Effects of self-etch adhesive agitation with diode laser on dentin bond strength

The present study assessed the effect of active application of self-etch adhesives with diode laser irradiation on the shear dentin bond strength. Sixty bovine incisors, each embedded individually in hard plaster blocks, were divided into two groups based on the adhesive system used: Group 1 Adper Easy One and Group 2 Clearfil SE Protect. Based on the application technique of self-etch adhesives, each main group was further divided into three subgroups: passive application, active application with a micro-brush, and active application with a 976-nm diode laser tip (phototherapy active application). Shear bond strength tests were conducted using a universal testing machine and the data were analyzed by two-way ANOVA. Post hoc multiple comparisons were performed with the Tukey HSD test. Additionally, the statistical analysis of failure mode distribution was carried out using the chi-squared test (p < 0.05). While the adhesive system exhibited significant differences in shear dentin bond strengths, there were no significant differences in application techniques. Regardless of the application technique, Clearfil SE Protect demonstrated significantly higher dentin bond strength than Adper Easy One. In the present study, the utilization of phototherapy through a 976-nm diode laser for the active application of the tested self-etch adhesives demonstrated similar initial dentin bond strengths to conventional application methods.

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.

Prolonged application time effects on universal adhesives in non-carious cervical lesions: An 18-month split mouth randomized clinical trial

OBJECTIVE

This double-blind, split mouth randomized clinical trial aimed to assess the clinical performance of Clearfil Universal Bond Quick (CBUq) universal adhesive under different application times (no waiting and waiting) compared to Clearfil SE Bond adhesive in non-carious cervical lesions (NCCLs) over 18 months.

METHODS

One hundred and eighty-three restorations were distributed randomly into three groups based on the adhesive system and waiting time: CUBq without waiting time (CUBq-NW), CUBq with a 20 s waiting time (CUBq-W), and CSE with a 20 s waiting time. After placement, restorations were evaluated after 18 months using the International Dental Federation (FDI) and United States Public Health Service (USPHS) criteria. Statistical analyses involved Friedman repeated measures analysis of variance and Wilcoxon tests, with a significance level set at 5 %.

RESULTS

Over the 18-month period, no restorations were lost across the tested groups. Marginal adaptation evaluation indicated minor discrepancies in 21 restorations (8 CUBq-NW, 6 CUBq-W, and 7 CSE). There were no significant differences observed among the three groups following the 18-month clinical assessment (p > 0.05). Only two restorations showed marginal discoloration after 18 months (1 CUBq-NW and 1 CSE).

CONCLUSIONS

The application of Clearfil Universal Bond Quick using either the "waiting" or "no-waiting" technique exhibited excellent clinical results in NCCLs during the 18-month follow-up period, demonstrating comparable performance to Clearfil SE Bond in all assessed outcomes.

CLINICAL SIGNIFICANCE

The findings suggest that the new universal adhesive applied using the no-waiting technique demonstrates promising clinical performance when compared to conventional application methods.

TRIAL REGISTRATION

ClinicalTrials.gov identifer RBR-69p7mpr.

Analysis of the adhesive interface of dentine treated with carbodiimide and chitosan before cementation of fiberglass posts with different resin cements

The objective of this study is to evaluate the effect of 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC) and chitosan (CHI) on the adhesive interface of resin cements to root dentine. Forty-five upper canines were sectioned, endodontically treated, prepared and divided into three groups according to dentine treatment (distilled water-DW, CHI 0.2% and EDC 0.5) and in three subgroups according to resin cement: RelyX ARC, Panavia F 2.0 or RelyX U200. Slices were obtained, with five slices of each third submitted to the analysis of the adaptation of the adhesive interface through scores and the perimeter with gaps in confocal laser scanning microscopy and one slice of each third later evaluated qualitatively in scanning electron microscopy. The results were analyzed using with Kruskal-Wallis and Spearman correlation tests. There was no difference in adaptation for the different resin cements (p = .438). EDC presented better adaptation when compared to the groups treated with DW and CHI (p < .001), while the CHI and DW presented similar adaptation values (p = .365). No difference was observed in the perimeter referring to the gap areas for the different resin cements (p = .510). EDC showed a lower percentage of perimeters with gaps when compared to CHI (p < .001), with the percentage of perimeter with gaps of teeth treated with CHI being lower than DW (p < .001). A positive correlation coefficient equal to 0.763 was obtained between the perimeter with gaps and the adaptation data of the adhesive interface (p < .001). EDC resulted in better adaptation of the adhesive interface and a lower percentage of perimeters with gaps compared to chitosan.

