Enamel deproteinization and its effect on acid etching: an in vitro study

Evaluation of NaOCl application prior to resin infiltrant or fluoride-containing resin varnish in the treatment of white spot lesions: An in vitro study

OBJECTIVE

The aim of this in vitro study is to investigate the effect of NaOCl (5.25 %) prior to resin infiltration and resin varnish on microhardness, surface roughness, and DIAGNOdent Pen values in the treatment of white spot lesions (WSLs).

METHODS

The artificial initial caries lesions were created in 160 human enamel samples. The demineralizated samples were divided into five groups: resin infiltration (ICON; DMG, Hamburg, Germany), NaOCl + ICON, resin varnish (Clinpro XT; 3M ESPE, Seefeld, Germany), NaOCl + Clinpro XT, and a negative control group. Enamel samples that underwent thermocycling aging were subjected to 5.000 cycles between 5-55 °C (N = 32, n = 16 for aging subgroups). Surface roughness (Ra), Vicker's microhardness (VHN), and DIAGNOdent Pen (Kavo, Biberach, Germany) (DDP) values were recorded at the baseline, after demineralization, after treatment, and after the thermal aging stages. The micro-CT analysis, microleakage, and Scanning Electron Microscope images were evaluated after treatment procedures and thermal aging. Robust ANOVA, Pearson's chi-square, and McNemar tests were used for statistical analysis. The significance level was p < 0.05.

RESULTS

The main effect of both group and stage was statistically significant for DDP, Ra, VHN, and micro-CT values. All treatment procedures improved the demineralized enamel compared to the negative control group (p < 0.001). The application of NaOCl (5.25 %) before resin infiltration increased microhardness but also in roughness. The resin-infiltrated groups showed less microleakage than the resin-varnish-treated groups (p < 0.001).

CONCLUSION

The application of NaOCl prior to resin infiltration or resin varnish did not result in any important alterations in the examined parameter values.

Comparative evaluation of shear bond strength and penetration of self-etch sealant with and without enamel deproteinization: an in vitro study

AIM

To compare the shear bond strength and penetration ability of self-etch sealant with and without enamel deproteinization.

MATERIALS AND METHODS

A total of 37 sound extracted teeth were selected and 31 teeth were used for testing shear bond strength of self-etch sealant. For this, crowns portions of selected teeth were cut longitudinally with a diamond disc into a mesial and distal half, thereby yielding 62 samples. They were further divided into two groups; in Group 1, samples were deproteinised with 5.25% sodium hypochlorite and a sealant cylinder was built on the proximal surface. In Group 2, sealant cylinders were built without deproteinising the surface. Shear bond strength was tested using Universal Testing Machine. The remaining six teeth were used for penetration evaluation of self-etch sealant. In Group 1, the occlusal surface was deproteinised with 5.25% sodium hypochlorite and self-etch sealant was directly applied. In Group 2, sealant was applied without deproteinisation. The samples obtained after sectioning were observed under scanning electron microscope for sealant penetration. Mann-Whitney test and Chi-square analysis were utilised for statistical analysis.

RESULTS

The results showed that the shear bond strength of the two groups was statistically not significant (p = 0.23). However, the comparison of % penetration revealed a statistically significant difference between the groups (p = 0.016).

CONCLUSION

Deproteinising the enamel surface prior to application of self-etch sealant enhanced the penetration ability of the sealant but did not show any effect on shear bond strength.

Enamel Deproteinization or Sandblasting for Enamel Reconditioning Before Acid Etching to Enhance the Shear Bond Strength of Metallic Brackets in a Third Bonding: An In Vitro Study

BACKGROUND

Enamel conditioning with 37% phosphoric acid is the most common technique during orthodontic bracket bonding procedures. However, due to the repeated de-bonding of the orthodontic brackets during treatment, other methods were needed to condition the enamel surface and increase the bond strength. This study aimed to compare the effect of conditioning the enamel surface by sandblasting with aluminum oxide particles or 5.25% sodium hypochlorite gel in combination with acid etching compared to acid etching alone on shear bond strength (SBS).

MATERIAL AND METHODS

One hundred eight extracted upper premolars were randomly divided into three groups according to the conditioning enamel surface method. After the first and second bonding of metal brackets, new metal brackets were bonded with a total-etching adhesive after enamel conditioning using different methods: acid etching only (37% phosphoric acid for 30 seconds) (AE group), sodium hypochlorite associated with acid etching (5.25% NaOCl gel for 60 seconds and then acid etching for 30 seconds) (NaOCl-AE group), and sandblasting associated with acid etching (sandblasting for five seconds and then acid etching for 30 seconds) (SB-AE group). The shear bond strengths of the brackets were tested with a universal testing machine. One-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) tests were used to detect significant differences in shear bond strength among groups at the third bonding. Repeated-measure ANOVA and Bonferroni's tests were used to detect significant differences in shear bond strength among the bonding attempts within each group.

RESULTS

5.25% sodium hypochlorite associated with the acid etching method produced significantly greater shear bond strength than sandblasting associated with acid etching and acid etching only methods at the third bonding (16.40 ± 5.80 MPa, 13.60.47 ± 6.40 MPa, and 9.90 ± 4.40 MPa, respectively; P < 0.001). However, there was no significant difference between the AE and SB-AE groups (P = 0.247). In addition, we found a significant decrease in the shear bond strength within each group after each bonding attempt.

