Paucity of Nanolayering in Resin-Dentin Interfaces of MDP-based Adhesives

Evaluation of Giomer Using Eighth Generation Bonding Agent and Resin-Modified Glass Ionomer Cement Restoration in Non-Carious Cervical Lesions

INTRODUCTION

Non-carious cervical lesions (NCCL) raise a considerable restorative challenge for the dentist in bonding, as adhesion is not as strong and predictable as enamel bonding. A critical factor for restorative success is the selection of restorative material. Clinicians have tried many restorative materials and techniques to obtain the best performance. The aim of the present study was to evaluate and compare the clinical outcome of a Giomer and Resin modified glass ionomer cement (RMGIC) restoration in NCCL using united states public health service (USPHS) criteria at baseline, 3, 6 and 12 months.

MATERIALS AND METHOD

Patients from age 25 - 50 years having non-carious cervical lesions on both the sides and requiring restorations were screened. 20 patients were selected and further divided into 2 groups using simple random sampling technique. Group A- Beautifil II restoration using G-Premio bond (n = 10) and Group B- Ketac N100 restoration (n = 10). Restorations were done according to manufacturer's instructions and consequently evaluated at baseline, 3, 6 and 12 months using the USPHS criteria for marginal discolouration, marginal integrity, surface texture, colour match, gross fracture and post-operative sensitivity.

RESULTS

Giomer restorations showed better results than RMGIC. There was decrease in alpha ratings in both the study groups i.e., Giomer and RMGIC from 6 to 12 months.

DISCUSSION

The overall findings suggest that both Giomer and RMGIC gave satisfactory clinical results when used to restore non-carious cervical lesions. Both the materials can successfully be used since there was no statistically significant difference in the clinical outcome.

48-month clinical evaluation of a copper-containing universal adhesive in non-carious cervical lesions: A double-blind randomised clinical trial

OBJECTIVES

This study aimed to evaluate the effect of copper nanoparticles (CuNp) on the clinical performance of a universal adhesive system used as an etch-and-rinse or self-etch strategy.

METHODS

A total of 216 class V (non-carious lesions) restorations were randomly placed in 36 subjects according to the following groups: ERcu, adhesive in etch-and-rinse with 0.1% CuNp; ERct, adhesive in etch-and-rinse without CuNp; SEcu, adhesive in self-etch with 0.1% CuNp; and Sect, adhesive in self-etch without CuNp. Restorations were evaluated at baseline and at 6, 12, 18, 36, and 48 months, using the FDI and USPHS criteria. Appropriate statistical analyses were performed (α = 0.05).

RESULTS

After 48 months, 14 restorations were lost (two for ERcu, five for SEcu, and seven for SEct) and the retention rates (95% confidence interval [CI]) were 74.1% for ERcu (95% CI 61.1-83.8); 81.5% for ERct (95% CI 69.2-89.6); 64.8% (95% CI 51.5-76.2) for SEcu; and 64.8% (95% CI 51.5-76.2) for SEct, with statistical differences between SEct vs. ERct and SEcu vs. ERct (p < 0.05). No significant differences between the groups were observed when the secondary parameters were evaluated (p > 0.05). Nineteen restorations (two for ERcu, two for ERct, six for SEcu, and nine for SEct) showed minor marginal staining, and 44 restorations (7 for ERcu, 8 for ERct, 14 for SEcu, and 15 for SEct) presented minimal marginal adaptation defects.

SIGNIFICANCE

This is the first long-term clinical trial to show that the addition of CuNp to a universal adhesive system does not affect clinical performance.

Effect of Different Surface Treatment Methods on the Shear Bond Strength of Resin Composite/Zirconia for Intra-oral Repair of Zirconia Restorations

OBJECTIVE

 A durable resin/zirconia bond is essential for successful intra-oral repair of zirconia restorations. The purpose of this study was to evaluate the influence of two mechanical treatments followed by seven chemical treatments on the shear bond strength (SBS) of composite resin to zirconia.

MATERIALS AND METHODS

 In this in vitro study, 280 zirconia blocks (Y-TZP) were either air-abraded or bur roughened and divided into seven experimental groups (n = 20) in terms of primer/resin application: 1) ZPP, Z-Prime Plus; 2) ZPP + GP, Z-Prime Plus followed by G-premio bond; 3) ZPP + ALB, Z-Prime Plus followed by All Bond Universal; 4) ZPP + CLRF, Z-Prime Plus followed by Clearfil SE Bond; 5)GP, G-Premio Bond 6) ALB, All Bond Universal; and 7) CLRF, Clearfil SE Bond. After composite bonding and storage in distilled water (24 hours), half of each group specimen (n = 10) were thermocycled. All specimens were subjected to shear force. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney test (α = 0.05).

RESULTS

 Significant reduction in SBS was observed in all groups after thermocycling(p < 0.05), except for the air-abraded ZPP + CLRF (p = 0.143). After aging, air-abraded CLRF exhibited the highest SBS (13.55 ± 7.8 MPa) and bur roughened ZPP showed the lowest SBS (1.16 ± 1.23 MPa). In the aged specimens, there was a significant difference between air abrasion and bur roughening in all groups (p < 0.05).

CONCLUSION

 Air-abrasion followed by application of adhesive (with/without prior primer application) is the most efficient technique for repair of veneered zirconia restorations with resin composite.

A self-etch bonding system with potential to eliminate selective etching and resist proteolytic degradation

OBJECTIVES

Bonded restorations using self-etch (SE) systems exhibit a limited lifespan due to their susceptibility to hydrolytic, enzymatic or fatigue degradation and poor performance on enamel. This study was conducted to develop and assess the performance of a two-step SE system using a functional monomer bis[2-(methacryloyloxy)ethyl]phosphate (BMEP) and demonstrate a strategy to enhance stability of bonded resin composite restorations to both enamel and dentine.

METHODS

A two-step SE system was formulated with a primer containing BMEP, with an adhesive with or without BMEP, and compared to a commercial 10-MDP-containing system, Clearfil^TM SE Bond 2 (CFSE). The systems were evaluated on enamel for surface roughness and microshear bond strength (µSBS) and on dentine for microtensile bond strength (µTBS), nanoleakage, MMP inhibition and cyclic flexural fatigue.

