A Critical Review of the Durability of Adhesion to Tooth Tissue: Methods and Results

Clinical survival and complication rate of ceramic veneers bonded to different substrates: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Evidence on the long-term clinical assessment and longevity of ceramic veneers bonded to different substrates is limited.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effect of various substrates, including enamel, dentin, or an existing composite resin restoration, on the clinical survival and complication rates of ceramic veneers.

MATERIAL AND METHODS

The PubMed, Scopus, and the Cochrane Library electronic databases were searched, and related journals were hand searched without time or language restrictions to identify clinical trials that compared the survival rate and clinical complication rates when bonding ceramic veneers to different tooth substrates. The success rate of the included participants was estimated by the number of veneers that did not require a clinical intervention, and the survival rate by all veneers that did not fail absolutely. The risk difference (RD) with 95% confidence intervals (CIs) for dichotomous outcomes was used to quantify the intervention effect.

RESULTS

Of 973 screened articles, 6 clinical studies were included. The survival and success rates varied depending on the bonding substrate. Enamel-bonded veneers had almost perfect rates of survival (99% with a range of 98% to 100%) and success (99% with a range of 98% to 100%). Veneers bonded to composite resin or surfaces with minimal dentin exposure had slightly lower survival rates (94% with a range of 91% to 97% and 95% with a range of 91% to 100%, respectively) and success rates (70% with a range of 60% to 80% and 95% with a range of 90% to 99%). Severe dentin exposure significantly decreased both survival rates (91% with a range of 84% to 98%) and success rates (74% with a range of 64% to 85%). The combined findings suggested that ceramic veneers bonded to enamel had fewer clinical complications (RD: -0.04; 95% CI: -0.09 to 0.02) and lower failure rates (RD: -0.13; 95% CI: -0.32 to 0.07) compared with those bonded to exposed dentin. Additionally, veneers attached to teeth with minimal dentin exposure were significantly less likely to require clinical interventions (RD: -0.16; 95% CI: -0.31 to -0.01) and had a reduced incidence of failure (RD: -0.08; 95% CI: -0.17 to 0.01) compared with those with severe dentin exposure.

CONCLUSIONS

Ceramic veneers bonded to enamel showed higher survival and success rates with lower clinical incidences of complications and failure than those bonded to dentin or teeth with existing composite resin restorations.

Effect of a novel mesh design and the sandblasting technique on the bond strength of computer-designed and three-dimension laser printed resin bonded bridges: an in vitro study

Resin-bonded bridges (RBBs) are a minimally invasive and aesthetically pleasing treatment modality. However, their frequent failure has posed challenges for both dental professionals and patients. This necessitates the exploration of innovative strategies to enhance the longevity of RBBs. This study aimed to assess the bond strength of a mesh bridge fabricated using computer-aided design and three-dimensional (3D) printing technology in comparison to the traditional aluminum oxide sandblasting method. A total of 48 lower incisors were embedded in acrylic bases according to a standardized computer-generated model to receive 24 metal RBBs. The two groups underwent distinct metal surface treatments: the 3D mesh novel design and sandblasting with aluminum oxide particles sized at 250.00 µm. The bond strength of the bridges was evaluated, and statistical analysis was performed using the independent samples t-test with a significance level set at α = 0.05. The findings revealed a significant difference between the two methods (p < 0.001). The 3D mesh design exhibited a mean bond strength of 387.89 ± 24.15 N, while the sandblasting technique yielded a mean value of 161.46 ± 31.25 N. In summary, the 3D mesh design substantially enhanced the bond strength of RBBs compared to the traditional sandblasting technique.

Color stability and marginal adaptation of ceramic veneers cemented using different composite resins

BACKGROUND

The purpose of this study was to compare the color stability and marginal adaption of lithium disilicate veneers before and after thermocycling using various resin composite materials employed as cement.

METHODS

Laminate veneer preparation was done on an acrylic tooth according to standardized procedures. The veneer preparations were duplicated into twenty-one dies. The veneers were fabricated from lithium disilicate using the CEREC in Lab system. According to the cement type, the twenty-one die specimens were randomly divided into three equal groups: group I, with light cured adhesive resin cement (N.=7), group II, with flowable light cured composite, and group III, with preheated nano filled composite. The cemented specimens underwent 5000 thermocycling cycles. Color was assessed using a reflective spectrophotometer. The vertical marginal gap, following cementation and thermocycling, was measured using a digital microscope. One-way ANOVA followed by Tukey's post-hoc test was used to statistically assess the data.

RESULTS

After thermocycling, there was no statistically significant difference in ΔE among cement type groups for color stability (P=0.369). However, the preheated composite showed the lowest ΔE mean values. Within adhesive resin cement and flowable composite groups, marginal gap means values recorded after thermocycling were significantly higher than those after cementation (P=0.013 and P<0.001, respectively).

CONCLUSIONS

Although preheated composite cement showed the highest marginal discrepancy, it would be the best choice regarding color stability.

Warm Air Delivery in Adhesive Application: Effect on Bonding Performance and Morphological Outcomes

Solvent evaporation within an adhesive layer is a crucial step during a bonding process. The aim of this current research was to test whether the use of different air temperatures (20 °C, 40 °C, and 60 °C) for solvent evaporation improves the performance of four adhesive systems to dentin. Sixty non-carious human molar teeth were randomly prepared for micro-tensile bond strength (μTBS) tests. Four different adhesive systems, Prime&Bond Universal (PBU), OptiBond Universal (OBU), OptiBond FL (OBFL), and Clearfil SE (CSE), were applied following the manufacturer's instructions. Three groups based on the air-drying temperature were used: solvent evaporation was performed with either of warm (40 °C), (60 °C), and cold air as control group (20 °C) for 10 s at a distance of 5 cm. In all bonded surfaces, three resin composite (Reflectys, Itena Clinical, Paris, France) layers of 2 mm thickness were built up. The resin-dentin samples were kept in distilled water at 37 °C for 24 h and 6 months, respectively, before μTBS testing. Failure analysis, scanning electron microscopy of resin-dentin bonded interface, and solvent evaporation rate were tested as secondary variables. All analyses were conducted using a significance level of α = 0.05. Bond strength (BS) values were similar among all the adhesive systems used (p > 0.05). Also, the aging factor did not affect the BS (p > 0.05). Only the factor of temperature used for solvent evaporation resulted in a statistically significant effect (p < 0.05), with the temperature of 60 °C being the highest value (p < 0.05). A failure mode evaluation revealed mostly adhesive or mixed modes of failures in all the different temperatures of air used for the solvent evaporation of each adhesive system. The thickness of the adhesive layer and the creation of resin tags varied amongst the temperatures evaluated. For all adhesive systems tested, the use of 40 °C or 60 °C air for solvent evaporation led to an increased mass loss. Warmer temperatures for solvent evaporation contributed positively to bonding performance, enhancing both the quality of the adhesive layer and its interaction with the dentin tissue. Optimizing solvent evaporation with warmer air temperatures (40 °C and 60 °C) significantly improved µTBS, offering a practical means to enhance the quality and longevity of adhesive restorations in esthetic dentistry.

Systematic review and network meta-analysis of restorative therapy and adhesive strategies in root caries lesions

AIM

This systematic review and network meta-analysis (NMA) aimed to establish a clinically relevant hierarchy of the different adhesive and/or restorative approaches to restore cavitated root caries lesions through the synthesis of available evidence.

MATERIALS AND METHODS

A systematic search was conducted in Medline/Web of Science/Embase/ Cochrane Library/Scopus/grey literature. RCTs investigating ≥2 restorative strategies (restorative /adhesive materials) for root caries lesions in adult patients were included. Risk of bias within studies was assessed (Cochrane_RoB-2) and the primary outcome was survival rate of restorations at different follow-up times (6-/12-/24-months). Network meta-analyses were conducted using a random effects model stratified by follow-up times. I2-statistics assessed the ratio of true to total variance in the observed effects. All available combinations of adhesives (1-SE: one-step self-etch; 2-3ER: two-/three-step etch-and-rinse) and restorative materials (conventional composite (CC) as well as conventional and resin-modified glass ionomer cements (GIC, RMGIC)) were included. Risk of bias across studies and confidence in NMA (CINeMA) were assessed.

RESULTS

547 studies were identified and nine were eligible for the NMA. In total, 1263 root caries lesions have been restored in 473 patients in the included clinical trials. Patients involved were either healthy (n = 6 trials), living in nursing homes (n = 1 trial) or received head-and-neck radiotherapy (n = 2 trials). There was statistically weak evidence to favour either of material/material combination regarding the survival rate. A tendency for higher survival rate (24-months) was observed for 2-3ER/CC (OR24mths 2.65; 95%CI=1.45/4.84) as well as RMGIC (OR24mths 2.05; 95%CI=1.17/3.61) compared to GIC. These findings were though not statistically significant and confidence of the NMA was low.

CONCLUSION

An evidence-based choice of restorative strategy for managing cavitated root caries lesions is currently impossible. There is a clear need for more standardised, well-designed RCTs evaluating the retention rate of root caries restoration approaches.

Advanced statistical analyses to reduce inconsistencies in bond strength data focused on donor factors: A six-factor analysis using linear mixed and nonlinear regression models

PURPOSE

This study aimed to investigate the effects of the age and sex of tooth donors on dentin bond strength.