CONCLUSION

Conditioning the enamel surface with 5.25% sodium hypochlorite associated with acid etching produced greater bond strength than conditioning by sandblasting associated with acid etching and acid etching only at the third bonding. The bond strength of the metal bracket decreased with increasing bonding attempts, even with the application of enamel surface conditioning methods.

Adhesive Performance of Pit and Fissure Sealants on Deproteinized Enamel with Different Proteolytic Agents: In Vitro Study

The objective of this work was to assess the efficacy of different proteolytic agents on the bond strength of pit and fissure sealants to bovine enamel. Eighty-four bovine enamel specimens were randomly assigned in groups according to the pit and fissure sealant applied (HelioSeal F or Dyad Flow). Then, the specimens were subdivided according to the proteolytic agent used (n = 7): Group 1, distilled water (control); Group 2, 10 wt.% Tergazyme®; Group 3, 10 wt.% ZYME®; Group 4, 10% papain gel; Group 5, 10% bromelain gel; and Group 6, 5.25 wt.% sodium hypochlorite. The cell viability of the proteolytic solutions was assessed through the MTT assay. The proteolytic agents were applied on the enamel surface prior to the acid-etching procedure; then, the pit and fissure sealants were placed. The micro-shear bond strength was evaluated after 24 h or 6 months of water storing at 37 °C. Representative SEM images were taken for each experimental group. The bond strength data were statistically analyzed by a three-way ANOVA test using a significance level of α = 0.05. Bromelain and papain proteolytic solutions did not exert any cytotoxic effect on the human dental pulp cells. After 24 h and 6 months of aging, for both pit and fissure sealants, sodium hypochlorite, papain, bromelain, and Tergazyme® achieved statistically significant higher bond strength values (p < 0.05). Irrespective of the deproteinizing agent used, Dyad Flow resulted in a better bond strength after 6 months of aging. The type 1 etching pattern was identified for sodium hypochlorite, papain, and bromelain. Tergazyme®, papain, and bromelain demonstrated efficacy in deproteinizing enamel surfaces prior to acid etching, leading to the improved bond strength of pit and fissure sealants. Clinically, this suggests that these proteolytic agents can be considered viable alternatives to traditional methods for enhancing sealant retention and longevity. Utilizing these agents in dental practice could potentially reduce sealant failures.

Detection of pit and fissure sealant microleakage using quantitative light-induced fluorescence technology: an in vitro study

This in vitro study aimed to evaluate the feasibility of quantitative light-induced fluorescence (QLF) technology for detecting the presence and severity of microleakage of pit and fissure sealants. The areas of interest (AOIs) were 160 pits and fissures of 40 extracted permanent teeth. Fluorescent images were acquired using a QLF device, and the maximum fluorescence loss ΔFmax of each AOI was analyzed. After staining and cross-sectioning of the teeth, histological dye penetration was scored on a scale of 0 to 3. The relationship between ΔFmax and microleakage depth was analyzed, and the areas under the curve (AUCs) were calculated. The │ΔFmax│ increased as microleakage depth increased. The ΔFmax values of microleakage areas showed a strong significant correlation with the histological scores of dye penetration (r = - 0.72, P = 0.001). AUC analysis showed a high diagnostic accuracy for microleakage depth (AUC = 0.83-0.91). The highest AUC of 0.91 was found when differentiating the outer half microleakage of the sealant (histological score 0 vs. 1-3). QLF technology is effective in assessing the presence and severity of microleakage, suggesting its potential for noninvasive detection and monitoring of sealant microleakage in clinical settings.

Effects of fluorosed enamel on orthodontic bracket bonding : An in vitro study

OBJECTIVE

To investigate the effect of enamel deproteinization and air abrasion on shear bond strength (SBS), adhesive remnant index (ARI) scores, and surface topography when bonding orthodontic brackets to fluorosed enamel.

MATERIALS AND METHODS

The sample included 90 fluorosed and 30 normal premolars divided into four groups: group I (fluorosed premolars subjected to air abrasion before acid etching), group II (fluorosed premolars subjected to deproteinization before acid etching), group III (fluorosed premolars; control for groups I and II), and group IV (normal premolars; control for group III). Bonding procedures included etching with 37% phosphoric acid, priming with TransbondTM XT primer (3M Unitek, Monrovia, CA, USA), and application of TransbondTM XT adhesive paste (composite; 3M Unitek, Monrovia, CA, USA). Air abrasion was done using 50 µm aluminum oxide particles under 0.28 MPa pressure for 5 s with the micro-etcher held at a distance of 10 mm. Deproteinization was done for 60 s with 5% sodium hypochlorite (NaOCl).

RESULTS

Fluorosed premolars subjected to deproteinization showed the lowest (median = 6.57 MPa) SBS among the four groups, followed by 8.14, 8.90, 8.14 MPa for groups I, III, and IV respectively. ARI scores were significantly different between the four groups (p = 0.006). Fluorosed enamel etched after air abrasion or deproteinization with NaOCl showed a predominance of type 4 etching pattern with some areas appearing unetched.

CONCLUSIONS

Shear bond strength of all groups was within the 6-8 MPa acceptable range for orthodontic purposes. Fluorosed premolars subjected to deproteinization showed the lowest values. Further studies are recommended to scrutinize the deproteinization technique.