Effectiveness of Different Application Modalities on the Bond Performance of Four Polymeric Adhesive Systems to Dentin

One of the major goals of adhesive dentistry is to improve the interaction of the already-existing adhesives with different substrates by using different application techniques. Thus, the objective of the present in vitro study was to assess the bond performance of four adhesive systems, Prime&Bond Universal (PBU), Clearfil SE Bond (CSE), OptiBond Universal (OBU), and OptiBond FL (OBFL), to dentin using various application modes: passive application (PA), active application (AA), Compo-Vibes modified application (CVM), and Compo-Vibes application (CV). Eighty extracted human molars were allocated into four groups based on the application modalities tested. The micro-tensile bond strength as well as fracture mode were tested in accordance with ISO/TS 11.405 after 24 h and 6 months of aging. Adhesive contact angle (CA) and scanning electron microscope analysis were also performed (n = 3). Statistical tests were performed with α = 0.05. After 24 h, a significant difference with a higher bond strength value was found for PBU in the AA modality and for CSE in the CVM modality (p < 0.05). However, no significant difference was shown between the techniques used among the other adhesives (OBFL and OBU). Moreover, at 24 h, only the PA demonstrated significant differences between the tested materials (p < 0.05). After 6 months, CSE, PBU, and OBU demonstrated significant differences between the techniques (p < 0.05), with a higher bond strength for CSE in AA and CVM modalities, for PBU in AA modality, and for OBU in AA and PA modalities. No significant differences were found between the techniques used among the OBFL (p > 0.05). In addition, only the CVM technique demonstrated significant differences between the tested materials after 6 months. CV and CVM showed a decreased value after aging for CSE and PBU, respectively. However, all the modalities decreased for OBU and OBFL after aging. All the adhesives showed marked resin infiltration into dentinal tubules in AA among all the modalities tested. Both universal adhesive systems (OBU and PBU) demonstrated statistically lower CA when compared to the other systems (CSE and OBFL) (p < 0.05) when applied in the PA mode. Concerning the AA mode, only CSE and OBFL were tested. The AA demonstrated lower CA values compared to the same adhesives in PA (p < 0.05). It could be concluded that the bond strength could be influenced by both materials and application techniques. It seems that the AA technique could be recommended as a gold standard for the application of an adhesive system to dentin. Plus, the CV and CVM modalities after 6 months of aging were considered stable for PBU and CSE, respectively. Consequently, the performance of these adhesive systems might vary when applied to other modalities. Future studies are needed to test this hypothesis.

Dental Fiber-Post Systems: An In-Depth Review of Their Evolution, Current Practice and Future Directions

The field of dental medicine is constantly evolving and advancing toward minimally invasive techniques. Several studies have demonstrated that bonding to the tooth structure, particularly enamel, yields the most predictable results. In some instances, however, significant tooth loss, pulpal necrosis, or irreversible pulpitis may limit the options available to the restorative dentist. In these cases, placement of a post and core followed by a crown is the preferred treatment option, provided all requirements are met. This literature review provides an overview of the historical development of dental FRC post systems as well as a comprehensive examination of the currently available posts and their bonding requirements. In addition, it offers valuable insights for dental professionals seeking to understand the current state of the field and the prospects of dental FRC post systems.

Some Myths in Dentin Bonding: An Evidence-Based Perspective

Laboratory investigations are essential models responsible for science development. However, laboratory discoveries must be confirmed in a clinical environment where many known and unknown variables and complex mechanisms are involved. Using conclusions from laboratory studies to make clinical recommendations can lead to widespread "unreliable truths" or so-called myths in any field of knowledge. These myths may increase the costs (financial and time) or even cause harm (side effects) that would be unnecessary, given that the current protocol or conduct was previously evaluated in a more complex and complete clinical setting. This article will discuss certain myths in dentin bonding that may influence clinical decision-making, bringing some principles of evidence-based practice to allow a more critical evaluation of the literature findings.