METHODS

A total of 38 extracted teeth (12 male and 26 female donors; age range: 17-82 years) were used in this study. In addition to donor age and sex, four other microtensile bond strength (μTBS) test specimen factors were evaluated: dentin position, bonding area, presence of voids at the interface, and computed tomography (CT) values of dentin. The μTBS was measured immediately (24 h) and 6 months after storage in water. After the μTBS testing, linear mixed and nonlinear regression models were used to analyze the effects of these factors on the μTBS data.

RESULTS

The results from the linear mixed model revealed that the bonding area (P = 0.02), presence of voids at the interface (P = 0.04), and storage time (P < 0.001) significantly affected bond strength. In contrast, no correlation was observed between the μ TBS and dentin position (P = 0.08) or sex (P = 0.07). The results of the nonlinear regression model with robust variance-covariance estimators revealed that age significantly affected bond strength (P < 0.001). In addition, a significant positive correlation was found between μTBS and age (P < 0.001), with nonlinearity (P = 0.002). However, no correlation was observed between the μTBS and CT values (P = 0.69) without nonlinearity (P = 0.39).

CONCLUSIONS

These findings suggest that bond strength increases with age until 60 years but not afterward.

Effect of universal adhesives and self-etch ceramic primers on bond strength to glass-ceramics: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

To simplify dental procedures, multicomponent products such as universal adhesives and self-etch ceramic primers have been recommended for glass-ceramic bonding; however, studies have shown a wide range of results.

PURPOSE

The purpose of this systematic review and meta-analysis was to analyze the in vitro bond strength promoted by hydrofluoric acid+silane-containing universal adhesives and a self-etch ceramic primer to glass-ceramics and compare it with that of conventional treatments.

MATERIAL AND METHODS

A systematic search was conducted in the PubMed/Medline, Scopus, LILACS, and ISI Web of Science databases up to April 2021. In vitro studies assessing the resin-mediated bond to glass-ceramics by using a self-etch ceramic primer and hydrofluoric acid+silane-containing universal adhesives and/or compared with traditional hydrofluoric acid+glass-ceramic primers were included. Selection of studies, data extraction, and risk-of-bias analysis were performed. Statistical analysis was performed by using a review management software program using a random effects model (α=.05).

RESULTS

A total of 33 studies were included in the qualitative analysis and 26 studies in the quantitative analysis. Bond strength to lithium disilicate ceramic was higher when a hydrofluoric acid+glass-ceramic primer was used than when using a hydrofluoric acid+silane-containing universal adhesive (P<.05), except when 9% to 10% acid concentration was used in combination with static aging (P=.100). A self-etch ceramic primer promoted bond strength values to lithium disilicate that were similar to those of the hydrofluoric acid+glass-ceramic primer (P>.100).

CONCLUSIONS

Hydrofluoric acid+silane-containing universal adhesive was not as effective as the hydrofluoric acid+glass-ceramic primer in promoting bond strength to glass-ceramic. Bond strength values generated by a self-etch ceramic primer to glass-ceramic were similar to those generated by the conventional treatment.

Does the universal adhesive's film thickness affect dentin-bonding effectiveness?

OBJECTIVES

To investigate the influence of adhesive resin application modalities on the film thickness of the adhesive resin and the effectiveness of a two-step universal adhesive (UA) bonded in self-etch (SE) bonding mode to high C-factor class-I cavity-bottom dentin.

MATERIALS AND METHODS

After application of the primer of G2-Bond Universal (G2B, GC), the adhesive resin was applied into standard class-I cavities (human molars) following four application modalities: (1) one layer, strongly air-blown; (2) one layer, gently air-blown; (3) two layers, each gently air-blown; (4) one layer, not air-blown. After being restored with composite, each tooth was sectioned to obtain one micro-specimen (n = 10), of which the adhesive resin film thickness was measured using optical microscopy. The micro-tensile bond strength (μTBS) was tested immediately or upon 100,000 thermocycles. Statistical analyses involved Kruskal-Wallis and Mann-Whitney U testing (p < 0.05).

RESULTS

G2B's μTBS was significantly affected by the adhesive resin application modality and aging. Gently air-blowing the adhesive resin resulted in significantly higher immediate μTBS than strong air-blowing or no air-blowing. No significant difference in μTBS was found between single or double gently air-blown adhesive resin applications. The adhesive resin film thickness significantly varied with the application modalities.

CONCLUSIONS

A too thin or too thick adhesive resin film thickness adversely affected bond strength of the two-step UA applied in SE mode and high C-factor condition.

CLINICAL RELEVANCE

The adhesive resin layer thickness can affect the bonding performance of two-step UAs in high C-factor cavities. Dental clinicians remain advised to avoid improper air-blowing of UAs and strictly follow the application instructions.

Bonding performance and interfacial adaptation of modern bulk-fill restorative composites after aging in artificial saliva: an in vitro study

OBJECTIVES

This study aimed at comparing the microtensile bond strength (MTBS) and interfacial adaptation of a modern self-curing and a light-curing restorative bulk-fill composite to a conventional composite applied with the layering technique.

METHODS

Forty-eight occlusal cavities were divided in three main groups (16/group) based on tested materials: (i) STELA, bulk-fill self-curing restorative (STELA, SDI Ltd.); (ii) 3 M-BULK, bulk-fill composite (Filtek One Bulk-Fill, 3 M Oral Care); and (iii) 3 M-CTR, a conventional composite (Filtek Supreme XTE, 3 M Oral Care). These were used in combination with their adhesives in self-etch (SE) or etch-and-rinse (ER) mode. Specimens stored in artificial saliva (24 h or 12 months) were evaluated for MTBS and fractography. The interfacial analysis was performed through confocal microscopy. ANOVA and Fisher's LSD post hoc tests were performed with a level of significance of 5%.

RESULTS

All the tested materials applied in ER mode presented (24 h) greater bond strength than in SE mode. Although all materials showed a significant drop in the bond strength after prolonged storage, STELA showed the highest bonding performance and interfaces with few gaps. 3 M-BULK had the lowest bond strength and an interface with several voids and gaps.

CONCLUSIONS

All materials were affected by interface degradation and bonding reduction over prolonged aging. However, their use in combination with adhesives applied in ER mode may offer greater immediate bonding performance.

CLINICAL RELEVANCE

The use of restorative light-curing bulk-fill composites may generate gaps at the bonding interface and voids. STELA may represent a suitable alternative to avoid such issues.

Tooth-composite bond failure with a universal and an etch-and-rinse adhesive depending on mode and frequency of application

OBJECTIVES

To evaluate the effect of an additional layer of universal adhesive on the interfacial enamel/dentin-composite gap formation in relation to application mode and aging, via spectral domain optical coherence tomography (SD-OCT) and scanning electron microscopy (SEM).

METHODS

In vitro class V cavities in 114 caries-free premolars were restored by applying one or two layers of a universal adhesive (Scotchbond Universal, SBU) in self-etch (se) and etch-and-rinse (er) mode or the reference adhesive OptiBond FL (OFL-er). The restorations were imaged by SD-OCT (six groups, n = 8) and SEM (n = 3) directly after filling (t1), water storage (t2, 24 h), embedding (t3), and thermo-mechanical loading (t4, TCML). The interfacial gaps were quantified using 26 parameters and analyzed using principal component analysis and linear mixed effect models.

RESULTS

Gap formation at enamel and dentin was significantly influenced by the adhesive, the application mode and number of layers (p < 0.001). This was due to the influence of the SBU-er mode (p < 1e-05), which showed significantly more gap formation and a greater range of variation with double application when compared to SBU-se and OFL. The fewest interfacial gaps occurred with one or two applications of OFL-er and one layer of SBU-er.

SIGNIFICANCE

Adhesive application mode and the number of adhesive layers are relevant factors in the tooth-composite bond failure. Double application worsened the adaptation of SBU to freshly prepared dentin conditioned with phosphoric acid.

The incidence of dental fractures in the Italian population during the COVID-19 pandemic: An observational study

Background

The COVID-19 infection has become a pandemic after breaking out in China in the past months of 2019 and spreading rapidly worldwide. To counter this pandemic, several governments worldwide have taken several drastic measures to try to stop the spread of the virus, including a very strict lockdown that has caused a sudden and, in many cases, negative change in people's daily lives. In the literature, several studies have shown how the pandemic has significantly impaired many people's mental health, causing short- and long-term stress, anxiety, and sleep disturbances.

Introduction

This study aims to analyze the correlation between the stress caused by the COVID-19 pandemic and the parafunctions of the temporomandibular joint and masticatory muscles, which in turn, have led to an increase in the incidence of fractures and dental injuries. The ultimate goal is to understand the best choice the dentist must make in the preventive and therapeutic fields.

Materials and Methods

A questionnaire called "Incidence of tooth fractures during the COVID-19 pandemic" was prepared using the Google® Forms platform. This questionnaire consists of 13 questions. This electronic questionnaire was addressed to all dentists in the Campania Region (ITA) and disseminated through social networks such as WhatsApp® or Facebook® or E-mail.

Results

A total of 730 dentists completed the survey. Of these, 450 (61.7%) stated that the number of patients reporting muscle and joint pain in the morning had increased during the COVID-19 pandemic. 414 (56.7%) dentists noted an increase in parafunction and 392 (53.6%) an increase in dental fractures during the pandemic period.

Discussion and Conclusions

As can be seen from the study results, an important correlation was found between the stress resulting from the COVID-19 pandemic and dental fractures. The dental elements treated endodontically, depending on the extent of the damage, require restoration, which is also the best preventive strategy in the case of dental fractures.