RESULTS

Whilst all bonding systems resulted in statistically similar µSBS, BMEP-based primers yielded greater enamel surface roughness than the CFSE primer. The BMEP-free adhesives resulted in statistically similar or higher µTBS and lower nanoleakage compared to CFSE. In situ zymography revealed minimal to no MMP activity within the hybrid layer of BMEP-based systems. The BMEP-free adhesive exhibited flexural strength and fatigue resistance statistically similar to CFSE.

CONCLUSIONS

Incorporation of BMEP in the primer led to satisfactory bond strengths with both enamel and dentine, potentially eliminating the need for selective enamel etching. Combined with an adhesive formulation that is solvent-free and hydrophobic, and confining the acidic functional monomer in the primer resulted in minimal interfacial leakage, and resistance to proteolytic degradation and the cyclic nature of chewing.

CLINICAL SIGNIFICANCE

The SE bonding system containing BMEP combines the potent etching of phosphoric acid with the therapeutic function of the phosphate-based monomer in creating a homogenous hybrid layer with protection against endogenous proteolytic enzymes. This strategy may overcome current challenges that arise during selective enamel etching.

Influence of calcium-based desensitizing toothpastes on the bonding performance of universal adhesive

The study evaluated the effect of calcium-based desensitizing toothpastes on the dentinal tubule occlusion and its influence on the dentin bond strength of universal adhesive. Mid-coronal dentin samples were prepared for hypersensitivity model and treated by the following calcium-based desensitizing toothpastes: no treatment (Control), Clinpro (fTCP), Pro-Relief (Pro-Argin), and Repair & Protect (Novamin). Single Bond Universal adhesive was applied in self-etch or etch-and-rinse mode. The dentinal tubule occlusion and adhesion interface were evaluated under scanning electron microscope (SEM). A double-fluorescence technique was used to examine interfacial permeability under confocal laser scanning microscopy (CLSM). The micro-tensile bond strength (μTBS) was employed, followed by the fracture interface observation. SEM showed the toothpastes occluded dentinal tubules, and the occlusion exhibited stability against acid and abrasion. Hindered resin infiltration was observed in the adhesion interface after desensitization. CLSM showed more water permeation within or under the adhesion interface in etch-and-rinse mode than self-etch mode. Desensitization decreased the μTBS in self-etch mode. When using etch-and-rinse mode, the desensitized samples presented similar μTBS to the control group. No difference in μTBS was found between the two bonding modes, except for the control group. Calcium-based desensitizing toothpastes can effectively occlude the exposed dentinal tubules with acid-resistant and abrasion-resistant stability. The desensitization reduced the dentin bond strength of the universal adhesive system in self-etch mode but did not affect the bond strength of etch-and-rinse mode.

Adhesive sonic agitation improves bonding durability to class-II cavity preparation

The purpose of this study was to evaluate the effect of adhesive sonic agitation on resin-dentin micro-tensile bond strength (µTBS) and interfacial morphology at the gingival wall of class-II cavity preparation. Seventy-two molars with prepared class-II cavities were divided into six groups (n = 12) according to the bonding mode; etch-and-rinse (E&R) or self-etch (SE) and application protocol of the universal adhesive (UA) employed (Clearfil Universal Bond Quick, Kuraray Noritake); following the manufacturer instructions (MI), manual agitation for 20 s (20s), or sonic agitation for 20 s using a modified sonic micro-brush mounted on EndoActivator device, Dentsply Sirona, (sonic). Restored teeth were sectioned into resin-dentin beams and slaps and µTBS was evaluated at 1 week (1w) and after thermocycling (10k). µTBS data were analyzed using the linear mixed-effects modeling with specific contrast (p < 0.05). The resin-dentin interfacial morphology was evaluated using a scanning electron microscope. Adhesive sonic agitation resulted in significantly higher µTBS means in both E&R and SE modes, compared to MI group. The µTBS of MI group showed significant reduction upon aging when applied in SE mode. Sonic agitation was associated with enhanced adhesive infiltration into dentin specially in E&R mode. Sonic agitation of UA using modified sonic micro-brush attached to EndoActivator device significantly improved the resin-dentin µTBS and interfacial morphology at the gingival wall of class-II cavity preparation.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

Comparison of Different Universal Adhesive Systems on Dentin Bond Strength

Over the past few decades, adhesive dentistry has advanced significantly. In light of minimal-invasive dentistry, this novel technique advocates a more conservative cavity design that relies on the efficiency of present enamel-dentine adhesives. The study aimed to address the scientific deficit in understanding the long-term bonding performance of universal adhesives and to provide a new clinical solution with desirable bond strength to dentin. The dentin bond strength of three bonding agents, G2-Bond Universal (GC), Clearfil SE Bond (Kuraray), and Scotchbond Universal Plus (3M ESPE), was evaluated following various storage and etching modes. The UltraTester (Ultradent) bond strength testing machine was used to assess shear bond strength. The results showed that thermal cycling and the choice of adhesive system significantly affected the shear bond strength (p = 0.018 and p = 0.001, respectively). Among the three adhesives, Scotchbond Universal Plus had the lowest bond strength value (mean value = 24.78 MPa), while G2-Bond Universal was found to have desirable shear bond strength to dentin compared to the other adhesives, even after one year in the oral environment (mean value = 35.15 MPa). These findings imply that the HEMA-free universal adhesive G2-Bond Universal is the most effective universal adhesive for clinical practices, particularly when applied in the self-etch mode.