Effectiveness of sodium hypochlorite treatment on the bonding of four adhesive systems to fluorotic enamel

The study evaluated the effect of sodium hypochlorite (NaOCl) treatment on fluorotic enamel bonding of four adhesive systems. They were Single Bond 2 (SB2), Prime&Bond NT (PBN), Clearfil SE Bond (CSB), and Single Bond Universal (SBU). One hundred eighteen extracted moderate fluorotic molars were divided into eight groups according to NaOCl pretreatment and four adhesive systems. The microshear bond strength (μSBS), etching pattern, and penetration depth (PD) were observed. The statistical method was two-way ANOVA and least significant difference (LSD) test (α=0.05). The application of NaOCl significantly increased the μSBS of PBN and SBU (p<0.05). The enamel-etching pattern of CSB and SBU was deeper under SEM. A noticeable increase of PD was in SB2 and SBU after the application of NaOCl (p<0.05). Pretreatment of 5.25% NaOCl for the 60 s can increase μSBS of PBN and SBU, PD of SB2 and SBU, and improve enamel-etching pattern of CSB and SBU to fluorotic enamel.

Shear Bond Strength and Microleakage of Pit and Fissure Sealants Placed after Saliva-Contaminated Etched Enamel

Saliva contamination of etched enamel before sealant application is the most common reason for failure of fissure sealants, thus affecting the effect of caries prevention. This study aimed to evaluate the shear bond strength (SBS) and microleakage of resin-based fissure sealant on saliva-contaminated etched enamel after rinsing, re-etching, and applying universal adhesive. Fifty human third molars were sectioned into 2 parts and embedded in acrylic resin to obtained 100 samples. The samples were randomly assigned to 5 groups: 1, etching; 2, etching + contamination; 3, etching + contamination + rinsing; 4, etching + contamination+ re-etching; 5, etching + contamination + universal adhesive. Each group was divided into 2 subgroups: 24 h storage and 5000× thermocycling. After measuring SBS, failure mode was analyzed. In an additional 15 teeth, microleakage was tested using dye penetration method. Three more teeth were used for scanning electron microscope (SEM) observation of the enamel surface morphology in each group. The adhesive group had significantly higher mean SBS after 24 h storage, while the re-etching group were better after 5000× thermocycling. The etching, etching+ contamination+ re-etching, and etching+ contamination+ universal adhesive groups showed the least microleakage. The SEM reveals considerable variations in the enamel surface appearance within groups. Re-etching or applying universal adhesive in saliva-contaminated etched enamel before sealant can achieve satisfactory results. Considering the less operative steps and the shorter chair time, applying universal adhesive is more recommended for a pediatric patient if saliva-contamination happened before sealant application.

Evaluation of developmentally hypomineralised enamel after surface pretreatment with Papacarie Duo gel and different etching modes: an in vitro SEM and AFM study

PURPOSE

This study aimed at investigating the surface morphology and nanotopography of normal enamel (NE) and developmentally hypomineralised enamel (HE) when subjected to various pretreatment protocols under scanning electron microscopy (SEM) and atomic force microscopy (AFM).

METHODS

Sixteen NE, 16 creamy/white (CW) HE and 16 yellow/brown (YB) HE specimens sectioned from extracted hypomineralised first permanent molars (FPMs) were included in this study. They were randomly distributed into 12 experimental groups (n = 4). Each group involved the following: (1) deproteinisation with Papacarie Duo^® gel or no deproteinisation, and (2) the use of Scotchbond™ Universal Adhesive (Scotchbond) in self-etch (SE) mode or 37% phosphoric acid etchant. Subsequently, the surface morphology and nanotopography of pretreated enamel specimens were evaluated under SEM and AFM, respectively.

RESULTS

SEM observation showed that deproteinisation with Papacarie Duo^® gel before phosphoric acid etching led to favourable etching patterns. This was consistent across all groups irrespective of the type of enamel specimen and the severity of hypomineralisation. In contrast, AFM results identified three factors that influenced surface parameters: (1) type of enamel specimen, (2) severity of hypomineralisation and (3) etching mode. YB HE recorded higher surface roughness values than CW HE and NE when subjected to the same pretreatment protocol. Deproteinisation and the application of Scotchbond in SE mode led to minimal topographic changes; however, acid etching was associated with an increase in surface roughness.

CONCLUSION

Deproteinisation with Papacarie Duo^® gel followed by acid etching contributed to improved etching patterns on HE.

Pathophysiology of Demineralization, Part II: Enamel White Spots, Cavitated Caries, and Bone Infection

PURPOSE OF REVIEW

Compare noninfectious (part I) to infectious (part II) demineralization of bones and teeth. Evaluate similarities and differences in the expression of hard tissue degradation for the two most common chronic demineralization diseases: osteoporosis and dental caries.

RECENT FINDINGS

The physiology of demineralization is similar for the sterile skeleton compared to the septic dentition. Superimposing the pathologic variable of infection reveals a unique pathophysiology for dental caries. Mineralized tissues are compromised by microdamage, demineralization, and infection. Osseous tissues remodel (turnover) to maintain structural integrity, but the heavily loaded dentition does not turnover so it is ultimately at risk of collapse. A carious tooth is a potential vector for periapical infection that may be life-threatening. Insipient caries is initiated as a subsurface decalcification in enamel that is not detectable until a depth of ~400μm when it becomes visible as a white spot. Reliable detection and remineralization of invisible caries would advance cost-effective wellness worldwide.

Effect of nonthermal atmospheric plasma, grape seed extract, and bromelain on immediate bonding of composite to bleached and microabraded surfaces

Background:

Tooth whitening procedures such as bleaching and microabrasion alters the enamel surface and thus reduce the composites’ bond strength. Hence, various surface treatments were introduced to overcome this problem.