Engineered Peptides Enable Biomimetic Route for Collagen Intrafibrillar Mineralization

Overcoming the short lifespan of current dental adhesives remains a significant clinical need. Adhesives rely on formation of the hybrid layer to adhere to dentin and penetrate within collagen fibrils. However, the ability of adhesives to achieve complete enclosure of demineralized collagen fibrils is recognized as currently unattainable. We developed a peptide-based approach enabling collagen intrafibrillar mineralization and tested our hypothesis on a type-I collagen-based platform. Peptide design incorporated collagen-binding and remineralization-mediating properties using the domain structure conservation approach. The structural changes from representative members of different peptide clusters were generated for each functional domain. Common signatures associated with secondary structure features and the related changes in the functional domain were investigated by attenuated total reflectance Fourier-transform infrared (ATR-FTIR) and circular dichroism (CD) spectroscopy, respectively. Assembly and remineralization properties of the peptides on the collagen platforms were studied using atomic force microscopy (AFM). Mechanical properties of the collagen fibrils remineralized by the peptide assemblies was studied using PeakForce-Quantitative Nanomechanics (PF-QNM)-AFM. The engineered peptide was demonstrated to offer a promising route for collagen intrafibrillar remineralization. This approach offers a collagen platform to develop multifunctional strategies that combine different bioactive peptides, polymerizable peptide monomers, and adhesive formulations as steps towards improving the long-term prospects of composite resins.

Effect of Different Application Modalities on the Bonding Performance of Adhesive Systems to Dentin: A Systematic Review and Meta-Analysis

Diverse types of dental adhesives exhibit different cytotoxic outcomes on cells in vitro. Currently, no standard adhesive application technique has so far been decisive for clinicians for better durability of resin-dentin bonds of adhesive systems. The purpose of this study was to systematically review the literature to evaluate the bonding performance of adhesive systems to dentin by using different application modalities. The systematic research strategy was conducted by two reviewers among multiple databases: PubMed, Scopus, Web of Science, Embase, and Scielo. In vitro studies reporting the effects of additional steps for the application of adhesive systems on the bond strength to dentin were selected. Meta-analysis was performed using Review Manager Software version 5.3.5 using the random effects model. The methodological quality of each in vitro study was assessed according to the parameters of a previous systematic review. The electronic research through different databases generated a total of 8318 references. After the examination of titles and abstracts, a total of 106 potentially relevant studies accessed the full-text evaluation phase. After full-text examination, 78 publications were included for the qualitative analysis, and 68 studies were included in the meta-analysis. Regarding the etch-and-rinse adhesive systems, the application modalities that improved the overall bond strength were the application of a hydrophobic resin layer (p = 0.005), an extended application time (p < 0.001), an application assisted by an electric current (p < 0.001), a double-layer application (p = 0.05), the agitation technique (p = 0.02), and the active application of the adhesive (p < 0.001). For self-etch adhesive systems, the techniques that improved the overall bond strength were the application of a hydrophobic resin layer (p < 0.001), an extended application time (p = 0.001), an application assisted by an electric current (p < 0.001), a double-layer application (p < 0.001), the agitation technique (p = 0.01), and the active application of the adhesive (p < 0.001). The in vitro evidence suggests that the application of adhesive systems using alternative techniques or additional strategies may be beneficial for improving their bond strength to dentin. The application modalities that favored the overall bond strength to dentin were an extended application time, a double-layer application, an application assisted by an electric current, the active application of the adhesive, and the application of a hydrophobic resin layer. Worth mentioning is that some techniques are intended to increase the degree of the conversion of the materials, and therefore, improvements in the biocompatibility of the materials can be expected.

Does the Application of Additional Hydrophobic Resin to Universal Adhesives Increase Bonding Longevity of Eroded Dentin?