Evaluation of the Combination of CO2 Laser and Bifunctional Bonding Agents for Composite Resin Repairs After 1 Year of Aging

Objective: to evaluate the bond strength of repairs to composite resin restorations treated with CO₂ laser and bifunctional monomers after 1 year of aging. Background: Adequate bond strength between a composite restoration and resin repair agent can be achieved through mechanical and/or chemical treatment. However, the longevity of such repairs is unknown. Methods: Resin blocks (volume: 125 mm³) were created. Failure surfaces were either not treated or were treated before the repair with a universal adhesive, a silane bonding agent and/or CO₂ laser. The blocks were distributed into six groups (n = 6 per group): resin+resin group (RRG), universal adhesive+resin group (ARG), silane+universal adhesive group (SAG), laser+silane+universal adhesive group (LSAG), laser+universal adhesive group (LAG), and laser+silane group (LSG). After treatment, repairs were made with another resin composite. "Sticks" (1.0 mm² in area and 1.0 cm in length) were cut from the specimens in each group and immersed in distilled water at 37°C. Microtensile bond strength was evaluated after 1 year of aging. Bond strength values were compared using the Kruskal-Wallis test and Dunn's test. Results: Bond strength was significantly higher in the LSAG compared with the RRG, adhesive system, LSG, whereas statistically similar results were found for the SAG, LSAG, and LAG. Bond strength was lowest in the RRG. The LSAG and LAG presented predominantly cohesive fractures. Conclusions: The bond strength of composite resin repairs was satisfactory over time. Treatment with CO₂ laser contributed to the maintenance of bond strength during the 1-year storage period and bifunctional monomers present in the universal adhesive on the irradiated repair surface were of fundamental importance to the maintenance of bond strength values, as demonstrated by microtensile bond test and fracture pattern analysis.

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

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

The Effect of Dental Adhesive Composition and Etching Mode on Microleakage of Bonding Agents in Primary Molar Teeth

Statement of the Problem

The dilemma of microleakage at the composite-tooth interface is still a major challenge in operative dental practice.

Purpose

This study aimed to compare the microleakage of universal adhesive with self-etch and total-etch bonding strategies for restoration of class-II primary molar cavities.

Materials and Method

This in vitro, experimental study was conducted on 75 extracted primary molars. Class-II cavities were prepared in mesial or distal surfaces. The teeth were randomly divided into five groups of Adper Single Bond 2 (3M ESPE; St Paul, MN, USA), Clearfil SE Bond (Kuraray Noritake, Osaka, Japan), G-Bond (GC Corp., Tokyo, Japan), G-Premio Bond (GC Corp., Tokyo, Japan) with total-etch mode and G-Premio Bond with self-etch mode. Cavities were also restored with Nano-hybrid resin composite (Grandio, VOCO, Cuxhaven, Germany) and incubated for 24 hours, followed by thermocycling at 1500× between 5-55°C within a dwell time of 20 seconds. Later, the cavities were placed in 1M silver nitrate solution and evaluated under a stereomicroscope. Finally, microleakage was assessed quantitatively and qualitatively. One tooth in each group was prepared and evaluated under a scanning electron microscope (SEM). Data were analyzed using One-way ANOVA, Tukey's post hoc test and Chi-square test (p< 0.05).

Results

The microleakage values were significantly different in the study groups (p&lt; 0.05). The highest level of microleakage was noted in G-Bond and the lowest in G-Premio Bond with total etching. There was a significant correlation between the qualitative and quantitative measurements of microleakage.

Conclusion

The G-Premio Bond yielded acceptable results in terms of microleakage in total-etch and self-etch modes. However, additional etching is recommended to improve the quality of bonding.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

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

Purpose

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

Methods

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

Results

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

Conclusion

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

Universal Adhesives and Adhesion Modes in Non-Carious Cervical Restorations: 2-Year Randomised Clinical Trial

This prospective, double-blind, six-arm parallel randomised controlled trial aimed to compare the performance of two universal adhesives (UAs) in non-carious cervical lesions (NCCLs), using the FDI criteria, and analysed if participants/NCCLs’ characteristics influenced the outcome. Thirty-eight 18- to 65-year-old participants were seeking routine dental care at a university clinic. At baseline, 210 NCCLs were randomly allocated to six groups (35 restorations’ each). The UAs tested were FuturabondU (FBU) and AdheseUniversal (ADU) applied in either etch-and-rinse (ER) and self-etch (SE) modes. FuturabondDC (FBDC) in SE and in SE with selective enamel etching (SE-EE) modes were controls. NCCLs were restored with AdmiraFusion. The analysis included nonparametric tests, Kaplan-Meier and log-rank tests (α = 0.05). At 2-years, of 191 restorations, ten were missed due to retention loss (all groups, p > 0.05). FBDC (p = 0.037) and FBU (p = 0.041) performed worse than ADU in SE mode. FBDC and FBU also showed worse functional success rate (p = 0.012, p = 0.007, respectively) and cumulative retention rates (p = 0.022, p = 0.012, respectively) than ADU. Some participants/NCCLs’ characteristics influenced (p < 0.05) the outcomes. FBU did not perform as well as ADU, especially in SE mode and due to functional properties. Participants’ age and NCCLs’ degree of dentin sclerosis and internal shape angle influenced FBU performance.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Investigating a Commercial Functional Adhesive with 12-MDPB and Reactive Filler to Strengthen the Adhesive Interface in Eroded Dentin

To compare the adhesive interface of eroded dentin formed by a functional dental adhesive and a gold standard strategy, by testing microtensile bond strength (μTBS), hardness/elastic modulus. Permanent sound human molars were randomly allocated to four experimental groups, all subject to artificial erosion (0.05 M citric acid; 3× daily, 5 days). Groups included control Clearfil SE Bond 2 (CFSE), and experimental group Clearfil SE Protect (CFP), at two different time points-immediate (24 h) and long term (3 months–3 M). Samples were sectioned into microspecimens for μTBS (n = 8) and into 2-mm thick slabs for nanoindentation assays (n = 3). Groups CFSE_3M and CFP_3M were stored in artificial saliva. Statistical analysis included two-way ANOVA for μTBS data, while hardness/modulus results were analyzed using Kruskal–Wallis H Test (significance level of 5%; SPSS v.27.0). Although no significant differences were found between mean μTBS values, for different adhesives and time points (p > 0.05), a positive trend, with μTBS rising in the CFP_3M group, was observed. Regarding hardness, no significant differences were seen in the hybrid layer, considering the two variables (p > 0.05), while the reduced elastic modulus rose in CFP_3M when compared to 24 h. Thus, CFP shows similar mechanical and adhesive performance to CFSE in eroded dentin, although it may comprise promising long-term results. This is advantageous in eroded substrates due to their increased enzymatic activity and need for remineralization.