Aim:

To assess the effect of nonthermal atmospheric plasma (NTAP), grape seed extract (GSE) and bromelain on the shear bond strength (SBS) of the composite after bleaching and microabrasion.

Materials and Methods:

Eighty extracted maxillary anterior teeth were distributed into two groups. Group 1: bleaching and Group 2: Microabrasion and further subdivided into four subgroups (n = 10) based on the form of surface treatment employed. Group A: no surface treatment, Group B: bromelain, Group C: GSE, Group D: NTAP. Composite resin was bonded to the labial surface and placed in artificial saliva for 24 h. SBS testing was done for all the samples.

Statistical Analysis:

Analysis was performed using two-way analysis of variance and post hoc Tukey's test with P < 0.05 considered statistically significant.

Results:

Group 1D revealed the highest bond strength (35.4 Mpa) and Group 1A showed the least bond strength values (15.7 Mpa). Among the bleaching groups, significant difference was observed between all the subgroups except Group 1A and 1B (P = 0.972). In microabrasion group, significant difference was observed between Group 2A and 2D (P = 0.0001), Group 2B and 2D (P = 0.0010), and Group 2C and 2D (P = 0.0001).

Conclusions:

Following bleaching, NTAP application and GSE significantly improved the SBS of composite resin. Application of NTAP to microabraded surfaces increased the bond strength of composite resin.

Evaluation of the Effects of Bromelain and Papain Enzymes on Shear Bond Strength of Composite Resin to Enamel

Aim

This study aimed to evaluate the effects of 6% bromelain and 10% papain enzymes on shear bond strength (SBS) of composite resin to enamel compared to conventional 37% phosphoric acid etching.

Materials and Methods

50 human maxillary premolar teeth were randomly divided into 5 groups (G1–G5/n = 10). In G1 and G2, after etching enamel with 37% phosphoric acid for 15 seconds and washing the surface, 10% papain and 6% bromelain enzymes were used, respectively. In G3 and G4, 6% bromelain or 10% papain enzymes were applied on enamel. In G5, the enamel surface was etched with 37% phosphoric acid for 15 seconds. A two-step etch-and-rinse adhesive system (Adper Single Bond 2) was applied. A nanohybrid composite (Z350) was placed using Teflon molds. All the samples were then subjected to the SBS test using a universal testing machine. Data analysis was performed using a one-way ANOVA test followed by the Tukey test. p values less than 0.05 were considered significant.

Results

Comparison of the mean SBS between G1, G2, and G5 shows no significant differences (p > 0.05); however, they had higher mean SBS compared with G3 and G4 (p < 0.0001).

Conclusions

The shear bond strength of composite to enamel was not affected significantly using either 6% bromelain or 10% papain enzymes after 37% phosphoric acid application. Moreover, 6% bromelain and 10% papain enzymes were not as effective as 37% phosphoric acid alone.

Effects of enamel deproteinization with different application times on the shear bond strength of a self-etching primer: An in vitro study

OBJECTIVE

The aim of this in vitro study was to evaluate the effects of enamel deproteinization on the shear bond strength of a self-etching primer Transbond Plus™(TBP), with different application times of sodium hypochlorite (NaOCl 5.25%), primarily and secondarily on the adhesive remnant index score.

MATERIALS AND METHODS

One hundred twenty-five freshly extracted human premolars were randomly and blindly divided into five groups according to the enamel surface preparation, as follows (n=25): group 1(control): Etching with 37% phosphoric acid for 15seconds+Bonding; group 2 (control): TBP™ without NaOCl, group 3: 60seconds NaOCl+TBP™, group 4: 30seconds NaOCl+TBP™, group 5: 15seconds NaOCl+TBP™. The same composite resin was used (Transbond XT™) to bond the orthodontic metal brackets. After the immersion of the teeth in distilled water at 37°C for 24hours the shear bond strength was measured using the universal testing machine and the adhesive remnant index score (ARI) was evaluated under an optical microscope (25×).

RESULTS

The mean SBS values (inMPa) of the groups were respectively: group 1: 13.03±5.36; group 2: 12.28±3.06; group 3: 12.38±4.55; group 4: 12.98±5.76; and group 5: 11.73±5.67. Enamel deproteinization increased the SBS for groups 3 and 4, but no statistically significant difference was found between the five groups (P=0.883). Group 1 showed the highest ARI scores, with 52% of the teeth retaining all the adhesive (score 3). However, for all the other groups, scores 0 and 1 were predominant, with less than half of the adhesive or no adhesive at all remaining on the teeth.

CONCLUSIONS

Enamel deproteinization with sodium hypochlorite (5.25%) and the variation of its application time has no effect on the SBS of the self-etching primer Transbond Plus ™.

Effect of surface treatments on the adhesive properties of metallic brackets on fluorotic enamel

OBJECTIVE

To compare the effectiveness of the pretreatment with sandblasting and deproteinization with NaOCl on bond strength (SBS), in situ conversion degree (CD) of brackets in fluorotic enamel, and enamel etching pattern.

METHODS

A total of 90 non-carious maxillary premolars were used. The teeth were then assigned to six experimental groups according to: enamel surface (sound and fluorotic enamel); surface treatment (Regular etch with 37% phosphoric acid [RE]; 5.2% sodium hypochlorite + phosphoric acid [NaOCl + RE]; sandblasting + phosphoric acid [sandblasting + RE]). After storage in distilled water (37°C/24h), the specimens were tested at 1 mm/min until failure (SBS). Enamel-resin cement interfaces were evaluated for CD using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a scanning electron microscope. Data from SBS and in situ CD values were analyzed using ANOVA two-away and Tukey test (α=0.05). The enamel etching pattern was evaluated only qualitatively.