This paper evaluates the effect of an additional hydrophobic resin coat (extra HL) associated with universal adhesives on sound and eroded dentin and evaluated immediately or after 2 years of water storage to improve the microtensile bond strength (μTBS) and nanoleakage (NL) when compared to the use of universal adhesives only. Sixty-four molars were assigned to eight groups using the following combinations: 1. dentin substrate, including sound and eroded dentin; 2. treatment, including the control and extra HL and storage time (immediately and after two-years of storage). Two universal adhesives (Prime & Bond Active or Scotchbond Universal) were evaluated. Before restoration, half of the teeth were subjected to soft-drink erosion. Composite buildups were bonded; specimens were stored (37 °C/24 h), sectioned into resin−dentin bonded sticks and tested for microtensile bond strength and nanoleakage using SEM (immediately and after two-years of storage). Three-way ANOVA and Tukey’s test (α = 0.05%) were used. In the immediate testing, the application of extra HL did not increase microtensile bond strength values compared with the control group in either substrate (p > 0.05). However, extra HL significantly decreased nanoleakage values when applied to eroded and sound dentin (p = 0.0001). After two years, the application of extra HL produced significantly higher microtensile bond strength and lower nanoleakage values than the control group for both adhesives (p = 0.0001). In all cases, sound dentin showed higher microtensile bond strength and lower nanoleakage values than eroded dentin (p = 0.000001). An extra HL increased the bond strength and reduced nanoleakage in eroded dentin after two-years of storage.

Effect of Dentin Moisture in Posterior Restorations Performed with Universal Adhesive: A Randomized Clinical Trial

OBJECTIVES

This double-blind, randomized clinical trial evaluated the influence of dentin moisture on postoperative sensitivity (POS), as well as, on clinical performance in posterior bulk-fill composite restorations, using a universal adhesive, until 12 months after clinical service.

METHODS AND MATERIALS

In accordance with a split-mouth design, 45 patients received posterior restorations, restored with a bulk-fill resin composite (Filtek Bulk Fill, 3M Oral Care) and a universal adhesive used in etch-and-rinse mode (SBU; Single Bond Universal Adhesive), which were applied on dry or moist dentin, with a cavity depth of at least 3 mm. Three operators placed 90 Class I/Class II restorations. Patients were evaluated for spontaneous and stimulated POS in the baseline, and after 48 hours, 7 days, and at 6 and 12 months. In addition, secondary parameters (marginal discoloration, marginal adaptation, fracture, and recurrent caries) were evaluated by World Dental Federation (FDI) criteria after 7 days and at 6 and 12 months. Statistical analyzes were performed using the Chi-square, Fisher exact, Friedman, Kruskall-Wallis, and Mann-Whitney tests (α=0.05).

RESULTS

No significant spontaneous and stimulated POS was observed when SBU was applied in dry and moist dentin (p>0.05). A significant and higher risk of spontaneous POS (20.0%; 95%CI 10.9-33.82 for dry dentin and 22.22%; 95%CI 12.54-36.27 for moist dentin) occurred up to 48 hours after restoration placement for the dry and moist dentin groups (p<0.02). However, the POS intensity was mild up to 48 hours with no significant difference between dry and moist dentin groups (p>0.79). When secondary parameters were evaluated, no significant differences between the groups were observed.

CONCLUSION

Dentin moisture did not influence POS in posterior bulk-fill composite restorations when associated with a universal adhesive applied in etch-and-rinse mode.

Bonding performance and ultramorphology of the resin-dentine interface of contemporary universal adhesives

OBJECTIVES

This study aimed at evaluating the microtensile bond strength (μTBS) and the resin-dentine ultramorphology (24 h and 10 months ageing) of contemporary universal adhesives applied in self-etch (SE) or etch-and-rinse (ER) mode.

MATERIALS AND METHODS

Sixty-four sound human molars were collected and randomly allocated in 4 main experimental groups (n = 16) according to the adhesive system employed and subsequently divided into two subgroups depending on their application mode SE or ER (n = 8): ZipBond X (ZBX-SE; ZBX-ER), Prime and Bond Active (PBA-SE; PBA-ER), Clearfil Universal Bond Quick (CBQ-SE; CBQ-ER) or Scotchbond Universal (SCH-SE; SCH-ER). The specimens were cut into sticks with a cross-sectional area of approximately 0.9 mm² and subjected to μTBS testing at 24 h or after 10 months of ageing in artificial saliva (AS). Five representative fractured specimens from each group were analysed using field-emission scanning electron microscopy (FE-SEM). Resin-dentine slabs (Ø 0.9mm²) from each experimental group were immersed in Rhodamine B and subsequently analysed using confocal microscopy analysis (CLSM). The μTBS results were analysed using a two-way ANOVA and Newman-Keuls multiple-comparison test (α = 0.05).

