Degradation-stage effect of self-etching primer on dentin bond durability

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.

MDP-salts as an adhesion promoter with MDP-primers and self-adhesive resin cement for zirconia cementation

PURPOSE

To evaluate the effect of zirconia priming with MDP-Salt before MDP containing primers and self-adhesive cement on the shear bond strength.

MATERIALS AND METHODS

Fully sintered high translucent zirconia specimens (n = 120) were assigned into 2 groups (n = 60 each): Control (No Pretreatment) and Methacryloyloxydecyl dihydrogen phosphate salt (MDP-Salt) pretreated. Each group was divided into 3 subgroups (n = 20) according to cementation protocol: 1) MDP + Silane primer and conventional resin cement, 2) MDP+ Bisphenyl dimethacrylate (BPDM) primer and conventional resin cement, and 3) MDP containing self-adhesive resin cement. Shear bond strength (SBS) was measured after 10,000 thermocycling. Contact angle was measured for tested groups. Surface topography was assessed using a 3D confocal laser scanning microscope (CLSM). Weibull analysis was performed for SBS and one-way ANOVA for contact angle and surface topography measurements (α = 0.05).

RESULTS

The use of MDP-Salt significantly improved the SBS (p < .05) for all tested subgroups. Self-adhesive cement showed an insignificant difference with MDP + Silane group for both groups (p > .05). MDP + BPDM showed a significantly lower characteristic strength compared to self-adhesive resin cement when both were pretreated with MDP-Salt. No difference between all tested groups in the surface topographic measurements while MDP-Salt showed the highest contact angle.

CONCLUSION

MDP-Salt pretreatment can improve bonding performance between zirconia and MDP containing products.

Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to collect and interpret the randomized clinical trials (RCTs) that investigated the outcome of the self-adhesive luting resins (SA) compared to total-etch (TE), selective etch with dentin adhesives (Sle), selective etch without dentin adhesives (SleSA) or self-etch adhesives (SE).

DATA SOURCES

A thorough search of Internet databases was conducted without language restrictions, and the search ran up to and including April 2022. The illegible records citations were checked for more relevant clinical studies.

STUDY SELECTION/RESULTS

The inclusion criteria were randomized controlled trials (RCTs) that compared self-adhesive luting resins with total-etch, selective-etch, or self-etch adhesives regarding postoperative sensitivity, incidences of debonding, and survival rates of indirect restorations. From 1732 records, 9 RCTs met the eligibility criteria. Three RCTs compared total-etch adhesive to self-adhesive luting resin for intracoronal restorations, one RCT compared selective etch to self-adhesive luting resin for inlays, and 5 RCTs compared self-adhesive to other protocols for partial ceramic crowns. Postoperative sensitivity showed a non-statistically significant difference between SA and other adhesive protocols, SA revealed a non-statistically significant difference in debonding and survival to TE, but a lower statistically significant difference to Sle, SleSA, and SE.

CONCLUSIONS

Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, TE revealed comparable survival to SA for intracoronal restorations. SE and Sle exhibited the best clinical outcomes, followed by SleSA. Selective etch, and self-etch adhesives are preferable to self-adhesive resins.

CLINICAL SIGNIFICANCE

The significance of enamel etching and the superiority of self-etching adhesives over self-adhesive luting resins for reliable and durable bonding and improved clinical outcomes. However, long-term RCTs, particularly for total-etch comparison to self-adhesive luting resins, might be recommended to derive further evidence.

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.

MDP Salts: A New Bonding Strategy for Zirconia

Durable resin-ceramic adhesion may influence the clinical success of ceramic restorations, which has been one of the challenging issues in dentistry. The present study assessed the bond strength and chemical interaction of 10-methacryloxydecyl dihydrogen phosphate (MDP), MDP+silane, and MDP-salt primers to alumina-blasted zirconia ceramic by tensile bond strength test, surface elemental composition with x-ray photoelectron spectroscopy analysis, contact angle measurement, surface morphology with scanning electron microscopy, and surface topography with 3-dimensional confocal laser scanning microscope analyses. MDP-salt showed the highest tensile bond strength before and after thermocycling when compared with MDP and MDP+silane (P < 0.05). The measured contact angle values differed significantly (P < 0.001) in the order of MDP-salt > control (no chemical pretreatment) > MDP+silane > MDP. There was no difference in surface roughness (P = 0.317) and surface topography among all tested groups. Zirconia treated with MDP-salt showed phosphorus peaks in addition to zirconia and alumina peaks. MDP-salt has zirconia priming properties, which improves bonding performance to resin cement.