An in-vitro study investigating the effect of air-abrasion bioactive glasses on dental adhesion, cytotoxicity and odontogenic gene expression

OBJECTIVE

To assess the microtensile bond strength (MTBS) and interfacial characteristics of universal adhesives applied on dentine air-abraded using different powders. The analysis includes the cytotoxicity of the powders and their effect on odontogenic gene expression.

METHODS

Sound human dentine specimens were air-abraded using bioglass 45S5 (BAG), polycarboxylated zinc-doped bioglass (SEL), alumina (AL) and submitted to SEM analysis. Resin composite was bonded to air-abraded or smear layer-covered dentine (SML) using an experimental (EXP) or a commercial adhesive (ABU) in etch&rinse (ER) or self-etch (SE) modes. Specimens were stored in artificial saliva (AS) and subjected to MTBS testing after 24 h and 10 months. Interfacial nanoleakage assessment was accomplished using confocal microscopy. The cytotoxicity of the powders was assessed, also the total RNA was extracted and the expression of odontogenic genes was evaluated through RT-PCR.

RESULTS

After prolonged AS storage, specimens in the control (SML) and AL groups showed a significant drop in MTBS (p > 0.05), with degradation evident within the bonding interface. Specimens in BAG or SEL air-abraded dentine groups showed no significant difference, with resin-dentine interfaces devoid of important degradation. The metabolic activity of pulp stem cells was not affected by the tested powders. SEL and BAG had no effect on the expression of odontoblast differentiation markers. However, AL particles interfered with the expression of the odontogenic markers.

SIGNIFICANCE

The use of bioactive glass air-abrasion may prevent severe degradation at the resin-dentine interface. Unlike alumina, bioactive glasses do not interfere with the normal metabolic activity of pulp stem cells and their differentiation to odontoblasts.

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

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Analysis of laboratory adhesion studies in eroded enamel and dentin: a scoping review

Aim

To summarize and report laboratory studies of adhesion in eroded substrates, which used bond strength as an outcome measure. To determine the strategies available to overcome bonding difficulties, the quality and consistency of the methodology and to find evidence gaps.

Materials and Methods

The present review followed PRISMA-ScR guidelines. A search was conducted on PubMed/Medline, Scopus and EMBASE (Ovid) databases to identify published peer-reviewed papers (2010–2020). For final qualitative synthesis, 29 articles were selected which respected the inclusion criteria. Data charting was carried out, independently, by two reviewers and quality assessment of the articles was performed.

Results

The primary studies included fall into four major categories: comparison of restorative materials and application modes, enzymatic inhibitors, surface pretreatments or remineralization strategies. Most studies found evaluated dentin (76%), while 17% evaluated enamel, and 7% evaluated both substrates. The majority of the studies reported an effective intervention (83%). Bond strength to eroded dentin is significantly reduced, while in enamel erosion is beneficial. The bond strength to eroded dentin is material-dependent and favored in systems containing 10-MDP. Great disparities among the erosion models used were found, with citric acid in different concentrations being the preferred method, although standardization is lacking.

Conclusions

Adhesives containing 10-MDP show beneficial results in eroded dentin, and surface preparation methods should be considered. Studies which evaluated adhesion to eroded enamel/dentin show high heterogeneity in what concerns aims and methodology. Strategies that focus on remineralizing dentin and strategies to protect bond longevity in this substrate require further research.

Modelling ATR-FTIR Spectra of Dental Bonding Systems to Investigate Composition and Polymerisation Kinetics

Component ratios and kinetics are key to understanding and optimising novel formulations. This warrants investigation of valid methods. Attenuated Total Reflectance Fourier Transform Infra-Red (ATR)-FTIR spectra of separate primers/adhesives were modelled using summed spectra of solvents (water, ethanol), methacrylate monomers (HEMA (hydroxyethyl methacrylate), Bis-GMA (bisphenol A glycidyl methacrylate), and 10-MDP (10-methacryloyloxydecyl dihydrogen phosphate)), and fillers, multiplied by varying fractions. Filler loads were obtained following their separation from the adhesives, by analysing three repetitions (n = 3). Spectral changes during light exposure at 37 °C (20 s, LED 1100-1330 mW/cm2) were used to determine polymerisation kinetics (n = 3). Independent samples T-test was used for statistical analysis (significance level of 5%). FTIR modelling suggested a primer solvent percentage of OBFL (Optibond FL) (30%) was half that of CFSE (Clearfil SE 2) (60%). OBFL included ethanol and water, while CFSE included only water. Monomer peaks were largely those of HEMA with lower levels of phosphate monomers. OBFL/CFSE adhesive model spectra suggested that both contained equal volumes of Bis-GMA/HEMA, with CFSE having 10-MDP. Filler levels and spectra from OBFL (48 wt.%) and CFSE (5 wt.%) were different. Both systems reached a 50% conversion rate within seconds of light exposure. The final conversion for OBFL (74 ± 1%) was lower compared to CFSE (79 ± 2%) (p < 0.05). ATR-FTIR is a useful method to investigate relative levels of main components in bonding systems and their polymerisation kinetics. Such information is valuable to understanding such behaviour.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

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

OVERVIEW

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

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

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

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

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

Five-year clinical evaluation of a universal adhesive: A randomized double-blind trial

OBJECTIVE

To evaluate the five-year clinical performance of Scotchbond Universal Adhesive (SU; 3M Oral Care, St. Paul, MN, USA) in non-carious cervical lesions (NCCLs) using two evaluation criteria.

METHODS

Thirty-nine patients participated in this study. Two hundred restorations were assigned to four groups: SU-ERm: etch-and-rinse + moist dentin; SU-ERd: etch-and-rinse + dry dentin; SU-Set: selective enamel etching; and SU-SE: self-etch. A nanofilled composite resin was placed incrementally. The restorations were evaluated at baseline and after 5 years using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. The survival rates (retention/fractures) were calculated with the Kaplan-Meier and the log-rank test. For the secondary outcomes, Friedman repeated measures analysis of variance by rank was applied (α = 0.05).