RESULTS

ZBX, PBA and SCH exhibited greater μTBS values than CQB at 24 h in both SE and ER modes (p < 0.05). CQB showed a significant decrease in μTBS values after ageing both when used in SE and ER mode (p < 0.05). ZBX-ER exhibited no significant differences in the μTBS test after ageing (p > 0.05), while a significant drop in μTBS was seen in SCH-ER and APB-ER after 10-month ageing (p < 0.05). Clear signs of degradation were evident in the resin-dentine interface created with CQB regardless of the application mode or the ageing time. In APB-ER and SCH-ER groups, such signs of degradation were evident after ageing in AS. ZBX showed slight dye infiltration both when used in ER and SE mode.

CONCLUSIONS

The long-term bonding performance of modern universal adhesives is usually influenced by the adhesive strategy employed; self-etching application should be prioritised during dentine bonding. Moreover, the use of shortened bonding protocols may compromise the quality of the resin-dentine interface and the bonding performance of most modern universal adhesives.

CLINICAL RELEVANCE

The use of etch-and-rinse bonding procedures, as well as "shortened" application protocols should be eluded when using modern universal adhesives in dentine. However, new generation universal adhesives based on innovative chemical formulations may probably allow clinicians to achieve long-term bonding performance with such simplified system also when employed in ER mode.

Thirty-six-month follow-up of cervical composite restorations placed with an MDP-free universal adhesive system using different adhesive protocols: a randomized clinical trial

OBJECTIVES

To evaluate the influence of different application strategies on the clinical behavior of an MDP-free universal adhesive placed in non-carious cervical lesions (NCCLs) over the course of 36 months.

MATERIALS AND METHODS

Thirty-one patients participated in this study (N = 31). One hundred twenty-four restorations were assigned to four groups: We used the self-etch strategy on groups with (SE-et) and without (SET) selective enamel etching, and the etch-and-rinse strategy on groups with dry (ER-D) and moist (ER-M) dentin. After applying the MDP-free universal adhesive (Xeno Select universal adhesive, Dentsply Sirona), cavities were filled using EvoluX composite resin (Dentsply Sirona). The restorations were evaluated at baseline and after 36 months according to World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. Friedman's repeated-measures analysis of variance rank (α = 0.05) was used for statistical analysis.

RESULTS

We evaluated the 31 patients after 36 months. Forty-two restorations were lost (ER-D = 5, ER-M = 7, SE-et = 14, SET = 16). The 36-month retention/fracture rates (95% confidence interval) were 83.9% for ER-D, 77.4% for ER-M, 54.9% for SE-et, and 48.4% for SET. ER strategy showed better retention rate than SE strategy (p < 0.05). Thirty-four restorations (ER-D = 6, ER-M = 10, SE-et = 10, SET = 8) showed marginal staining per FDI criteria and 15 restorations (ER-D = 1, ER-M = 2, SE-et = 6, SET = 6) showed marginal staining per USPHS criteria. No restorations showed postoperative sensitivity or recurrence of caries.

CONCLUSION

The retention rate of Xeno Select universal adhesive was poor, mainly in the self-etch strategy.

TRIAL REGISTRATION

REBEC clinical registry under protocol RBR-4wh4sh.

CLINICAL RELEVANCE

MDP-free universal adhesive behavior depends on the bonding strategy used.

Sonic application of one-step self-etch adhesive in composite restorations of non-carious cervical lesions: A double-blind randomized clinical trial

OBJECTIVES

To evaluate the influence of the sonic device on the clinical performance of one-step self-etch adhesive systems in non-carious cervical lesions (NCCLs) after 18 months.