RESULTS

For sound enamel, RE showed the highest SBS values, when compared to NaOCl + RE and Sandblasting + RE groups (p< 0.01). Regarding CD, only NaOCl + RE significantly compromised the mean DC, in comparison with other groups (p= 0.002). For fluorotic enamel, the Sandblasting + RE group significantly increased the mean SBS values, in comparison with RE group (p= 0.01) and no significant change was observed for CD (p> 0.52).

CONCLUSIONS

The application of NaOCl or sandblasting associated to phosphoric acid improved the SBS of the brackets in fluorotic enamel without compromising the CD of the resin cement, with improving of enamel interprismatic conditioning.

Assessment of shear bond strength and microleakage of fissure sealant following enamel deproteinization: An in vitro study

BACKGROUND

To evaluate the effect of two different deproteinizing agents (5.25% sodium hypochlorite and Papacarie®) prior to acid etching on the shear bond strength and microleakage of a fissure sealant material.

MATERIAL AND METHODS

A total of 123 extracted noncarious human third molar teeth were randomly divided into three groups for each test: acid etching alone (control) (C), sodium hypochlorite (NaOCl), and Papacarie Duo® (PC). The shear bond strength tests were performed using a universal testing machine, and microleakage was evaluated using a dye penetration method.

RESULTS

The mean shear bond strength values obtained in Group C were significantly lower than those of Group NaOCl and Group PC (p=0.0001). There were no significant differences between Group NaOCl and Group PC (p>0.05). No statistically significant difference was observed among the groups in terms of microleakage (p>0.05).

CONCLUSIONS

Papacarie Duo® and 5.25% sodium hypochlorite treatments before etching increased the shear bond strength of the fissure sealant. However, pre-treatment with these agents did not decrease the microleakage between teeth and sealant. Key words:Deproteinization, microleakage, papain, dental seal, shear bond strength.

Characteristics of adhesive bonding with enamel deproteinization

OBJECTIVE

To evaluate the effect of using sodium hypochlorite (NaOCl) on the bond characteristics of orthodontic metal brackets bonded to enamel surface using three adhesive systems.

METHODS

One hundred twenty premolars were selected and randomly divided into two equal groups of 60 teeth/ each (Groups I and II). The teeth of Group I were left untreated while those of Group II were exposed to 5.25% NaOCl for 1 minute. The teeth in either group were randomly subdivided into three equal subgroups of 20 teeth/ each (A, B and C), according to the type of adhesive system used to bond the brackets. In Subgroup A, phosphoric acid + Transbond XT primer and adhesive were used. In subgroup B, Transbond Plus self-etching primer (SEP) + Transbond XT adhesive were utilized. In subgroup C, phosphoric acid + SmartBond LC adhesive were used. The shear bond strength (SBS) and the degree of adhesive penetration to enamel surface were assessed. Data analyses were performed using ANOVA, post-hoc (LSD), t and chi-square test.

RESULTS

Transbond XT had significantly higher SBS than SmartBond LC (p< 0.05). Phosphoric acid provided significantly higher SBS and degree of adhesive penetration than SEP (p< 0.05). NaOCl significantly increased SBS and degree of adhesive penetration in Subgroups B and C (p< 0.05).

CONCLUSION

Adhesion quality of Transbond XT adhesive is better than SmartBond LC. Phosphoric acid is more effective than SEP. NaOCl enhances the bond characteristics.

Effects of different deproteinizing agents on topographic features of enamel and shear bond strength - An in vitro study

OBJECTIVES:

To evaluate and compare the effect of different enamel deproteinizing agents on topographic features of enamel and shear bond strength before acid etching.

MATERIALS AND METHOD:

In total, 120 sound human maxillary premolars were taken and divided into three groups: Group 1 control (37% phosphoric acid (H₃PO₄), Group 2, (5.25% Sodium Hypochlorite (NaOCl)+ 37% H₃PO_4, and Group 3, (10% Papain gel + 37% H₃PO₄). These groups were further divided into A and B subgroups. In subgroups 1A, 2A, and 3A (n30) topographic features were evaluated using Scanning electron microscope (SEM) at different magnifications. Insub-groups 1B, 2B, and 3B (n90) metal brackets were bonded with Transbond™ XT, and all the samples were subjected for Shear Bond Strength (SBS) evaluation using universal testing machineat a cross speed of 0.5 mm²/min. The failure mode was analyzed using adhesive remnant index (ARI). Statistical analysis was done using one-way ANOVA for the shear bond strength, and Kruskal-Wallis test followed by Mann-Whitneywas performed for ARI scores.

RESULTS:

SEM showed predominance of type 3 etching pattern in control Group (1A) and type 1 and type 2 in deproteinizedGroups (2A and 3A). Mean values of shear bond strength showed statistically significant differences between evaluated groups (P < 0.005). The lowest and highest shear bond strength was attributed to Group 1B (Control) and 3B (10% papain gel), respectively. Statisticallysignificant differences were noted for the mean ARI scores between control and deproteinized group (P < 0.05).

CONCLUSION:

10% papain geland 5.25% NaOCl can be used as deproteinizing agents on enamel surface before acid etchingto enhance the shear bond strength of orthodontic brackets.