RESULTS

After 5 years the recall rate was 86%. The retention/fracture rates were 93% for Erm and ERd, 88.4% for SEet and 81.4% for SE. A significant difference was observed for SE vs. ERd and SE vs. ERm (p = 0.01). Also, marginal discoloration and adaptation showed significant differences with ERm and ERd resulting in fewer marginal discrepancies than SE (p < 0.05).

SIGNIFICANCE

After 5 years, the clinical behavior of the universal adhesive in the etch-and-rinse strategy was better when compared to the self-etch strategy. The use of selective enamel etching is highly recommended for the self-etch strategy. The FDI and USPHS evaluation criteria showed similar results after 5 years.

Pure Ormocer vs Methacrylate Composites on Posterior Teeth: A Double-blinded Randomized Clinical Trial

CLINICAL RELEVANCE

The clinical behavior of pure ormocer composite is reliable when used in class II restorations after 24 months of evaluation.

SUMMARY

Dentin microshear bond strength of various resin luting agents to zirconia-reinforced lithium silicate ceramics

STATEMENT OF PROBLEM

The performance of adhesive and resin luting cements used to bond zirconia-reinforced lithium silicate (ZLS) ceramics to dentin has not been well established.

PURPOSE

The purpose of this in vitro study was to examine the microshear bond strength (μSBS) of an etch-and-rinse adhesive system, a universal adhesive, and a self-adhesive resin cement that were used to bond ZLS to dentin.

MATERIAL AND METHODS

VITA Suprinity (VS) and Celtra Duo (CD) blocks were sectioned into 36 and 72 microbars (1×1×3 mm). All VS were crystallized, while half of CD were additionally fired and defined as fired-Celtra Duo (FCD). The others were defined as unfired-Celtra Duo (UCD). Each microbar was cemented to each flat occlusal dentin surface of a human first premolar, following the adhesive luting systems: Scotchbond Multi-purpose (SM), Single Bond Universal (SU) combined with RelyX Ultimate, and RelyX Unicem (U2) (n=12 per group). μSBS at 24 hours was then determined, and the data were analyzed by using 2-way ANOVA and a Tukey post hoc test (α=.05). Failure modes were analyzed under a stereomicroscope at ×40 magnification.

RESULTS

Two-way ANOVA revealed that the type of ZLS had no influence on μSBS (P=.699). However, the kinds of adhesive luting cements and their interaction had a statistically significant effect on μSBS (P<.001 and P=.002). U2 had a statistically significant lower mean μSBS, regardless of the type of ZLS, than SM and SU (P≤.05), while UCDU2 did not show a statistically significant difference in μSBS from UCDSU (P=.478).

CONCLUSIONS

Resin cement used with an etch-and-rinse and a universal adhesive agent demonstrates higher bond strength for the cementation of zirconia-reinforced lithium silicate ceramics to dentin than a self-adhesive resin cement.

Effect of Chitosan as a Cross-Linker on Matrix Metalloproteinase Activity and Bond Stability with Different Adhesive Systems

The aim of the present study was to evaluate the effect of 0.1% chitosan (Ch) solution as an additional primer on the mechanical durability and enzymatic activity on dentine using an etch-and-rinse (E&R) adhesive and a universal self-etch (SE) adhesive. Microtensile bond strength and interfacial nanoleakage expression of the bonded interfaces for all adhesives (with or without pretreatment with 0.1% Ch solution for 1 min and air-dried for 5 s) were analyzed immediately and after 10,000 thermocycles. Zymograms of protein extracts from human dentine powder incubated with Optibond FL and Scotchbond Universal on untreated or Ch-treated dentine were obtained to examine dentine matrix metalloproteinase (MMP) activities. The use of 0.1% Ch solution as an additional primer in conjunction with the E&R or SE adhesive did not appear to have influenced the immediate bond strength (T0) or bond strength after thermocycling (T1). Zymography showed a reduction in MMP activities only for mineralized and demineralized dentine powder after the application of Ch. Application of 0.1% Ch solution does not increase the longevity of resin–dentine bonds. Nonetheless, the procedure appears to be proficient in reducing dentine MMP activities within groups without adhesive treatments. Further studies are required to comprehend the cross-linking of Ch with dentine collagen.

Etch-and-rinse vs self-etch mode for dentin bonding effectiveness of universal adhesives

In this study, dentin bond fatigue resistance and interfacial science characteristics of universal adhesives through etch-and-rinse and self-etch modes were investigated. Resin composite was bonded to human dentin with four universal adhesives, namely, Adhese Universal, All-Bond Universal, G-Premio Bond, and Scotchbond Universal Adhesive. The initial bond strengths, bond fatigue strengths, and interfacial science characteristics of the universal adhesives with dentin through etch-and-rinse and self-etch modes were determined. Bond fatigue resistance (initial bond strength and bond fatigue strength) of universal adhesives in etch-and-rinse mode showed no significant difference in contrast to that in self-etch mode and was material-dependent regardless of the etching mode. Although phosphoric acid conditioning of dentin did not have a strong impact on the bond fatigue resistance, surface free energy and parameters of dentin were significantly decreased by etching and by application of universal adhesives regardless of etching mode. Changes in γ_S and γ_S^h for when universal adhesive was applied to etched and ground dentin were significantly different depending on the adhesive. The results suggest that bonding performance of universal adhesives was effective in both etching modes; however, bonding mechanisms may be different for each.

18-month clinical evaluation of a copper-containing universal adhesive in non-carious cervical lesions: A double-blind, randomized controlled trial

OBJECTIVE

This study aimed to evaluate the addition of copper nanoparticles (CuNp) on the clinical performance of a universal adhesive system used as etch-and-rinse (ER) and self-etch (SE).

METHODS

216 restorations were randomly placed in 36 subjects according to the following groups: ERcu = etch-and-rinse with 0.1% CuNp; ERct = etch-and-rinse without CuNp; SEcu = self-etch with 0.1% CuNp; SEct = self-etch without CuNp. Resin composite was placed incrementally and light-cured. The restorations were evaluated at baseline and 6, 12 and 18 months using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α = 0.05).