Shelf Life and Storage Conditions of Universal Adhesives: A Literature Review

This paper presents state of the art universal adhesive systems and the effect of shelf-life and storage conditions on their bond performance. Three topics are explored in this review: an introduction to the topic, the mechanisms responsible for the degradation of the hybrid layer, and the factors that play a role in the stability of universal adhesives. In addition, issues such as potential durability and clinical importance are discussed. Universal adhesive systems are promising but must be handled and stored according to the manufacturer's instructions, with careful attention given to the details of shelf-life and storage conditions for maximal success. It appears that the components of universal adhesives play an important role in their stability. Furthermore, HEMA-free formulations using methacrylamides lead to longer shelf-life. Further research is needed to prove these hypotheses.

10-MDP Based Dental Adhesives: Adhesive Interface Characterization and Adhesive Stability-A Systematic Review

The incorporation of functional monomers in dental adhesive systems promotes chemical interaction with dental substrates, resulting in higher adhesion forces when compared to micromechanical adhesion only. The 10-MDP monomer, whose chemical structure allows for a polar behavior which is favorable to adhesion, also promotes the protection of collagen fibers through the formation of MDP-calcium salts. This systematic review aimed to characterize the interface created by 10-MDP containing adhesive systems through an evaluation of the following parameters: Formation of nano-layered structures, capacity to produce an acid-base resistant zone, and adhesion stability. The research was conducted using PubMed, Cochrane Library, Web of Science and Embase, limited to English, Spanish, and Portuguese articles. The research was done according to the PICO strategy. The 10-MDP monomer has the capacity to produce an acid-base resistant zone on the adhesive interface, which increases the response to acid-base challenges. The adhesion established by these systems is stable over time. To have the best of these adhesive solutions, a scrubbing technique must be used to apply the adhesive system on dental substrates, in order to improve monomers infiltration and to create a stable bond. Time must be given for the solution to infiltrate, hybridize and form the MDP-Ca, improving adhesive stability.

Novel fluoro-carbon functional monomer for dental bonding

Among several functional monomers, 10-methacryloxydecyl dihydrogen phosphate (10-MDP) bonded most effectively to hydroxyapatite (HAp). However, more hydrolysis-resistant functional monomers are needed to improve bond durability. Here, we investigated the adhesive potential of the novel fluoro-carbon functional monomer 6-methacryloxy-2,2,3,3,4,4,5,5-octafluorohexyl dihydrogen phosphate (MF8P; Kuraray Noritake Dental Inc., Tokyo, Japan) by studying its molecular interaction with powder HAp using solid-state nuclear magnetic resonance ((1)H MAS NMR) and with dentin using x-ray diffraction (XRD) and by characterizing its interface ultrastructure at dentin using transmission electron microscopy (TEM). We further determined the dissolution rate of the MF8P_Ca salt, the hydrophobicity of MF8P, and the bond strength of an experimental MF8P-based adhesive to dentin. NMR confirmed chemical adsorption of MF8P onto HAp. XRD and TEM revealed MF8P_Ca salt formation and nano-layering at dentin. The MF8P_Ca salt was as stable as that of 10-MDP; MF8P was as hydrophobic as 10-MDP; a significantly higher bond strength was recorded for MF8P than for 10-MDP. In conclusion, MF8P chemically bonded to HAp. Despite its shorter size, MF8P possesses characteristics similar to those of 10-MDP, most likely to be associated with the strong chemical bond between fluorine and carbon. Since favorable bond strength to dentin was recorded, MF8P can be considered a good candidate functional monomer for bonding.

A review of the developments of self-etching primers and adhesives -Effects of acidic adhesive monomers and polymerization initiators on bonding to ground, smear layer-covered teeth

This paper reviews the developments of self-etching primers and adhesives, with a special focus on the effect of acidic adhesive monomers and polymerization initiators on bonding to ground, smear layer-covered teeth. Ionized acidic adhesive monomers chemically interact with tooth substrates and facilitate good bonding to ground dentin. Polymerization initiators in self-etching primers further promote effective bonding to ground dentin. To promote bonding to both dentin and enamel, phosphonic acid monomers such as 6-methacryloyloxyhexyl phosphonoacetate (6-MHPA) were developed. These novel adhesive monomers also have a water-soluble nature and are hence endowed with sufficient demineralization capability. A new single-bottle, self-etching, 2-hydroxyethyl methacrylate (HEMA)-free adhesive comprising 6-MHPA and 4-acryloyloxyethoxycarbonylphthalic acid (4-AET) was developed. This novel adhesive enabled strong adhesion to both ground enamel and dentin, but its formulation stability was influenced by pH value of the adhesive. To develop hydrolytically stable, single-bottle, self-etching adhesives, hydrolytically stable, radical-polymerizable acidic monomers with amide or ether linkages have been developed.