Etching Patterns of Sodium Hypochlorite Pretreated Hypocalcified Amelogenesis Imperfecta Primary Molars: SEM Study

Aim: To investigate the etching patterns of hypocalcified amelogenesis imperfecta (AI) in primary molars pretreated with 5.25% NaOCl prior to phosphoric acid application using scanning electron microscopy (SEM). Study design: Ten hypocalcified AI primary molars were collected, sectioned longitudinally into 2 parts and allocated into two groups of ten specimens each. The enamel surface in the first group (control group) was etched using 37% phosphoric acid gel for 15 seconds; while in the second group (study group), it was pretreated using 5.25 sodium hypochlorite(NaOCl) for 60 seconds prior to acid etching. Each specimen was examined at 16 different sites, and evaluated for the etching pattern (types I, II, and III) distribution using SEM. A total of 320 microphotographs at 1,500 magnification were obtained using Auto-Cad 2007 software. Results: The etching pattern with phosphoric acid was not uniform with predominance of type III etching (65.63%), while the pretreated enamel surfaces showed a significant increase in type I and II(82.5%) etching patterns (P<0.001). Conclusion: Treatment of primary teeth affected by hypocalcified AI using 5.25% NaOCl prior to phosphoric acid etching significantly improves the etching pattern which is required for good resin bonding.

Shear Bond Strength of Orthodontic Brackets Luted with RMGIC After Er:YAG Laser Etching with Two Pulse Modes Using a Digitally Controlled "X-Runner" Handpiece

OBJECTIVE

To compare the shear bond strength (SBS) values of orthodontic brackets luted using a resin-modified glass ionomer cement (RMGIC) on enamel surfaces etched using either an Er:YAG laser in two different working modes, or a conventional etching protocol, including phosphoric acid.

MATERIALS AND METHODS

Sixty healthy human premolars were randomly allocated to three experimental groups (n = 20) and etched with: Group 1: Er:YAG laser in super-short pulse (SSP) mode (100 mJ, 20 Hz, 2 W); Group 2: Er:YAG laser in quantum square pulse mode (120 mJ, 10 Hz, 1.2 W) using a digitally controlled handpiece ("X-Runner"); Group 3 (control): 5.25% sodium hypochlorite pretreatment, then 37% phosphoric acid for 15 sec. Stainless steel brackets were bonded using light-curing RMGIC for orthodontic bonding. After term cycling (1800 cycles), SBS testing was performed using a universal testing machine. After debonding, both enamel and bracket surfaces were examined to determine the amount of RMGIC still present on the surfaces.

RESULTS

Group 3 surfaces gave the lowest mean SBS (10.6104 ± 2.66196 MPa), whereas Group 1 provided the highest 1 (13.1795 ± 3.37904 MPa), which was significantly different from the control (Group 3, p = 0.0226). Group 2 provided intermediate values (11.8486 ± 0.59832 MPa) nonsignificantly different from the control or from SSP (p = 0.4215 and p = 0.3082, respectively).

CONCLUSIONS

Er:YAG laser treatment in SSP mode of enamel surfaces for orthodontic bonding provided higher SBS and a shear behavior of the luting material similar to the conventional acid-etching procedures, making it a viable alternative to acid etching.

Combined Effect of Enamel Deproteinization and Intermediate Bonding in the Retention of Pit and Fissure Sealants in Children: A Randomized Clinical Trial

OBJECTIVE

This manuscript shows if enamel deproteinization along with an intermediate layer of bonding enhances the retention of pit and fissure sealants..

STUDY DESIGN

Two hundred six mandibular first permanent molars were allocated to Group I (n=103) and Group II (n=103). Group I underwent deproteinization, acid etching, bonding agent application and pit & fissure sealant placement while Group II treated with acid etching followed by pit & fissure sealant application only. Clinical analysis of all the teeth in the two groups was performed at 1, 3, 6, 9 and 12 months respectively. Pearson's chi - square test was utilized to evaluate the success of both treatment procedures (p<0.05).

RESULTS

At 12 months follow up the differences between the groups pertaining to Marginal integrity, Marginal discoloration and Anatomical form were statistically significant suggesting enhanced retention in Group I.

CONCLUSIONS

Enamel deproteinization along with the use of intermediate bonding layer significantly enhances the retention of pit and fissure sealants in terms of enhanced marginal integrity, decreased marginal discoloration and preserving the anatomical form.

Effect of Enamel Deproteinization in Primary Teeth

OBJECTIVE

To evaluate and compare the topographical features of enamel surface, etched with different materials.

STUDY DESIGN

10 extracted human primary molars were randomly selected and cut and trimmed to 1 mm². Each group comprised of 10 blocks and the enamel was treated as follows: Group I-35% H₃PO_4; Group II-5.25% NaOCl + 35% H₃PO_{4 ;}Group III-5.25% NaOCl; Group IV no treatment was carried out. All the samples were prepared for Scanning electron microscope analysis. The images were obtained and evaluated for the quality type I-II etching of the enamel surface using Auto-CAD 2011 software.

STATISTICAL ANALYSIS USED

Wilcoxon Signed Ranks Test (p<0.001).

RESULTS

The mean surface area of type I and II etching pattern values for Group- I was 39608.18 μm² and Group- II was 45051.34 μm².

CONCLUSION

Deproteinization with 5.25% Sodium hypochlorite prior to acid etching could be used to increase the surface area of adhesion of composite material with the tooth surface.