A glycol chitosan derivative with extrafibrillar demineralization potential for self-etch dentin bonding

OBJECTIVES

Extrafibrillar demineralization is an etching technique that removes only minerals from around the collagen fibrils for resin infiltration. The intrafibrillar minerals are left intact to avoid their replacement by water that is hard for adhesive resin monomers to displace. The present work reported the synthesis of a water-soluble methacryloyloxy glycol chitosan-EDTA conjugate (GCE-MA) and evaluated its potential as an extrafibrillar demineralization agent for self-etch dentin bonding.

METHODS

Glycol chitosan-EDTA was functionalized with a methacryloyloxy functionality. Conjugation was confirmed using Fourier transform-infrared spectroscopy. The GCE-MA was used to prepare experimental self-etch primers. Extrafibrillar demineralization of the primers was evaluated with scaning electron microscopy and transmission electron microscopy. The feasibility of this new self-etch bonding approach was evaluated using microtensile bond strength testing and inhibition of dentin gelatinolytic activity. The antibacterial activity and cytotoxicity of GCE-MA were also analyzed.

RESULTS

Conjugation of EDTA and the methacryloyloxy functionality to glycol chitosan was successful. The functionalized conjugate was capable of extrafibrillar demineralization of mineralized collagen fibrils. Tensile bond strength of the experimental self-etch primer to dentin was comparable to that of phosphoric acid-etched dentin and the commercial self-etch primer Clearfil SE Bond 2. The GCE-MA also inhibited soluble rhMMP-9. In-situ zymography detected minimal fluorescence in hybrid layers conditioned with the experimental primer. The GCE-MA was noncytotoxic and possessed antibacterial activities against planktonic bacteria.

SIGNIFICANCE

Synthesis of GCE-MA brought into fruition a self-etch conditioner that selectively demineralizes the extrafibrillar mineral component of dentin. A self-etch primer prepared with GCE-MA achieved bond strengths comparable to commercial reference adhesive systems.

Internal Adaptation of Composite Fillings Made Using Universal Adhesives-A Micro-Computed Tomography Analysis

This study aimed to evaluate internal tooth-filling interfaces of composite fillings made using universal adhesives using micro-computed tomography (µCT). Sixty class V cavities were randomly assigned into six groups: Peak Universal etch and rinse (PER), Peak Universal self-etch (PSE), Adhese Universal etch and rinse (AER), and Adhese Universal self-etch (ASE). Two further adhesives considered gold standards were used as control groups: OptiBond FL (OER) for the etch and rinse technique and Clearfil SE for the self-etch technique (CSE). All teeth were subjected to thermomechanical loading and four-year water storage. Next, they were analyzed using µCT to investigate the internal tooth-filling interfaces. The proportions between the gap volume (GV) at the tooth-filling interface and the volume of applied composite filling (FV), between the gap and cavity volumes (CV), and between the gap volumes at the tooth-filling interface of the external (EGV) and internal (IGV) parts were calculated. Adhese Universal achieved the significantly lowest gap-to-filling- and gap-to-cavity-volume ratios for both types of etching techniques comparing to those of the Peak Universal and control groups. Significant differences between the gaps in external and internal parts of the tooth-filling interface were only noted in the control groups. Internal gap formation and development at the tooth-filling interface depend on the material as well as the type of its application.

To etch or not to etch, Part III: On the hydrophobic-rich content and fatigue strength of universal adhesives after long-term ageing

OBJECTIVES

To examine whether dentin-etching extension and/or the hydrophobic-rich content of hybrid layers would affect fatigue strengths of a mild universal adhesive after long-term aging.

METHODS

Twin-bonded resin-dentin interfaces were produced by etching sound midcoronal dentin beams with 32 % ortho-phosphoric acid for 15 s (OPA15s), 3 s (OPA3s) or 10 % meta-phosphoric acid for 15 s (MPA15s). Samples were bonded with a mild universal adhesive with or without additional coating using a solvent-free bisGMA-based bonding resin. Self-etch application served as control. Composite buildups were made with a nanofilled composite. Bar-shaped twin-bonded interfaces (0.9 × 0.9 × 12 mm) were aged for two years in artificial saliva at 37 ℃ and tested under 4-point flexure at quasi-static (n = 16) and cyclic loads (n = 35) until failure. The stress-life fatigue behavior was evaluated using the staircase method at 4 Hz. Crack initiation and fracture patterns were evaluated by SEM. Cyclic-loaded data was analyzed by Kruskal-Wallis on Ranks (α = 0.05).

RESULTS

Significantly higher fatigue life distributions and higher endurance limits were observed for less aggressive etch-and-rinse protocols (OPA3s and MPA15s) after long-term ageing. Hydrophobic-rich coating produced 20-32 % higher endurance limits, prevented micrometer-sized porosities at bonded interfaces, reduced etching-associated variability and lowered crack formation. Significance Long-term hydrolysis produces detrimental effects on the fatigue strength of resin-dentin interfaces. The bond-promotion effect of less aggressive etch-and-rinse protocols and the creation of hybrid layers with higher hydrophobic-rich content are critical to extend the durability of mild universal adhesives. Therefore, current oversimplification trends in adhesive dentistry may limit resin-dentin bonding performance.

Influence of Application Modes on Increasing Bond Strength Longevity of Self-etching and Universal Adhesive Systems to Enamel

The present study aimed to evaluate the influence of application mode on the short-term microshear bond strength longevity of self-etching and universal adhesive systems to enamel, the failure mode, and the resulting enamel surface micromorphology. Ninety enamel surfaces were obtained from sound third molars, planed, and randomly assigned to nine groups, according to the application mode and the adhesive system (n=10). There were three primer application modes: according to the manufacturer's recommended application time (control), using double the application time recommended for the primer and selective enamel etching. The adhesive systems used were: Clearfil SE Bond (Kuraray), FL-Bond II (SHOFU), and Futurabond U (Voco). At least two resin-bonded composite cylinders (Grandioso Light Flow, Voco) were placed on each enamel surface, and then evaluated for microshear bond strength at 24 hours and 180 days of storage in solution body fluid (SBF) at pH 7.4. Failure modes were evaluated with a stereoscopic microscope at 20× magnification. A micromorphological analysis of the enamel surface was performed under a scanning electron microscope at 5000× magnification before and after the treatments. Mixed models for repeated measures over time showed significant interaction among application modes, adhesive systems, and time periods (p=0.0331). The bond strength of FL-Bond II adhesive to enamel observed after performing selective enamel etching was significantly higher than that observed after applying the control treatment (p=0.0010) at both 24 hours and 180 days. However, no significant difference was observed between the application of this same adhesive at double the time recommended by the manufacturer and the other two application modes (p>0.05). There was also no significant difference in the microshear bond strength for the enamel treatments applied using Clearfil SE Bond and Futurabond U (p>0.05). A significant reduction in bond strength to enamel was observed at the 180-day storage time for all the adhesive systems when selective enamel etching was performed (p<0.0001). No significant association was observed between the adhesive system failure mode and the enamel treatments (p=0.1402 and p=0.7590 for 24 hours and 180 days, respectively). The most prevalent failure was the adhesive type.

Clinical performance of non-carious cervical lesions restored with using self-etch mode of adhesives according to the FDI criteria

AIM

The purpose of this study was to evaluate the 18-month retrospective study of self-etch adhesive (Prime&Bond One Select) and self-etch mode of universal adhesives (Single Bond Universal, Gluma Bond Universal) applied to non-carious cervical lesions according to the World Dental Federation criteria.

MATERIALS AND METHODS

Thirty patients without any systemic disease, good oral hygiene, having at least 20 teeth and six non-carious cervical lesions treated using a self-etch mode of adhesives operated between January and March 2017. Accordingly, 335 restorations were evaluated according to the World Dental Federation criteria at 3, 6, 12 and 18 months. Pillai's Trace test was used to determine the interaction of criteria with time and adhesive systems. IBM SPSS Statistics 21.0 program was used in the analysis. Value of P < 0.05 was accepted as a criterion for statistical significance.

RESULTS

At the end of 18 months, participation was 100%. There was a statistically significant difference P < 0.05 between Prime&Bond One Select and Single Bond Universal, Prime&Bond One Select and Gluma Bond Universal in the 18-month period. In terms of marginal staining, fracture of material and retention, recurrence of caries, erosion and abfraction, tooth integrity criteria at the end of the 18 months, Prime&Bond One Select performed clinically very good, Single Bond Universal and Gluma Bond Universal performed clinically good according to World Dental Federation criteria. Marginal adaptation criteria, Prime&Bond One Select, Single Bond Universal and Gluma Bond Universal performed clinically good. Retention loss rate was found to be the lowest in Prime&Bond One Select and the highest in Gluma Bond Universal.

CONCLUSION

Accordingly, 18-month evaluation of all adhesives used in the study showed clinically acceptable results in all of the World Dental Federation criteria.

Concentration effect of DMSO-dry bonding on the stability of etch-and-rinse bonds

OBJECTIVES

To examine whether lower dimethyl sulfoxide (DMSO) concentrations would affect long-term bond stability of simplified or multistep water-based adhesives to dry-etched dentin.

METHODS

H3PO4-etched mid-coronal dentin surfaces from human molars were randomly blot- or air-dried for 30 s and pretreated or not with 5 or 50 % (v/v) ethanolic DMSO solutions. Untreated samples served as control. Samples were bonded with a two-step or a three-step etch-and-rinse adhesive. Restored crown segments (n = 5/group) were stored in distilled water for 24 h and sectioned for microtensile bond strength testing. Resin-dentin beams (0.8 mm2) were tested under tension until fracture (0.5 mm/min) after 24 h and one year of storage in artificial saliva at 37 °C. Nanoleakage evaluation and hybrid layer characterization were performed by SEM. Bond strength data was examined by three-way ANOVA followed by the Tukey test (α = 0.05).