RESULTS

The addition of CuNp did not increase the clinical performance (FDI / USPHS) of the universal adhesive tested after 18-month when applied in the ER mode (p > 0.05). The addition of CuNp in SE restorations increased the retention rate significantly and decreased the marginal discrepancies after 18 months (p < 0.05).

CONCLUSION

The clinical performance of universal adhesive was significantly increased when applied in the SE mode with the addition of copper nanoparticles.

CLINICAL RELEVANCE

This is the first study that demonstrates a slight improvement in the clinical performance of universal adhesive systems in non-carious cervical lesions when added CuNp in lower concentration.

Reactivity and Bond Strength of Universal Dental Adhesives with Co-Cr Alloy and Zirconia

The aim of this study was to evaluate (a) the reactivity of six universal dental adhesives with polished cobalt-chrome (Co-Cr) alloy and zirconia (3Y-TZP) surfaces; and (b) to assess the shear bond strength (SBS) of a resin composite with polished and alumina-blasted surfaces as mediated by these adhesives. The products tested were Adhese Universal (AD), All-Bond Universal (AB), Clearfill Universal Bond (CB), G-Premio Bond (GP), Prelude One (PO) and Scotchbond Universal (SB). The reactivity on polished substrates was evaluated by reflection infrared microscopy (RFTIRM). The roughness parameters of polished and 50 μm alumina grit-blasted surfaces were assessed by optical profilometry. The SBS of the composite bonded to the substrates treated with each adhesive (n = 10/product) was evaluated after 1 week of storage (H₂O/37 °C) by Weibull statistics. Evidence of phosphate interaction with polished substrates was obtained by FTIRM, with higher peaks on the alloy. Alumina-blasting increased all roughness parameters with higher values on the alloy. AD, CB were the strongest (σ₀) treatments on alloy surfaces and AD, CB, AB, SB on zirconia. GP was the weakest on both substrates and the least reliable (β) on alloy. On polished alloy GP, PO performed better (σ₀), whereas on zirconia there were no significant differences. All adhesives showed more prominent reaction with the Co-Cr alloy than with 3Y-TZP.

Immediate enamel bond strength of universal adhesives to unground and ground surfaces in different etching modes

The purpose of this study was to determine the immediate bond effectiveness of universal adhesives to unground and ground enamel surfaces in different etching modes, through shear bond strength (SBS) tests and scanning electron microscopy observations. Three universal adhesives, a conventional two-step self-etch adhesive, and a conventional single-step self-etch adhesive were compared. Human enamel specimens from lower anterior teeth were divided into four groups and subjected to the following treatments: (i) unground enamel in self-etch mode; (ii) ground enamel in self-etch mode; (iii) unground enamel in etch-&-rinse mode; and (iv) ground enamel in etch-&-rinse mode. Bonded assemblies were subjected to SBS testing. All the adhesives showed significantly higher SBS values in etch-&-rinse mode than in self-etch mode, regardless of whether enamel was unground or ground. The influence of the enamel surface condition on SBS was different in different etching modes. Without pre-etching, all tested materials showed lower SBS values in unground enamel than in ground enamel. In etch-&-rinse mode, no significant differences in SBS values were observed between unground enamel and ground enamel for any of the adhesives tested. Phosphoric acid pre-etching before application of self-etch adhesives to an unground enamel surface is essential to enhance initial enamel bond effectiveness.

Effect of a hydrophobic bonding resin on the 36-month performance of a universal adhesive-a randomized clinical trial

OBJECTIVES

To evaluate if the addition of a layer of a hydrophobic bonding resin to the recommended application sequence of a universal adhesive improves the respective clinical behavior in non-carious cervical lesions (NCCLs) after 36 months.

MATERIALS AND METHODS

Scotchbond Universal Adhesive (SBU, 3M Oral Care) was applied in NCCLs of 39 subjects using four adhesion strategies: (1) three-step ER (etch-and-rinse), (2) two-step ER, (3) two-step SE (self-etch), and (4) one-step SE. An extra layer of a hydrophobic bonding resin was applied for strategies three-step ER and two-step SE. The same composite resin (Filtek Supreme XTE, 3M Oral Care) was used for all strategies. Restorations were evaluated at baseline and 18 and 36 months using the modified United States Public Health Service (USPHS) criteria. Kruskal-Wallis, Mann-Whitney U, Friedman, and Wilcoxon non-parametric tests were computed.

RESULTS

The cumulative failure rate was 8.6%. The 36-month retention rates were 100% for both 3-ER and 2-ER, 76.0% for 2-SE, and 86.2% for 1-SE. A lower retention rate was observed for two-step SE at 36 months compared with both three-ER (p < 0.01) and two-ER (p < 0.01). Identical retention rates were measured for the two SE groups. When retention rate was compared at baseline versus 36 months for each adhesion strategy, a significant decrease was observed for 2-SE. The restorations performed with 3-ER, 2-SE, and 1-SE had a significant deterioration in marginal discoloration at the 18-month recall.

CONCLUSIONS

The 36-month clinical performance of Scotchbond Universal Adhesive improved for both etch-and-rinse strategies.

CLINICAL RELEVANCE

Phosphoric acid etching is still recommended to provide retention to composite restorations in NCCLs.