Effect of sandblasting and enamel deproteinization on shear bond strength of resin-modified glass ionomer

INTRODUCTION

The purpose of this study was to compare, in vitro, the shear bond strength of resin-modified glass ionomer (RMGI) bonded to an enamel surface prepared by either sandblasting with 50μm of aluminium oxide particles, deproteinization with 5.25% NaOCl, or by combining both techniques.

MATERIAL AND METHODS

One hundred and fifty human premolars were cleaned and randomly divided into five groups. In group 1, the teeth were etched using 37% phosphoric acid and bonded with Transbond XT. In group 2, the teeth were etched using 37% phosphoric acid and bonded with Fuji Ortho LC. In group 3, the teeth were deproteinized with 5.25% NaOCl for one minute then etched with 37% phosphoric acid and bonded with Fuji Ortho LC. In group 4, the enamel was sandblasted with 50μm of aluminium oxide particles for 5seconds prior to etching and bonding with Fuji Ortho LC. In group 5, the teeth were both sandblasted with 50μm of aluminium oxide particles for 5seconds and deproteinized with 5.25% NaOCl for one minute prior to etching using 37% phosphoric acid and bonding with Fuji Ortho LC. The shear bond strength was tested using a universal testing machine with a crosshead speed of 1.0mm/min. The adhesive remnant index (ARI) index was also determined for each group.

RESULTS

The mean shear bond strengths were as follows: group 1: 11.33±2.60MPa, group 2: 8.14±2.09, group 3: 9.57±3.25MPa, group 4: 9.49±1.99MPa and group 5: 9.76±2.29MPa (P=0.0001).

CONCLUSION

The results show that pre-treating the enamel with either sandblasting, NaOCl, or both, could give a significantly higher shear bond strength than using RMGI with acid etch alone.

Deproteinization of Fluorosed Enamel with Sodium Hypochlorite Enhances the Shear Bond Strength of Orthodontic Brackets: An In vitro Study

Context:

Improving bonding strength to fluorosed teeh.

Aims:

To determine the effect of deproteinization using 5.25% sodium hypochlorite (NaOCl) prior to acid etching on shear bond strength of orthodontic brackets bonded to fluorosed teeth.

Settings and Design:

In vitro experimental study.

Methods and Material:

Forty freshly extracted human mandibular first premolars with TFI 4 were selected and divided into two groups of 20 each. In Group I the teeth were acid etched with 37% phosphoric acid and bonded with composite. In Group II the teeth were deproteinized with 5.25% NaOCl prior to acid etching with 37% phosphoric acid and were bonded with composite. Samples were then subjected to shear bond test by Instron Universal Testing machine. The sample from each group were selected for the SEM study (prior to bonding) to analyze the etching patterns achieved.

Statistical Analysis Used:

Data was checked for normality by Shapiro Wilk Test, to compare the two groups unpaired t test was used. P value was predetermined at ≤ 0.05.

Results:

The S BS of Group II (11.75 ± 2.83 MPa) was higher than Group I (7.44 ± 2.43 MPa) and the difference was statistically significant (P = 0.000). On SEM the etching pattern was more of type 1 and 2 in Group II.

Conclusions:

Deproteinization using 5.25% NaOCl prior to acid etching significantly increases the shear bond strength of brackets bonded to fluorosed teeth and can be used as a convenient and effective option in orthodontic bonding to fluorosed teeth.

The effect of enamel proteins on erosion

Enamel proteins form a scaffold for growing hydroxyapatite crystals during enamel formation. They are then almost completely degraded during enamel maturation, resulting in a protein content of only 1% (w/v) in mature enamel. Nevertheless, this small amount of remaining proteins has important effects on the mechanical and structural properties of enamel and on the electrostatic properties of its surface. To analyze how enamel proteins affect tooth erosion, human enamel specimens were deproteinated. Surface microhardness (SMH), surface reflection intensity (SRI) and calcium release of both deproteinated and control specimens were monitored while continuously eroding them. The deproteination itself already reduced the initial SMH and SRI of the enamel significantly (p < 0.001 and p < 0.01). During the course of erosion, the progression of all three evaluated parameters differed significantly between the two groups (p < 0.001 for each). The deproteinated enamel lost its SMH and SRI faster, and released more calcium than the control group, but these differences were only significant at later stages of erosion, where not only surface softening but surface loss can be observed. We conclude that enamel proteins have a significant effect on erosion, protecting the enamel and slowing down the progression of erosion when irreversible surface loss starts to occur.

Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions

OBJECTIVES

The objectives of this study were to evaluate ex vivo the effects of resin infiltration on the areal surface roughness of natural non-cavitated proximal subsurface lesions with or without previous deproteinization and to determine differences between E2 and D1 lesions or between premolars and molars.

MATERIALS AND METHODS

Forty premolars and 40 molars with proximal carious lesions and macroscopically intact surfaces (International Caries Detection and Assessment System (ICDAS) II; code 2) were radiologically assessed and randomly allocated to four groups (with 20 E2 and 20 D1 lesions, respectively). In each group, 10 lesions were deproteinized (NaOCl; 1%) before etching (HCl; 15%) and resin infiltration (Icon). Areal surface roughness (Sa) at the most demineralized lesion part (DIAGNOdent) was evaluated topometrically before and after deproteinization, after etching, and after infiltration using focus variation 3D scanning microscopy.

RESULTS

Pretreatment with NaOCl (n = 40) had no significant effects on Sa (p = 0.208), but resulted in significantly differing Sa values between premolars and molars after etching (p = 0.011). Regarding the effects between etching and baseline, significantly differing Sa values (p = 0.0498) were found for premolars and molars (n = 40/40); Sa after resin infiltration (compared to etching) differed significantly between premolars and molars (p = 0.009). No treatment regimen lead to differences among the radiological grades (E2 vs. D1; p > 0.106).