RESULTS

Dry bonding produced significantly lower bond strengths than conventional wet bonding for both water-based adhesive systems (p < 0.05). DMSO-dry bonding restored bond strengths and reduced nanoleakage levels, regardless of adhesive type or DMSO concentration (p < 0.05). Bond strengths of DMSO-dry bonded samples were not significantly affected by long-term ageing regardless of adhesive type or DMSO concentration (p < 0.05).

SIGNIFICANCE

Although bonding methacrylate-based resins to etched dentin is normally performed under wet conditions, hybridization of air-dried collagen can outperform conventional wet bonding by employing water-free DMSO solutions with concentrations as low as 5 %. Reduced moisture-related technique sensitivity, higher bonding performance and improved hybrid layer stability may contribute to extend the service life of resin-dentin bonding.

Analysis of the bond strength between conventional, putty or resin-modified calcium silicate cement and bulk fill composites

BACKGROUND

The aim of this study was to evaluate the shear bond strength of three different calcium silicate-based cements (CBCs) with two different bulk-fill composite resins (CRs).

METHODS

Plexiglas moulds with a diameter of 4 mm and a thickness of 2 mm were prepared (n = 60). The Biodentine, NeoPutty and MTA Cem LC samples were randomly divided into two subgroups containing 10 samples each. Surfaces of samples were air dried and Single Bond universal adhesive was applied. Cylindrical plastic capsules of 4 mm height and 2 mm inner diameter belonging to Filtek Bulk-fill and EverX Posterior CRs were centred on coating material and polymerized for 20 s. After shear bond strength (SBS) testing, all samples were examined by scanning electron microscopy (SEM) to identify failure patterns. Three samples, one from each group, were prepared to evaluate chemical composition of CBCs and examined with an energy dispersive X-ray spectroscopy for surface elemental analysis.

RESULTS

The values obtained from the tests were evaluated as statistically significant (P < 0.05). After SBS testing, the difference between all CBCs was statistically significant in both CRs.

CONCLUSION

According to the findings in this study, it was concluded that MTA Cem LC had highest SBS values in both CRs. © 2023 Australian Dental Association.

Influence of inorganic nanoparticles on dental materials' mechanical properties. A narrative review

Inorganic nanoparticles have been widely incorporated in conventional dental materials to help in improving their properties. The literature has shown that incorporating nanoparticles in dental materials in different specialties could have a positive effect on reinforcing the mechanical properties of those materials; however, there was no consensus on the effectiveness of using nanoparticles in enhancing the mechanical properties of dental materials, due to the variety of the properties of nanoparticles itself and their effect on the mechanical properties. This article attempted to analytically review all the studies that assessed the effect of different types of inorganic nanoparticles on the most commonly used dental materials in dental specialties such as polymethyl methacrylate, glass ionomer cement, resin composite, resin adhesive, orthodontic adhesive, and endodontic sealer. The results had shown that those inorganic nanoparticles demonstrated positive potential in improving those mechanical properties in most of the dental materials studied. That potential was attributed to the ultra-small sizes and unique physical and chemical qualities that those inorganic nanoparticles possess, together with the significant surface area to volume ratio. It was concluded from this comprehensive analysis that while a definitive recommendation cannot be provided due to the variety of nanoparticle types, shapes, and incorporated dental material, the consensus suggests using nanoparticles in low concentrations less than 1% by weight along with a silane coupling agent to minimize agglomeration issues and benefit from their properties.

The cross-linking and protective effect of artemisinin and its derivatives on collagen fibers of demineralized dentin surface

OBJECTIVE

To investigate the cross-linking and protective effect of artemisinin (ART), dihydroartemisinin (DHA), and artesunate (AST) on collagen fibers of demineralized dentin surface.

METHODS

Molecular docking was used to predict potential interactions of ART, DHA, and AST with dentin type I collagen. Human third molars without caries were completely demineralized and treated with different solutions for 1 min. The molecular interactions and cross-linking degree of ART and its derivatives with dentin collagen were evaluated by FTIR spectroscopy, total extractable protein content, and a ninhydrin assay. Scanning electron microscopy, hydroxyproline release, and ultimate microtensile strength tests (μUTS) were employed to confirm the mechanical properties and anti-collagenase degradation properties of dentin collagen fibers.

RESULTS

ART, DHA, and AST combined with dentin type I collagen mainly through hydrogen bonding and hydrophobic interactions, and the cross-linking reaction sites were mainly C=O and CN functional groups. Compared to the control group, ART and its derivatives significantly increased the degree of cross-linking. Additionally, significant increases were observed in resistance to enzymatic digestion and mechanical properties of the artemisinin and its derivatives group.

CONCLUSION

ART, DHA, and AST could cross-link with demineralized dentin collagen, through improving the mechanical properties and anti-collagenase degradation properties.

CLINICAL SIGNIFICANCE

The study endorses the potential use of ART and its derivatives as a prospective collagen cross-linking agent for degradation-resistant and long-period dentin bonding in composite resin restorations.

Effect of varying functional monomers in experimental self-adhesive composites: polymerization kinetics, cell metabolism influence and sealing ability

The aim was to evaluate the effects of adding different functional monomers to experimental self-adhesive composites (SACs) on polymerization kinetics, cell metabolic activity, and sealing ability. SACs were formulated using urethane dimethacrylate as the base monomer and triethylene glycol dimethacrylate. Additionally, 10 wt.% of distinct functional monomers were added - 10-methacryloyloxydecyl dihydrogen phosphate, glycerol phosphate dimethacrylate (GPDM), 2-hydroxyethyl methacrylate (HEMA) or hydroxyethyl acrylamide (HEAA). ATR-FTIR was used to determine real-time polymerization kinetics (20 min,n= 3). The final extrapolated conversion and polymerization rates were determined (DC,max;Rp,max). TheDC,maxvalues were employed to calculate volumetric shrinkage. The MTT assay was performed on MDPC-23 cells using disc extracts at different concentrations (n= 8). Class V cavities were prepared in 60 sound human molars, assigned to six groups (n= 10), depending on the composite used and aging type (T0 or TC, if thermocycled for 10 000 cycles). One-way ANOVA, two-way, andKruskal-Wallistests were employed to treat the data (ɑ= 0.05). Varying the functional monomers had a large impact on DC,max, as confirmed by one-way ANOVA (p<0.001). The highest was obtained for HEMA (64 ± 3%). The HEMA and HEAA formulations were found to be significantly more toxic at concentrations below 100%. For microleakage, having a functional monomer or not did not show any improvement, irrespective of margin or aging period (Mann-Whitney U,p> 0.05). Larger functional monomers MDP and GPDM affected polymerization properties. Conversely, their acidity did not seem to be detrimental to cell metabolic activity. Regarding sealing ability, it seems that the functional monomers did not bring an advantage to the composites. Varying the functional monomer in SACs had a clear impact on the polymerization kinetics as well as on their cytotoxic potential. However, it did not confer better microleakage and sealing. Claiming self-adhesiveness based only on functional monomers seems dubious.

Impact of Dentine Pretreatment with Matrix Metalloproteinase Inhibitors on Bond Strength of Coronal Composite Restorations: A Systematic Review and Meta-analysis of In Vitro Studies

Matrix metalloproteinase (MMP) enzymes participate in collagen matrix degradation, including in dentine, potentially compromising bond strength. Therefore, MMP inhibitors have been hypothesized to improve restoration bond strength and stability. This systematic review aimed to evaluate the influence of different MMP inhibitors applied as dentine surface pretreatments on the immediate (24 hours) and longer term (months) bond strength of direct coronal composite restorations. This systematic literature review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. A systematic literature search of three databases (Ovid MEDLINE, Ovid Embase, and Google Scholar) was conducted independently by two reviewers from inception to April 2022. An adapted quality assessment tool was independently applied by two reviewers for risk of bias assessment. RevMan v5.4 software was used for meta-analyses. A randomeffectsmodel was used to generatemean differences with 95% confidence intervals for treatment and control comparisons. The Q-test and I2-test were used to test for heterogeneity. The proportion of total variance across studies attributable to heterogeneity rather than chance was calculated. Overall effects were tested using the Z-test, while subgroup differences were tested using Chi-squared tests. Of 934 studies, 64 studies were included in the systematic review and 42 in the meta-analysis. Thirty-one MMP inhibitors were reported, three of which were included in the meta-analysis: 2% chlorhexidine (CHX), 0.3M carbodiimide (EDC), and 0.1% riboflavin (RIBO). Pretreatment with 2% CHX for 30 and 60 seconds did not significantly improve bond strength compared with controls either immediately or after long-termageing. However, pretreatment with 0.3MEDC and 0.1% RIBO (but not CHX) significantly improved bond strength compared with control groups both immediately and over time. Most studies showed a medium risk of bias. These in vitro findings pave the way for rationale clinical trialing of dentine surface pretreatment with MMP inhibitors to improve clinical outcomes.

Application of modified aldehyde compounds in self-etching bonding of dentin

OBJECTIVE

The aim of this study was to evaluate the ability of 4-formylphenyl acrylate (FA) to enhance the bond strength and stabilize the resin-dentin bonding interface of universal adhesives in self-etching mode over time.