Limitations in bonding to dentin and experimental strategies to prevent bond degradation

The limited durability of resin-dentin bonds severely compromises the lifetime of tooth-colored restorations. Bond degradation occurs via hydrolysis of suboptimally polymerized hydrophilic resin components and degradation of water-rich, resin-sparse collagen matrices by matrix metalloproteinases (MMPs) and cysteine cathepsins. This review examined data generated over the past three years on five experimental strategies developed by different research groups for extending the longevity of resin-dentin bonds. They include: (1) increasing the degree of conversion and esterase resistance of hydrophilic adhesives; (2) the use of broad-spectrum inhibitors of collagenolytic enzymes, including novel inhibitor functional groups grafted to methacrylate resins monomers to produce anti-MMP adhesives; (3) the use of cross-linking agents for silencing the activities of MMP and cathepsins that irreversibly alter the 3-D structures of their catalytic/allosteric domains; (4) ethanol wet-bonding with hydrophobic resins to completely replace water from the extrafibrillar and intrafibrillar collagen compartments and immobilize the collagenolytic enzymes; and (5) biomimetic remineralization of the water-filled collagen matrix using analogs of matrix proteins to progressively replace water with intrafibrillar and extrafibrillar apatites to exclude exogenous collagenolytic enzymes and fossilize endogenous collagenolytic enzymes. A combination of several of these strategies should result in overcoming the critical barriers to progress currently encountered in dentin bonding.

Influence of storage conditions of adhesive vials on dentin bond strength

This study was carried out to examine the effect of storage conditions of adhesive vials on the dentin bond strength of single-step self-etch adhesive systems. The adhesive/resin composite combinations used were: Absolute 2/Ceram.X(AB), Adper Prompt L-Pop/Filtek Supreme(AP), Bond Force/Estelite sigma Quick(BF), Clearfil tri-S Bond/Clearfil AP-X(CT) and G-Bond/Gradia Direct(GB). Vials of adhesives were stored at 5 degrees C, 23 degrees C or 40 degrees C. Specimens for the dentin bond strength tests were made after 0, 1, 2, 3, 4, 5 and 6 months. Labial bovine mandibular incisor dentin was wet ground with #600 SiC. The adhesives were applied according to the manufacturer's instructions. After adhesive light irradiation, resin composite cylinders were created (4 mm x 2 mm) and polymerized (n = 10). Samples were stored in 37 degrees C distilled water for 24 hours, then shear tested at a crosshead speed of 1.0 mm/minute. ANOVA and Dunnet tests were performed at a significance level of 0.05. Scanning electron microscopic (SEM) observations of the dentin surfaces were made. Bond strengths varied, with storage conditions ranging from 2.2 +/- 1.4 to 9.3 +/- 2.4 MPa for AB, 4.5 +/- 1.5 to 13.3 +/- 2.7 MPa for AP, 5.1 +/- 1.9 to 5.1 +/- 1.9 MPa for BF, 7.7 +/- 1.9 to 19.7 +/- 2.0 MPa for CT and 7.4 +/- 1.3 to 15.7 +/- 2.8 MPa for GB. With longer storage periods and higher temperatures, significant decreases in bond strength were found for all the adhesives. From SEM observation, the etching effect of the adhesives was weakened and the remaining smear layer was observed. The data suggests that the storage conditions of adhesive vials significantly affects the bond strengths of single-application self-etch adhesive systems.

Degradation of 10-methacryloyloxydecyl dihydrogen phosphate

To understand the mechanism of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) hydrolysis, we investigated the degradation of 2-methacryloyloxyethyl dihydrogen phosphate (MEP), because the MEP molecule has the methacryloxy and phosphate ester portions of MDP but, unlike the latter, is water-soluble. The MEP-N-methcryloyl glycine (NMGly), MDP-NMGly, and MDP-2-hydroxyethyl methacrylate (HEMA) primers were designed, stored for different periods, and then analyzed. Our null hypotheses were that (1) the mechanism of MDP hydrolysis differs from that of MEP and (2) the type of hydrophilic monomer--NMGly or HEMA--has no effect on the MDP hydrolysis rate. Similar to the production of methacrylic acid (MA) and 2-hydroxyethyl dihydrogen phosphate (HEP) during MEP hydrolysis, MDP produced MA and 10-hydroxydecyl dihydrogen phosphate (HDP) during hydrolysis. However, the rate of MDP hydrolysis depended on the type of hydrophilic monomer: Compared with HEMA, NMGly significantly increased the rate of MDP hydrolysis.