CONCLUSIONS

Resin infiltration showed only minor effects on Sa values of etched subsurface lesions (p < 0.170) and did neither equal nor improve baseline surface roughness (p > 0.401) of the different tooth types.

CLINICAL RELEVANCE

Deproteinization should be recommended before etching and infiltration, even if surface roughness of infiltrated advanced (pre-)molar lesions will not be improved.

The impact of surface preparation on shear bond strength of metallic orthodontic brackets bonded with a resin-modified glass ionomer cement

AIM

The aim of this study was to assess the effects of four enamel preparation techniques on shear bond strength (SBS) of brackets bonded with a resin-modified glass ionomer cement (RMGIC). Adhesive Remnant Index (ARI) and enamel surface roughness (Ra) were also investigated after cement removal.

MATERIALS AND METHODS

One hundred and forty-four human premolars were divided into four groups (n = 36 in each group) as follows: Group 1, 37% phosphoric acid (i.e. conventional); Group 2, sandblasting; Group 3, sodium hypochlorite and 37% phosphoric acid; and Group 4, sodium hypochlorite and sandblasting. Twenty-four hours after bonding, the brackets were debonded with an Instron machine using a crosshead speed of 1·0 mm/min; the ARI was evaluated by an image analyser system; the Ra was measured by profilometry; and the morphology of the tooth enamel surface was observed by scanning electron microscope evaluation. Data were submitted to ANOVA and the Kruskal-Wallis test (α = 0·05).

RESULTS

Mean SBS values for Groups 1-4 were 13·86, 9·08, 17 and 9·63 MPa, respectively. Mean ARI for Groups 1-4 were 11·16, 2·06, 20·66 and 3·73%. The SBS and ARI showed statistically significant differences between the four groups (P<0·001). The Ra (μm) showed no significant differences between groups.

CONCLUSIONS

Bracket bonding using RMGIC showed adequate adhesion for clinical use, and the type of enamel preparation had a significant influence.

A comparative evaluation of the retention of metallic brackets bonded with resin-modified glass ionomer cement under different enamel preparations: A pilot study

Introduction:

For orthodontists, the ideal bonding material should be less moisture-sensitive and should release fluoride, thereby reducing unfavorable iatrogenic decalcification. Resin-Modified Glass Ionomer Cements (RMGICs), due to their ability to bond in the presence of saliva and blood can be a very good bonding agent for orthodontic attachments especially in the areas of mouth, which are difficult to access. Moreover, their fluoride releasing property makes them an ideal bonding agent for patients with poor oral hygiene. However, their immediate bond strength is said to be too low to immediately ligate the initial wire, which could increase the total number of appointments. The effect of sandblasting and the use of sodium hypochlorite (NaOCL) on the immediate bond failure of RMGIC clinically have not been reported in the literature until the date. This investigation intended to assess the effect of sandblasting (of the bracket base and enamel) and NaOCL on the rate of bond failure (with immediate ligation at 30 min) of Fuji Ortho LC and its comparison with that of conventional light cured composite resin over a period of 1 year.

Materials and Methods:

400 sample teeth were further divided into 4 groups of 100 each and bonded as follows: (1) Group 1: Normal metallic brackets bonded with Fuji Ortho LC. (2) Group 2: Sandblasted bracket base and enamel surface, brackets bonded with Fuji Ortho LC. (3) Group 3: Deproteinized enamel surface using sodium hypochlorite and brackets bonded with Fuji Ortho LC. (4) Group 4: Normal metallic bracket bonded with Transbond XT after etching enamel with 37% phosphoric acid. This group served as control group.

Results and Conclusion:

Results showed that sandblasting the bracket base and enamel, can significantly reduce the bond failure rate of RMGIC.

Effects of enamel deproteinization on bracket bonding with conventional and resin-modified glass ionomer cements

The objective of this study was to test the effects of enamel deproteinization on bracket bonding with conventional and resin-modified glass ionomer cement (RMGIC). One hundred premolars, extracted for orthodontic reasons, were divided into five groups (n = 20). Group 1 (control): enamel was etched with 35 per cent phosphoric acid, a thin layer of adhesive was applied, and the brackets were bonded with Transbond XT. Group 2: enamel was etched with 10 per cent polyacrylic acid and the brackets were bonded with conventional glass ionomer cement (GIC). Group 3: enamel was treated with 5.25 per cent NaOCl, etched with 10 per cent polyacrylic acid, and the brackets were bonded with conventional GIC. Group 4: enamel was etched with 10 per cent polyacrylic acid and the brackets were bonded with RMGIC. Group 5: enamel was treated with 5.25 per cent NaOCl, etched with 10 per cent polyacrylic acid, and the brackets were bonded with RMGIC. The teeth were stored in distilled water for 24 hours before they were submitted to shear testing. The results demonstrated that bond strength values of group 1 (17.08 ± 6.39 MPa) were significantly higher in comparison with the other groups. Groups 2 (3.43 ± 1.94 MPa) and 3 (3.92 ± 1.57 MPa) presented values below the average recommended in the literature. With regard to adhesive remnant index, the groups in which the enamel was treated with NaOCl showed a behaviour similar to that of the resin composite. It is conclude with enamel treatment with NaOCl increased bonding strength of brackets bonded with GIC and RMGIC, but increased bond strength was not statistically significant when compared to the untreated groups.