METHODS

Different concentrations of FA (1%, 3%, 5%, 7%, 9%) were prepared as primer. The optimal group was selected according to degree of conversion of 2 universal adhesives (Single Bond Universal (SBU)/All-Bond Universal (ABU)), and grouped according to the pre-treatment time (30s, 1min, 2min). The micro-tensile strength before and after 10,000 times thermocycling aging was used to evaluate the bonding performance.

RESULTS

The 1min application of FA (5%) increased the conversion rate of the adhesive. The expressions of microtensile bond strength and nanoleakage in the FA treatment group did not decrease significantly compared with their immediate values even after 10,000 thermocycling of aging. In situ zymography results showed that the hydrolytic activity of endogenous proteins decreased significantly in FA-1min group.

CONCLUSIONS

Treatment by FA primer can effectively enhance the bond stability at the bonding interface.

CLINICAL RELEVANCE

FA can be used as a functional monomer in self-etching bonding system to dentin, which not only had high biocompatibility, but also can show good collagen cross-linking ability within clinically acceptable application time.

Does extended air-drying time improve bond strength of universal adhesives to enamel?

OBJECTIVE

To investigate the effect of extended air-drying time on the microshear bond strength (MSBS) of universal adhesives to enamel.

MATERIALS AND METHODS

The distal and mesial specimens from third molars were wet-ground and randomly assigned to three groups according to adhesives tested (n = 60): Clearfil Bond Universal, Gluma Bond Universal, and G-Premio Bond. The adhesives were applied in etch-and-rinse or self-etch modes, followed by air-drying for 5, 15, or 25 s. Composite buildups were constructed and subjected to the MSBS test after 24-h or thermocycling. MSBS results were evaluated using a four-way ANOVA. The thickness of the adhesive layer and the degree of solvent evaporation were further evaluated.

RESULTS

At 24-h, MSBS of G-Premio Bond significantly improved with the 25 s air-drying in both of the etching modes when compared to the 5 s air-drying. After thermocycling, the extended air-drying did not produce a significant difference on the MSBS, regardless of the application strategy. Extended air-drying (25 s) evaporated almost all of the volatile part of Gluma Bond Universal and G-Premio Bond.

CONCLUSIONS

Extended air-drying times increased solvent evaporation but did not contribute to the bonding effectiveness of the adhesives, regardless of the etching mode.

CLINICAL SIGNIFICANCE

Air-drying applications for more than 5 s had no significant effect on enamel bonding performance of universal adhesives.

The Role of Bacterial, Dentinal, Salivary, and Neutrophil Degradative Activity in Caries Pathogenesis

Until recently, it was widely accepted that bacteria participate in caries pathogenesis mainly through carbohydrate fermentation and acid production, which promote the dissolution of tooth components. Neutrophils, on the other hand, were considered white blood cells with no role in caries pathogenesis. Nevertheless, current literature suggests that both bacteria and neutrophils, among other factors, possess direct degradative activity towards both dentinal collagen type-1 and/or methacrylate resin-based restoratives and adhesives, the most common dental restoratives. Neutrophils are abundant leukocytes in the gingival sulcus, where they can readily reach adjacent tooth roots or gingival and cervical restorations and execute their degradative activity. In this review, we present the latest literature evidence for bacterial, dentinal, salivary, and neutrophil degradative action that may induce primary caries, secondary caries, and restoration failure.

Influence of Phosphoric, Glycolic, and Ferulic Acids on Dentin Enzymatic Degradation, Ultimate Tensile Strength, and Permeability

This study evaluated dentin enzymatic degradation based on the total matrix metalloproteinase (MMP) activity of demineralized dentin matrices before and after exposure to phosphoric acid (PA), glycolic acid (GA), and ferulic acid (FA). The release of hydroxyproline (HP), ultimate tensile strength (UTS), and dentin permeability (DP) were also evaluated. Dentin collagen matrices were assessed according to total MMP activity before and after treatment with the tested acids (n=10) for 15 seconds and compared with the control (GM6001 inhibitor). Dentin beams were analyzed for HP release and UTS after the treatments. Dentin discs were tested for DP at a pressure of 5 psi before and after treatment with the acids (n=10). The FA group had a lower percentage of enzymatic inhibition than the PA and GA groups (p<0.0001). No significant difference in UTS was found among the acids (p=0.6824), but HP release was significantly higher in the FA group than in the PA and GA groups (p<0.0001). No significant difference in DP was found for the acids (p=0.0535). GA led to less activation of MMPs and less release of HP, whereas the UTS and DP for GA were like those found for PA. In contrast, FA promoted greater enzymatic activity and greater release of HP, while having similar results to GA and PA regarding mechanical properties.

Comparative evaluation of fracture resistance among conventional versus herbal irrigants in root canal treated teeth: In vitro study

To evaluate the efficacy of conventional irrigants and herbal extracts materials which helps to resist fracture of endodontically treated teeth. 75 maxillary human permanent incisor teeth instrumented using ProTaper rotary files till apical size(F4). Instrumented samples divided into 5 groups with n = 15 based on various irrigants used. Group I: normal saline, Group II: 5% sodium hypochlorite (NaOCl), Group III: 2% chlorohexidine, Group IV: 10% Azadirachta indica (neem extract) and Group V: 10% Ocimum sanctum (tulsi extract).After that, root canals were proceeded to be filled by using single gutta-percha cone and Sealapex sealer. Specimens were then prepared and loaded until root fracture occurred. Maximum mean flexural strength of dentin (fracture resistance) was obtained from group treated with 2% chlorohexidine and 10% neem extract. Least fracture resistance was observed with 5% NaOCl. Herbal irrigants can be used as an alternative to NaOCl as they exhibit high fracture resistance.

Endodontic Outcome of Root Canal Treatment Using Different Obturation Techniques: A Clinical Study

OBJECTIVE

To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables.

METHODS

This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected.

RESULTS

The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome.

CONCLUSIONS

The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.

Machine Learning Analysis of Microtensile Bond Strength of Dental Adhesives

Dental adhesives provide retention to composite fillings in dental restorations. Microtensile bond strength (µTBS) test is the most used laboratory test to evaluate bonding performance of dental adhesives. The traditional approach for developing dental adhesives involves repetitive laboratory measurements, which consumes enormous time and resources. Machine learning (ML) is a promising tool for accelerating this process. This study aimed to develop ML models to predict the µTBS of dental adhesives using their chemical features and to identify important contributing factors for µTBS. Specifically, the chemical composition and µTBS information of 81 dental adhesives were collected from the manufacturers and the literature. The average µTBS value of each adhesive was labeled as either 0 (if <36 MPa) or 1 (if ≥36 MPa) to denote the low and high µTBS classes. The initial 9-feature data set comprised pH, HEMA, BisGMA, UDMA, MDP, PENTA, filler, fluoride, and organic solvent (OS) as input features. Nine ML algorithms, including logistic regression, k-nearest neighbor, support vector machine, decision trees and tree-based ensembles, and multilayer perceptron, were implemented for model development. Feature importance analysis identified MDP, pH, OS, and HEMA as the top 4 contributing features, which were used to construct a 4-feature data set. Grid search with stratified 10-fold cross-validation (CV) was employed for hyperparameter tunning and model performance evaluation using 2 metrics, the area under the receiver operating characteristic curve (AUC) and accuracy. The 4-feature data set generated slightly better performance than the 9-feature data set, with the highest AUC score of 0.90 and accuracy of 0.81 based on stratified CV. In conclusion, ML is an effective tool for predicting dental adhesives with low and high µTBS values and for identifying important chemical features contributing to the µTBS. The ML-based data-driven approach has great potential to accelerate the discovery of new dental adhesives and other dental materials.

The effect of carbodiimide on push-out bond strength of fiber posts and endogenous enzymatic activity

BACKGROUND

To investigate the effect of 0.3 M 1-ethyl-3(3-dimethylaminopropyl) carbodiimide (EDC) aqueous solution pretreatment on push-out bond strength (PBS) and matrix-metalloproteinases (MMPs) activity within radicular dentin when different post cementation strategies were employed.

METHODS

One hundred and twenty monoradicular human teeth were endodontically treated and randomly divided into six groups, depending on the cementation strategy and root dentin pretreatment (n = 20): EAR: cementation with an etch-and-rinse adhesive (LuxaBond Total Etch, DMG) and resin cement (LuxaCore Z Dual, DMG); EAR/EDC: 1 min EDC pretreatment after etching + EAR; SE: cementation with a self-etch primer (Multilink Primer, Ivoclar Vivadent) and corresponding cement (Multilink Automix, Ivoclar Vivadent); SE/EDC: self-etch primer + EDC pretreatment + SE; SA: cementation with a universal self-adhesive cement (RelyX Universal, 3 M); SA/EDC: EDC pretreatment + SA. Slices were submitted to PBS test and interfacial nanoleakage evaluation 24 h after cementation or after thermocycling (40.000 cycles, 5-55 °C). To investigate the effect of EDC on MMPs activity, 4 additional first maxillary premolars per group were processed for in situ zymography analysis. Multivariate ANOVA and post hoc Tukey tests were used to analyze PBS values. The data from in situ zymography were analyzed with Kruskal-Wallis test and Dunn's pairwise multiple comparison procedures (α = 0.05).

RESULTS

The variables "EDC pretreatment", "root region" and "thermocycling" significantly influenced PBS (p < 0.05), while the variable "cementation strategy" had no influence (p > 0.05). Thermocycling significantly reduced PBS in SE and SA groups (p < 0.05). EDC was effective in preserving PBS after artificial aging. EDC pretreatment significantly reduced enzymatic activity at baseline in EAR and SE groups, and in SA group after thermocycling (p < 0.05).