Universal Adhesives: Setting Characteristics and Reactivity with Dentin

The aim of the study was to evaluate the performance of six commercially available universal dental adhesives: Adhese Universal (ADU), All-Bond Universal (ABU), Clearfil Universal Bond Quick (CBQ), G-Premio Bond (GPB), Prelude One (PRO) and Scotchbond Universal (SBU). The properties tested were: (a) degree of C=C conversion (DC%); (b) Vickers micro-hardness (VHN); (c) extent of oxygen inhibition (OI/μm), all related with the adhesive film properties; (d) extent of dentin demineralisation (DM%), insoluble salt formation (AS%); and (e) shear bond strength (SBS, self-etch mode) related to the adhesive-dentin interactions. Statistical analysis (α = 0.05) was performed by one-way ANOVA and Tukey's test (DC%, VHN, OI, DM% AS%) and Weibull analysis (SBS, σ_0-β). The DC ranged from 67.2-82.5% (all >GPB), OI from 5.6-18.6 μm (SBU > ADU, GPB, ABU > CBQ > PRO), microhardness from 1.1-6.6 VHN (SBU > ADU > ABU > CBQ > PRO > GPB: not measurable), DM from 69.3% (GPB) to 16-12.5% (CBQ, SBU, ADU) and 13.2-10.6% (ABU, ADU, PRO), in homogeneous groups and AS from 26-15.9% (ABU, CBQ > GPB, PRO, ADU, SBU). For SBS the σ₀ (characteristic life) ranged from 29.3-16.6 MPa (CBQ, ADU, ABU, SBU > PRO > GPB), the β (reliability) from 5.1-9.7 (p > 0.05). All failure modes were of mixed type (adhesive and composite cohesive). Although all these adhesives were based on the 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) adhesive monomer, the different co-monomers, solvents and catalysts led to variations in their film properties, reactivity and bonding capacity with dentin.

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.

Comparison of self-adhering flowable composite microleakage with several types of bonding agent in class V cavity restoration

BACKGROUND

The aim of the present study was to compare the marginal seal of self-adhering flowable composite resin with three universal bonding systems using the self-etch technique in Cl V cavities at enamel and dentin margins.

MATERIALS AND METHODS

In this in vitro study, Cl V cavities were prepared on the buccal surfaces of forty premolars, with the occlusal margin of each cavity on enamel and gingival margin on dentin. The teeth were divided into four groups (n = 10) in terms of the adhesive used; Group 1: Vertise Flow (VF) self-adhering composite resin, Group 2: Clearfil S3 Bond Universal (CS3BU), Group 3: G-Premio Bond (GPB), Group 4: Single Bond Universal (SBU). In Groups 2, 3, and 4, Z350 flowable composite resin was used to restore the cavities. After thermocycling, the samples were immersed in 10% methylene blue for 24 h and evaluated under a stereomicroscope after buccolingual sectioning; microleakage at enamel and dentin margins was recorded. Kruskal-Wallis and Mann-Whitney tests were used for statistical analyses. Statistical significance was set at P < 0.5.

RESULTS

Vertis Flow self-adhering composite resin exhibited significantly higher microleakage at enamel and dentin margins compared to SBU and CS3BU; however, it had significantly less microleakage at enamel margin compared to GPB (P < 0.05). At the enamel and dentin margins, the minimum microleakage values were recorded at SBU and CS3BU margins, respectively. GPB exhibited the highest microleakage values among the groups evaluated and in all the groups, microleakage at dentin and enamel margins was significantly different (P < 0.05) except for SBU group.

CONCLUSION

The marginal sealing ability of self-adhering flowable composite resin at enamel and dentin margins was poor compared to the majority of bonding agents evaluated.

Influence of ethanol-wet dentin, adhesive mode of application, and aging on bond strength of universal adhesive

The aim of this study was to evaluate the effect of ethanol on the bond longevity of a universal adhesive system to bovine dentin, under different modes of adhesive application and artificial aging. Bovine dentin was exposed, and the smear layer was standardized by sandpaper polishing. Specimens were randomly divided into 2 groups: ethanol (E) and non-ethanol (N). Groups were subdivided according to adhesive mode of application into etch-and-rinse (Er) and self-etching (S). Resin blocks were built onto the treated surface, and the specimens were stored in deionized water at 37°C for 48 h. Half of the specimens (n = 10) were subjected to thermomechanical aging (A for aged and Na for non-aged). Resin/dentin beams were obtained and subjected to microtensile test in a universal testing machine. Data were analyzed using a three-way ANOVA and Tukey's tests (α = 5%). There was interaction among the three factors (p=0.0003). The use of ethanol resulted in higher values, except for the Er and Na groups (E_Er_Na = N_Er_Na). The mode of application was similar, except for the N and A groups (N_S_A > N_Er_A). For the A groups, the values were lower, except in the cases using ethanol, in which the results were not affected. The study concluded that the use of ethanol resulted in higher microtensile bond strength values, even after aging. The mode of adhesive application did not influence the results.

Selective dentin etching: A potential method to improve bonding effectiveness of universal adhesives

OBJECTIVES

To evaluate whether selective dentin etching protocols using reduced phosphoric acid (H₃PO₄) etching-times would affect the resin-dentin interaction of a universal adhesive to improve long-term bonding effectiveness.

METHODS

Mid-coronal flat dentin surfaces were produced on sound third molars, selectively etched with 32% H₃PO₄ for 3, 5, 10 or 15 s and bonded with a universal adhesive (Scotchbond Universal, 3 M ESPE: SU). SU in self-etch mode and a three-step etch-and-rinse adhesive were used as control groups. Bonded specimens were stored in deionized water for 24 h and sectioned into beams (cross sectional area of 0.7 mm²). Micro-tensile bond strength test (n = 6) and nanoleakage evaluation were performed immediately, after thermocycling or 6-month storage in artificial saliva. Energy dispersive X-ray analysis (n = 6) was performed to determine the residual Ca-content ratio at the hybrid layers and scanning electron microscopy (SEM) was used to observe the micromorphology of the etched dentin surfaces before and after SU application. Data were analyzed by ANOVA and Tukey test (α = 0.05).

RESULTS

Selective dentin etching for 3 s improved the interaction depth of the tested universal adhesive without overexposing demineralized collagen or reducing Ca-content availability at the bonded interface. The improved immediate bond strengths of the selective etching protocol remained significantly higher (p < 0.05) after long-term aging producing hybrid layers without significant differences (p > 0.05) in silver uptake levels compared to those produced on non-etched dentin.

CONCLUSIONS

Despite the adjunctive conclusion that universal adhesives used in self-etch mode produce superior long-term dentin bonding compared to the etch-and-rinse mode, selective etching for 3 s with conventionally used H₃PO₄ improves dentin bonding effectiveness; nonetheless, longer etching times should be strictly avoided.

