 mJ, 45 degrees non-contact, 0.72 J/cm(2). Bonding procedures were carried out and the micro-shear-bond strength (MSBS) test was performed. The adhesive surfaces were analyzed under SEM. Two-way ANOVA and multiple comparison tests revealed that MSBS was significantly influenced by the laser irradiation (p < 0.05). Mean values (MPa) of the MSBS test were: G1 (44.97 +/- 6.36), G2 (23.83 +/- 2.46), G3 (30.26 +/- 2.57), G4 (35.29 +/- 3.74), G5 (41.90 +/- 4.95), G6 (27.48 +/- 2.11), G7 (34.61 +/- 2.91), G8 (37.16 +/- 1.96), and G9 (41.74 +/- 1.60). It was concluded that the Er:YAG laser can constitute an alternative tool for dentin treatment before bonding procedures.