CONCLUSIONS

The use of EDC prevents the reduction of bond-strength values after artificial aging and silences endogenous enzymatic activity within radicular dentin when different cementation strategies were employed.

The Influence of Hydrofluoric Acid Temperature and Application Technique on Ceramic Surface Texture and Shear Bond Strength of an Adhesive Cement

All-ceramic restorations are the foundation of modern esthetic dentistry. Clinical approaches for preparation, durability, aesthetics, and repair have been reformed by the idea of adhesive dentistry. The aim of the study and the objective question was to evaluate the impact of heated hydrofluoric acid pretreatment and the application technique's influence on the surface morphology and roughness of leucite-reinforced glass-ceramic materials (IPS Empress CAD, Ivoclar Vivadent), which is fundamental for understanding the adhesive cementation process. Scanning electron microscopy was used to observe the effectiveness of the two HF (Yellow Porcelain Etch, Cerkamed) application techniques and the HF's temperature impact on the surface topography of the ceramic. Based on surface conditioning methods, the adhesive cement (Panavia V5, Kuraray Noritake Dental Inc., Tokyo, Japan) was applied to the conditioned ceramic samples and light-cured. Shear bond strength values were correlated with the micro-retentive surface texture of the ceramic. With universal testing equipment at a 0.5 mm/min crosshead speed, SBS values between the resin cement and the ceramic material were assessed until failure. Analyzing the fractured surfaces of the specimens by digital microscopy, the failure modes were divided into three categories: adhesive, cohesive, and mixed failure. Analysis of variance (ANOVA) was used to statistically analyze the collected data. The results show that alternative treatment methods affected the material's surface characteristics and have an influence on the shear bond strength.

Final irrigation protocols can be used to promote stable long-term bond strength of AH Plus to dentin

Irrigation solutions might affect dentin surface characteristics and, consequently, endodontic sealers adhesion. This study analyzed the effect of different final irrigation protocols on push-out bond strength (BS) of AH Plus to dentin seven days and 20 months after obturation. Scanning electron micrographs were obtained from the dentin surface of one sample/group after final irrigation. Canals of bovine incisors were instrumented and received final irrigation with (n=21): G1 - 2.5% sodium hypochlorite (NaOCl) + distilled water; G2 - 2.5% NaOCl + 17% EDTA; G3 - 2.5% NaOCl + 17% EDTA + 2.5% NaOCl; G4 - 2.5% NaOCl + 17% EDTA + 2% chlorhexidine (CHX); G5 - mixture 5% NaOCl + 18% etidronate (HEDP); and G6 - mixture 5% NaOCl + 10% tetrasodium EDTA (Na4EDTA). After irrigation, one root/group was split and images were obtained by scanning electron microscopy (SEM). The other 20 roots/group were filled with only AH Plus sealer. Three slices/root were used for push-out assessment seven days and 20 months after obturation. One-way analysis of variance and Tukey (α<0.05) were used to compare the results among experimental groups, and unpaired t-test (α<0.05) was used to compare the results of the same group over time. The photomicrographs showed that, excepting G1, all groups completely removed the smear layer from the samples. In G2 and G4, the opening of the dentin tubules enlarged. In G3, erosion was observed in the peritubular and intertubular dentin. Values of the BS in the seven days were G2=G3=G4=G5>G6=G1 and in the 20 months were G3=G5>G6=G4>G1=G2. G3, G5, and G6 presented values of BS in 20 months similar to the values of seven days (P>0.05). The final irrigation protocols tested produced dentin surfaces with different characteristics. Only G3 and G5 presented high BS values that were stable over time.

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.

Degradation and Failure Phenomena at the Dentin Bonding Interface

Damage in the bonding interface is a significant factor that leads to premature failure of dental bonded restorations. The imperfectly bonded dentin-adhesive interface is susceptible to hydrolytic degradation and bacterial and enzyme attack, severely jeopardizing restorations' longevity. Developing caries around previously made restorations, also called "recurrent or secondary caries," is a significant health problem. The replacement of restorations is the most prevailing treatment in dental clinics, leading to the so-called "tooth death spiral". In other words, every time a restoration is replaced, more tooth tissue is removed, increasing the size of the restorations until the tooth is eventually lost. This process leads to high financial costs and detriment to patients' quality of life. Since the complexity of the oral cavity makes prevention a challenging task, novel strategies in Dental Materials and Operative fields are required. This article briefly overviews the physiological dentin substrate, features of dentin bonding, challenges and clinical relevance. We discussed the anatomy of the dental bonding interface, aspects of the degradation at the resin-dentin interface, extrinsic and intrinsic factors affecting dental bonding longevity, perspectives on resin and collagen degradation and how these subjects are connected. In this narrative review, we also outlined the recent progress in overcoming dental bonding challenges through bioinspiration, nanotechnology and advanced techniques to reduce degradation and improve dental bonding longevity.

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.

A comparative evaluation of micro shear bond strength and microleakage between the resin-modified glass ionomer cement and residual dentin following excavation of carious dentin using Carie CareTM and conventional caries removal in primary teeth: an in vitro study

Background: The bond between the dentin and restorative material contributes to the success of the restoration. Structural changes associated with prepared dentin may influence the bonding of restorative materials. The present study evaluates the bond between the resin-modified glass ionomer cement (RMGIC) and residual dentin following excavation of carious dentin using Carie Care ^TM and conventional caries removal in primary teeth.

METHODS

52 primary teeth with dentinal caries were randomly grouped into group I, where caries removal was done using the conventional method, and group II which used Carie Care ^TM. All the teeth were restored using RMGIC. Micro shear bond strength between the residual dentin and the cement was tested using universal testing machine and the dye penetration method was used for microleakage testing. Independent t-test was performed for intergroup comparison. Pearson chi-square test was carried out to evaluate the microleakage patterns in the enamel and dentin.

RESULTS

The mean micro-shear bond strength of group I was 6.03±1.6 and that of group II was 8.54±2.92; this difference was statistically significant with a p-value of 0.012. Microleakage was higher in the test group (1.38±0.51) than the control group (0.77±0.6) and was significant with a p -value of .036.

CONCLUSIONS

Papain-based chemomechanical agent Carie Care ^TM can be used as an alternative method to conventional caries removal. However, further studies need to explore methods to improve the marginal sealing capacity of RMGIC to the residual dentin after chemomechanical caries removal.

Synergistic effect of collagen cross-linking and remineralization for improving resin-dentin bond durability

In this study, the synergistic effect of glutaraldehyde-cross-linking and remineralization on the strength and durability of resin-dentin bonds was investigated. Dentin surfaces were etched with 35% phosphoric acid. The control specimens were bonded with Adper Single Bond 2 using wet bonding without pretreatment. The experimental specimens were pretreated with 5% (v/v) glutaraldehyde solution for 3 min and placed in a remineralizing solution for 0, 12, and 24 h, followed by dry bonding. After performing composite build-ups on the specimens, they were longitudinally sectioned, immediately, and after aging for 3 h with sodium hypochlorite (NaOCl), to evaluate microtensile bond strength (µTBS). The cross-linked specimens exhibited µTBS values comparable with those of the control group, but the µTBS decreased significantly after NaOCl aging. The cross-linked dentin remineralized for 24 h exhibited an increase in µTBS. After aging in NaOCl, the µTBS of the specimens remineralized for 24 h did not decrease and was significantly higher than for the other experimental groups. Cross-linking with dry bonding maintained µTBS in specimens before aging in NaOCl, but the bonding durability was compromised. Remineralization of cross-linked dentin for 24 h followed by dry bonding increased the immediate µTBS and improved bond durability. Therefore, combining cross-linking with remineralization of collagen fibrils progressively increased resistance to degradation, improving bond durability.

Effect of polyhydroxy-terminated PAMAM dendrimer on dentin matrix metalloproteinases within the hybrid layers

BACKGROUND

Intrafibrillar remineralization within the hybrid layers (HLs) has recently attracted extensive attention in achieving durable resin-dentin bonds. The polyhydroxy-terminated poly(amidoamine) dendrimer (PAMAM-OH) at fourth generation becomes a desirable candidate to induce intrafibrillar remineralization to protect exposed collagen fibrils within HLs based on the size exclusion effect of fibrillar collagen. However, the remineralization process in vivo is time-consuming, during which the exposed collagen fibrils are vulnerable to enzymatic degradation, resulting in unsatisfactory remineralization. Thereby, if PAMAM-OH itself possesses concomitant anti-proteolytic activity during the induction of remineralization, it would be very beneficial to obtain satisfactory remineralization.

METHODS

Binding capacity tests using adsorption isotherm and confocal laser scanning microscopy (CLSM) were performed to assess if the PAMAM-OH had adsorption capacity on dentin. Anti-proteolytic testings were detected by MMPs assay kit, in-situ zymography and ICTP assay. Adhesive infiltration of resin-dentin interface and tensile bond strength before and after thermomechanical cycling were implemented to assess if the PAMAM-OH adversely affected resin-dentin bonds.

RESULTS

Anti-proteolytic testings performed using MMPs assay kit, in-situ zymography and ICTP assay indicated that PAMAM-OH inhibited exogenous soluble MMP-9 as well as had inhibitory effect on the endogenous proteases. Adhesive infiltration of resin-dentin interface and tensile bond strength before and after thermomechanical cycling were implemented to indicate that the PAMAM-OH pretreatment had no adverse effects on immediate dentin bonding and prolonged the durability of resin-dentin bonds.