Water-associated attributes in the contemporary dentin bonding milieu

OBJECTIVES

The water-associated attributes of resin-dentin interfaces created by contemporary adhesives are important determinants of bond integrity and stability. In the present work, these attributes were estimated from the perspectives of causality, to examine the behavior of the first and most-recently launched versions of universal adhesives when applied in either the etch-and-rinse mode or the self-etch mode.

METHODS

The immediate cause of interfacial permeability and the time-dependent cause of water sorption were investigated in conjunction with the intermediate effect of interface degradation and the more long-term effect of loss of mechanical strength, before and after thermomechanical cycling. The results were compared with control etch-and-rinse and self-etch adhesives.

RESULTS

Although the introduction of this new class of universal adhesives has brought forth significant changes to the dental adhesion arena, including more application options, reduced bonding armamentarium and increased user friendliness, the water-associated attributes that are critical for making resin-dentin bonds more durable to environmental challenges and less susceptible to degradation have remained unchanged at large, when compared with benchmarks established by former classes of adhesives.

CONCLUSION

It appears that the current trend of adhesive development has brought forth significant changes but lacks the vigor that demarcates progress and technological sublimity.

CLINICAL SIGNIFICANCE

The advent of the user friendly universal adhesives has brought forth significant changes to the dental adhesion arena. However, the elements that are critical for making resin-dentin bonds more durable to environmental challenges and less susceptible to degradation have remained unchanged at large.

Does Shortened Application Time Affect Long-Term Bond Strength of Universal Adhesives to Dentin?

OBJECTIVE

This study evaluated the effect of shortened application time on long-term bond strength with universal adhesives.

METHODS AND MATERIALS

Three universal adhesives were used: Clearfil Universal Bond (CU, Kuraray Noritake Dental Inc, Tokyo, Japan), Scotchbond Universal Adhesive (SB, 3M ESPE, St Paul, MN, USA) or G-Premio Bond (GP, GC Corp, Tokyo, Japan). Sixty molars were cut to expose midcoronal dentin and prepared with a regular diamond bur. Each adhesive was applied either according to the manufacturer's instruction or with shortened time. Specimens were stored in distilled water at 37°C for 24 hours and then cut into resin-dentin sticks. Microtensile bond strength (μTBS) was tested after either 24 hours or 1 year of water storage. Data were analyzed by the three-way ANOVA and Duncan tests ( α=0.05). Fracture modes were analyzed under a scanning electron microscope (SEM). One dentin stick per group was selected after fracture mode analysis and further observed using transmission electron microscopy (TEM). Six additional dentin discs were prepared and conditioned with each adhesive under the different application time to observe the adhesive-smear layer interaction by SEM.

RESULTS

Shortened application time affected the μTBS ( p<0.001) while storage time did not affect bond strength ( p=0.187). A significant effect of shortened application time on μTBS was observed in the CU at 1 year and in the GP at both storage times.

CONCLUSIONS

One-year storage time had no effect on the μTBS of universal adhesives to bur-cut dentin. The performance of universal adhesives can be compromised when applied using a shortened application time.

Acidic pH weakens the bonding effectiveness of silane contained in universal adhesives

OBJECTIVES

Some silane-containing universal adhesives were introduced that a separate ceramic primer was unnecessary to glass-ceramic bonding because of incorporated silane. We aimed to investigate the effectiveness of silane in universal adhesives with acidic media.

METHODS

A functional γ-methacryloxypropyltrimethoxysilane (γ-MPTS) was used, and its pH value was adjusted to 2.7 by adding hydrochloric acid (HCl) or 10-methacryloxydecyl phosphate (MDP). The prepared acidic silane solutions after 2h or 10d storage were characterized by Fourier transform infrared spectroscopy (FTIR), ¹H and ¹³C nuclear magnetic resonance (NMR) spectroscopy. Micro-shear bond strength (μSBS) was used to evaluate the bonding performance of glass ceramics. Two silane-containing and two silane-free universal adhesives were included. Field-emission scanning electron microscopy fractography analysis was also performed.

RESULTS

FTIR, ¹H and ¹³C NMR revealed that the hydrolysis of γ-MPTS and the self-condensation reaction of silanol groups occurred over time under acidic conditions (HCl or MDP solution). This reaction formed the siloxane oligomers. For glass-ceramic bonding, the μSBS of acidic silane after 10 d storage was lower than that of silane stored for 2h storage (p<0.05), although the difference among the μSBS of the four universal adhesives were nonsignificant (p>0.05). Additionally, cohesive failure was the main fracture pattern of universal adhesive bonding.

SIGNIFICANCE

The effectiveness of silane contained in low pH universal adhesives can be weakened by dehydration self-condensation and consequently became unstable. For the enhancement of glass-ceramic bonding efficiency with universal adhesives, a separate ceramic primer was recommended.

Dipentaerythritol penta-acrylate phosphate - an alternative phosphate ester monomer for bonding of methacrylates to zirconia

The present work examined the effects of dipentaerythritol penta-acrylate phosphate (PENTA) as an alternative phosphate ester monomer for bonding of methacrylate-based resins to yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) and further investigated the potential bonding mechanism involved. Shear bond strength testing was performed to evaluate the efficacy of experimental PENTA-containing primers (5, 10, 15, 20 or 30 wt% PENTA in acetone) in improving resin-Y-TZP bond strength. Bonding without the use of a PENTA-containing served as the negative control, and a Methacryloyloxidecyl dihydrogenphosphate(MDP)-containing primer was used as the positive control. Inductively coupled plasma-mass spectrometry (ICP-MS), X-ray photoelectron spectroscopy (XPS) and Fourier-transform infrared spectroscopy (FTIR) were used to investigate the potential existence of chemical affinity between PENTA and Y-TZP. Shear bond strengths were significant higher in the 15 and 20 wt% PENTA groups. The ICP-MS, XPS and FTIR data indicated that the P content on the Y-TZP surface increased as the concentration of PENTA increased in the experimental primers, via the formation of Zr-O-P bond. Taken together, the results attest that PENTA improves resin bonding of Y-TZP through chemical reaction with Y-TZP. Increasing the concentration of PENTA augments its binding affinity but not its bonding efficacy with zirconia.