CONCLUSIONS

PAMAM-OH possesses anti-proteolytic activity and prevents exposed collagen fibrils within HLs from degradation, which lays the foundation for the satisfactory intrafibrillar remineralization induced by PAMAM-OH within HLs to achieve durable resin-dentin bonds in the next work.

Stamp Technique: An Explorative SEM Analysis

BACKGROUND

Achieving correct tooth anatomy and saving time at the dental chair are some of the goals of modern restorative dentistry. Stamp technique has gained acceptance in clinical practice. The aim of this study was to evaluate the effectiveness of this technique in terms of microleakage, voids, overhangs and marginal adaptation of Class I restorations, and to analyse the operative times in comparison with traditional restorative procedures.

METHODS

Twenty extracted teeth were divided into 2 groups. Ten teeth in the study group (SG) were Class I prepared and restored using stamp technique, and ten teeth in the control group (CG) were Class I restored traditionally. SEM analysis was performed to evaluate voids, microleakage, overhangs, and marginal adaptation, and operative times were recorded. A statistical analysis was performed.

RESULTS

There were no significant differences in microleakage, marginal adaptation and filling defects between the two groups, however, the stamp technique seems to facilitate the formation of large overflowing margins that require a careful finishing phase.

CONCLUSIONS

Stamp technique does not seem to have any critical aspects in terms of restoration durability and it can be performed in a short time.

Cleaning methods of contaminated zirconia: A systematic review and meta-analysis

OBJECTIVES

The aims of this study were to systematically review the literature and statistically analyze the effectiveness of different cleaning methods on the bond strength of resin cement to zirconia in short- and long-term aging conditions.

DATA/SOURCES

The literature was electronically searched in PubMed (MEDLINE), EMBASE, Wiley, Scopus, and Open Access Theses and Dissertations databases to select relevant articles that evaluated the bond strength between contaminated zirconia and resin cements. A manual search was performed by scanning the reference lists of included studies.

STUDY SELECTION

All articles were published online before April 2022 and in English. Meta-analyses were conducted using random effects models to calculate standardized mean differences (SMD) between uncontaminated zirconia and various cleaning methods in two aging conditions (short- and long-term). Statistical heterogeneity was assessed using I-square statistics. The risk of bias of all included studies was assessed. All statistical analyses were conducted using STATA (StataCorp, College Station, Texas).

RESULTS

Of the 1181 studies, 25 studies met the inclusion criteria for qualitative analyses. In short-term aging condition, cleaning contaminated zirconia with water, alcohol, or acid etching reported significantly lower bond strength than uncontaminated zirconia. For long-term aging condition, cleaning contaminated zirconia with water, cleaning agents, alcohol, or acid etching reported significantly lower bond strength than uncontaminated zirconia. Alumina air-abrasion or cleaning with sodium hypochlorite were comparable to uncontaminated zirconia for both short- and long-term aging conditions.

CONCLUSIONS

This meta-analysis appeared to indicate that the cleaning methods of contaminated zirconia restoration have an effect on zirconia bonding.

Synthesis, characterization, photo-polymerization, hydrolytic stability, and etching behavior of new self-etch adhesive monomers

Considering the poor hydrolytic stability of the most methacrylate-based functional monomers of self-etch dental adhesives in acidic and aqueous conditions, in this study allyl-based photo-polymerizable self-etch monomers was synthesized in order to improve the hydrolytic stability. The new self-etch monomers based on phosphonic acid functional groups were synthesized through a two-step procedure. First, phosphoric anhydride, poly-phosphoric acid, and polyethylene glycol were reacted to produce phosphate ester precursor (P-PEG-P). Next, allyl 2, 3-epoxypropyl ether was reacted with P-PEG-P to synthesize allyl self-etch monomer. Glycidyl methacrylate was also reacted with P-PEG-P to synthesize a methacrylate self-etch analogue monomer. The monomers were characterized using FTIR and 1H-NMR spectroscopy. The viscosities of monomers were measured using a rheometer. The degree photopolymerization conversion of monomers was measured using FTIR spectroscopy. The pH assay was performed by a digital pH-meter. The etching behavior of the monomers on human teeth was studied using scanning electron microscopy (SEM). Thermo-gravimetric analysis (TGA) was performed to evaluate the possible interaction of the monomers with tricalcium phosphate (TCP). The solubility of synthesized monomers was examined in ethanol, acetone, and water. The hydrolytic stability of cured resins in artificial saliva during 4 months was also surveyed. The synthesis of new self-etching monomers was successfully confirmed by spectroscopy analyses. The results represented appropriate viscosity of self-etching monomers around 1 (Pa s). The resin containing methacrylate monomer exhibited its degree of conversion is more than that of allyl monomer (p < 0.05). The allyl and methacrylate self-etch monomers exhibited pH values of 1.2 and 1.3, respectively. SEM micrograph verified that the synthesized monomers were able to suitable etching of the enamel human premolar teeth. The data obtained from TGA tests revealed that thermal stability of (TCP) containing monomers is enhanced. Also, the monomers exhibited an excellent solubility in polar solvents, but when they are mixed with TCP, they are not, anymore, dissolved in these solvents. Furthermore, the allyl monomer showed higher hydrolytic stability than the methacrylate monomer. The new photo-polymerizable acidic monomer based on allyl functionality showed enhanced hydrolytic stability compared to methacrylate-based monomer. It may be considered as a promising monomer for self-etch dental adhesives.

Evaluation of a novel primer containing isocyanate group on dentin bonding durability

OBJECTIVES

To evaluate the benefits of a novel dentin-bonding primer, namely, isocyanate-terminated urethane methacrylate precursor (UMP), which can form covalent bonds with demineralized dentin collagen.

METHODS

The synthesized and purified UMP monomer was characterized and tested its effects on the degree of conversion (DC) and wettability of an acetone-based dental adhesive. Then UMP primers of different concentrations were formulated and used to prepare adhesive specimens, which were compared with solvent-treated groups. Primer-treated specimens with and without aging were also compared. To evaluate the bonding interface, microtensile strength tests, nano-indentation tests and nanoleakage- eavaluation were performed using a field-emission scanning electron microscope and nano-indenter. Data were analyzed using SPSS 20.0 software with significance set at α = 0.05 using one-way analysis of variance (ANOVA) and two-way ANOVA to characterize the effects of the primer.

RESULTS

Treatment with the UMP primer promoted the DC and wettability of the adhesive on the demineralized dentin surface (P < 0.05); it also increased the bond strength of the aged dentin bonding interface (P < 0.05). Nanoleakage was reduced; the bonding interface became more stable, and the continuity and strength of the hybrid layer improved (P < 0.05) following UMP treatment. The application of 5 mM UMP as a primer for dentin bonding could lead to a stable bonding interface and long-lasting bonding effects.

SIGNIFICANCE

The use of 5 mM UMP primer developed in this study could improve dentin bonding durability and has excellent clinical application prospects.

Enamel and Dentin Etching with Glycolic, Ferulic, and Phosphoric Acids: Demineralization Pattern, Surface Microhardness, and Bond Strength Stability

This study evaluated the etching pattern, surface microhardness, and bond strength for enamel and dentin submitted to treatment with phosphoric, glycolic, and ferulic acids. Enamel and dentin blocks were treated with phosphoric, glycolic, and ferulic acid to evaluate the surface and adhesive interface by scanning electron microscopy (2000×). Surface microhardness (Knoop) was evaluated before and after etching, and microtensile bond strength was evaluated after application of a two-step adhesive system (Adper Single Bond 2, 3M ESPE) at 24 hours and 12 months storage time points. Analysis of variance (ANOVA) and Tukey's test showed a decrease in the microhardness values for both substrates after application of each acid (p<0.0001). The reduction percentage was significantly higher for enamel treated with phosphoric acid (59.9%) and glycolic acid (65.1%) than for ferulic acid (16.5%) (p<0.0001), and higher for dentin that received phosphoric acid (38.3%) versus glycolic acid (27.8%) and ferulic acid (21.9%) (p<0.0001). Phosphoric and glycolic acids led to homogeneous enamel demineralization, and promoted the opening of dentinal tubules, whereas ferulic acid led to enamel surface demineralization and partially removed the smear layer. The adhesive-enamel interface showed micromechanical embedding of the adhesive in the interprismatic spaces when phosphoric and glycolic acids were applied. Ferulic acid showed no tag formation. Microtensile bond strength at both time points, and for both substrates, was lower with ferulic acid (p=0.0003/E; p=0.0011/D; Kruskal Wallis and Dunn). The bond strength for enamel and dentin decreased when using phosphoric and glycolic acids at the 12-month time evaluation (p<0.05). Glycolic acid showed an etching pattern and microhardness similar to that of phosphoric acid. Ferulic acid was not effective in etching the enamel or dentin, and it did not provide satisfactory bond strength to dental substrates.

A randomized clinical study of the performance of self-etching adhesives containing HEMA and 10-MDP on non-carious cervical lesions: A 2-year follow-up study

OBJECTIVE

To evaluate the association of HEMA and 10-MDP in the clinical performance of self-etching adhesives in the restoration of NCCLs during 2-years.

MATERIALS AND METHODS

60 restorations were performed in 17 volunteers and randomized into three groups: G1 (n = 20) - Prime and Bond Universal (10-MDP); G2 (n = 20) - Optibond All-in-One (HEMA); and G3 (n = 20) - Clearfil SE (10-MDP and HEMA). No cavity preparation was performed. After 2 years, the restorations were evaluated using the modified USPHS criteria for retention, marginal adaptation/ staining, postoperative sensitivity and secondary caries. The results were analyzed using Fisher's exact test and Kruskal-Wallis test.

RESULTS

All groups showed 100% retention rate, except G1, who lost two restorations (p > 0.05). Regarding marginal adaptation, G1 showed greater deficiency, as only eight restorations (40%) remained intact (p < 0.05). Regarding marginal staining, G1 and G2 showed higher rate, as only 12 restorations (65%) in each one were free of staining (p < 0.05). All groups showed similar results for postoperative sensitivity and secondary caries (p > 0.05).

CONCLUSION

The association of HEMA and 10-MDP monomers in the self-etching adhesives did not influence the clinical performance of the NCCL restorations with respect to retention, postoperative sensitivity, and incidence of secondary caries. However, positively influenced the marginal adaptation and marginal staining at the 2-year follow-up.

CLINICAL SIGNIFICANCE

The association of HEMA and 10-MDP monomers in the self-etching adhesives positively influence the clinical performance of the NCCL restorations with respect to marginal adaptation and marginal staining.

Microleakage of Class II Bulk-Fill Resin Composite Restorations Cured with Light-Emitting Diode versus Quartz Tungsten-Halogen Light: An In Vitro Study in Human Teeth

Background: Resin composites undergo a certain degree of shrinkage when light-cured with different light sources available on the market, resulting in microleakage of dental restorations. The aim of the present study was to assess microleakage of class II restorations with bulk-fill resin composites cured with LED (light-emitting diode) and QTH (quartz tungsten-halogen light) units, both in cervical and occlusal areas of cavity preparations. Materials and Methods: In the present in vitro experimental study, a total of 30 human molar teeth were used, in which 60 class II cavities were prepared (mesial and distal) and restored with Filtek bulk fill resin composite. Restorations were equally distributed in 3 groups according to type of curing light: A, QTH (Litex 680A Dentamerica^®); B, LED (Bluephase N^® 3rd generation); and C, LED (Valo^® 3rd generation). Each group was further subdivided into subgroups 1 and 2 according to IV-A or IV-B resin composite color. Restored teeth were subjected to 20,000 thermal cycles between 5° and 55 °C, then immersed in 1M silver nitrate solution for 24 h. Subsequently, the teeth were sectioned mesiodistally to obtain samples for observation under stereomicroscope in order to determine microleakage degree. Kruskal-Wallis H and Mann-Whitney U statistical tests were applied with a significance level of 5% (p < 0.05). Results: No statistically significant differences were found in the degree of microleakage of bulk-fill resin composites light-cured with LED and QTH units for both occlusal (p > 0.05) and cervical areas (p > 0.05). Additionally, no significant differences were found when comparing microleakage between occlusal and cervical areas (p > 0.05), regardless of lamp type. In addition, significant differences in microleakage degree were found between bulk-fill resins with IV-A and IV-B shades when they were light-cured with QTH at cervical level (p = 0.023). However, there were no significant differences when comparing these bulk-fill resin composite shades at occlusal level with LED (p > 0.05) and QTH (p > 0.05) units. Conclusions: Class II restorations with bulk-fill resin composite in IV-A and IV-B shades light-cured with third generation LED lamp and QTH showed no significant differences in microleakage when compared in both occlusal and cervical areas. On the other hand, significantly more microleakage was found at the cervical level when a darker shade of resin composite was used and light-cured with the QTH unit.

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 bonding effectiveness of a universal adhesive to the plasma-activated dentin surface

This study aimed to evaluate the effect of non-thermal atmospheric pressure plasma on the bond strength of a universal adhesive used in etch-and-rinse mode. Dentin surfaces were etched with phosphoric acid and samples were divided into groups exposed to either dry bonding, plasma-dried bonding, plasma-dried and rewetted bonding, or wet bonding (n  =  10). Dentin surfaces of the plasma-dried specimens were treated with a plasma jet before the adhesive procedure. After application, composite blocks were built, and specimens were subjected to micro-tensile bond strength testing after 24 h and after 10,000 thermal cycles. The hybrid layer formation was evaluated by micro-Raman spectral analysis; the resin-dentin interface was analyzed by scanning electron microscopy. One-way ANOVA and Tukey's post hoc multiple comparison tests were used to statistically analyze the data. The bond strength values of the plasma-dried bonding groups were statistically higher than the non-plasma-treated groups both before and after aging. After the thermal cycles, bond strength values decreased significantly only in the wet bonding group. Micro-Raman spectral analysis revealed that plasma-drying increased adhesive penetration, especially hydrophobic monomer infiltration. This may increase the mechanical properties and durability of the resin-dentin interface, provide long-term stability, and improve the polymerization rate of the adhesive layer.

Impact of different pretreatments and attachment materials on shear bond strength of indirectly bonded brackets using CAD/CAM transfer trays to monolithic zirconia

OBJECTIVE

Investigating the impact of different pretreatment methods, attachment materials and aging regimens on shear bond strength (SBS) between zirconia and indirectly bonded brackets using CAD/CAM transfer trays.

METHODS

Zirconia substrates were conditioned with silica coated alumina (CoJet) and a) Clearfil Ceramic Primer Plus (CF), b) RelyX Ceramic Primer (RXP), c) Futurabond U (FU). Brackets were virtually placed, transfer tray designed (OnyxCeph) and 3D-printed for indirect bonding with a) Transbond LV (TBL), b) Nexus NX3 (NX3), c) Maximum Cure (MC). SBS testing was performed with a universal testing machine after 24 h, 500 thermal cycles, 90 d. Directly bonded brackets to human enamel using Transbond XT Adhesive served as control. The adhesive remnant index (ARI) was evaluated. Data was analyzed with Shapiro-Wilk, Kruskal-Wallis and Dunn's post-hoc test with Bonferroni correction, Chi² test (p < 0.05), and the Weibull modulus was calculated.

RESULTS

SBS ranged from 0.1 to 15.5 MPa and were influenced mostly by the attachment material. NX3 generally showed the highest values (9.5-15.8 MPa). Initially RXP/TBL and FU/TBL presented the lowest values (4.3/4.8 MPa). Aging regimens reduced SBS of MC irrespective of pretreatment, after 90 d values ranged from 0.1 to 0.9 MPa. ARI 1 was predominant in all MC groups and FU/NX3, 2 and 3 in the other groups. Weibull moduli ranged between 0.15 (MC/RXP/500 TC) and 6.24 (NX3/RXP/500 TC).

SIGNIFICANCE

MC seems not to be suitable for indirect bonding using CAD/CAM transfer trays to zirconia. NX3 showed similar SBS values compared to the control, TBL lower.

Bond durability of a two-step adhesive with a universal-adhesive-derived primer in different etching modes under different degradation conditions

This study investigated the enamel and dentin bond durability of a two-step adhesive system, using a universal adhesive-derived primer (G2-Bond Universal [GU]), and compared it with the two conventional, two-step, self-etch adhesive systems (Clearfil SE Bond 2 [CS] and OptiBond XTR [OX]) under thermal cycling (TC) and long-term water storage (WS). The shear bond strengths to bovine enamel and dentin were determined using the etch-and-rinse and self-etch modes. Twelve specimens per test group were prepared and further divided into the following subgroups: 1) subjected to TC, 2) long-term WS, and 3) WS for 24 h (baseline). The enamel and dentin bond durability of GU was superior to those of CS and OX in different etching modes and under different degradation conditions. The latest two-step adhesive system, which utilizes universal adhesives' benefits in its primer, might offer durable clinical bonding performances and can be widely used in a clinical setting.

Evaluation of Chitosan-Oleuropein Nanoparticles on the Durability of Dentin Bonding

Purpose

To evaluate the effects of dentin pretreatment with chitosan-loaded oleuropein nanoparticles (CONPs) on the durability of resin-dentin bonding interfaces.

Methods

Eighty freshly extracted non-carious human third molars were randomly divided into four groups (n = 20 each): a de-ionized water (DW) group, a chitosan (CS) group, a chlorhexidine (CHX) group and a CONP group. The dentin in the DW, CS, CHX, and CONP groups were pretreated with de-ionized water, 1.0 mg/L CS solution, 2% chlorhexidine solution, and CONP suspension (prepared with 100 mg/L oleuropein), respectively, followed by the universal adhesive and resin composites. The bonded teeth of each group were randomly divided into two subgroups: an immediate subgroup and an aged subgroup. The bonded teeth of each group were then cut into the bonded beams. We measured their microtensile bond strength (μTBS), observed the characteristics of bonding interface by atomic force microscope, calculated the percentage of silver particles in a selected area for interfacial nanoleakage analysis, and evaluated the endogenous gelatinase activity within the bonding interface for in-situ zymogram analysis. Data were analyzed with two-way ANOVA and LSD multiple comparison test (P < 0.05).

Results

Regardless of after 24 h or after thermocycling, CONP exhibited better μTBS (P < 0.05) than the other three groups except that there was not a statistical significance (P > 0.05) in the CONP and CHX groups after 24 h. Besides, the CONP group presented significantly higher modulus of elasticity in the hybrid layers (P < 0.05), lower expression of nanoleakage (P < 0.05), and better inhibitory effect of matrix metalloproteinases than the other three groups before and after thermocycling.

Conclusion

Altogether, the CONPs had the potential to act as a dentin primer, which could effectively improve the dentin-resin binding durability.