MATERIALS AND METHODS

Forty patients participated in this study. Eighty restorations were assigned to two groups (n = 40): Sonic application and Manual application. After the adhesive application (iBond Self-Etch, Kulzer, Hanau, Germany), NCCLs were restored using composite resin (Charisma, Kulzer, Hanau, Germany). The restorations were evaluated at baseline and after 18 months both according to the Word Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon test for significance in each pair were applied (α = 0.05).

RESULTS

After 18 months, 38 patients were evaluated. Twenty-three restorations were lost (19 for manual vs. 4 for sonic application). The retention rates (95% confidence interval) were 50% (CI 34.8%-65.1%) for manual application and 84.2% (CI 69.6%-92.6%) for sonic application (p < 0.05). Twelve restorations showed marginal staining (nine for manual vs. three for sonic application; FDI, p < 0.05) and nine some marginal discrepancy (seven for manual vs. two for sonic application; FDI, p < 0.05). No restorations showed postoperative sensitivity and caries recurrence at the time.

CONCLUSION

The sonic application increases the retention rate of iBond Self-Etch after 18 months of clinical evaluation in NCCLs.

CLINICAL RELEVANCE

The application of a simplified self-etch adhesive (iBond Self-Etch) associated to a sonic device seems to be an alternative to improve the clinical behavior in NCCLs.

Evaluation of Immediate and Delayed Microleakage of Class V Cavities Restored with Chitosan-incorporated Composite Resins: An In Vitro Study

Aim and objective

To evaluate and compare the microleakage of unmodified microhybrid composite and 0.2% chitosan-incorporated composite in class V cavities restored immediately and after 3 months of storage in artificial saliva.

Materials and methods

Sixty human permanent maxillary premolars were collected and standardized class V cavity prepared on the buccal surface of each tooth with dimensions: mesiodistally 3 mm, occluso cervically 2 mm, and depth of 1.5 mm and restored with microhybrid composite and chitosan-incorporated composite resins respectively and randomly divided: Group I: control-microhybrid composite (n = 30): (a) 15 teeth tested immediately (b) 15 teeth tested after 3 months. Group II–restored with chitosan + composite (n = 30): (a) 15 teeth tested immediately (b) 15 teeth tested after 3 months. Specimens were stored in artificial saliva following which a dye extraction test was carried out using a spectrophotometer.

Results

There was no statistically significant difference in microleakage score between the chitosan-composite group and unmodified composite group when evaluated immediately after placing the restoration. Microleakage values of the unmodified composite group increased significantly after 3 months of storage in artificial saliva and values of the chitosan-composite group did not differ significantly even after 3 months of storage. Microleakage was seen significantly less in the chitosan-composite group compared to the unmodified composite group after 3 months of storage in artificial saliva.

Conclusion

It can be concluded that chitosan-incorporated composite seems to have improved mechanical properties and forms a more stable bond when compared with unmodified microhybrid composite in addition to being antibacterial.

Clinical significance

Considering the advantageous properties of this material, it may be clinically useful in restoring class V cavities in patients with high caries risk. However, further in vitro and in vivo studies need to be carried out.

How to cite this article

Deb A, Pai V, Nadig RR. Evaluation of Immediate and Delayed Microleakage of Class V Cavities Restored with Chitosan-incorporated Composite Resins: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(5):621–627.

Evaluation of the Interfaces between Restorative and Regenerative Biomaterials Used in Vital Pulp Therapy

BACKGROUND

Calcium-silicate-based cements (CSC) have gained an increasing scientific and clinical relevance, enabling more conservative approaches, namely pulp preservation and regeneration therapies. This research aims to study the influence of four clinical variables on the interfaces between CSC and composite adhesive restoration, concerning shear bond strength (SBS) and ultra-morphological patterns.

METHODS

SBS tests were performed in 320 specimens divided in 16 groups (n = 20) according to: two CSC (NuSmile^® NeoMTA, Biodentine^TM); two adhesive systems (Clearfil^TM SE Bond 2 (CSEB2), Clearfil^TM Universal Bond Quick (CUBQ)); optional application of an additional hydrophobic bonding layer (HBL); two restoration times (immediate, seven days). Scanning electron microscopy (SEM) was performed to conduct the ultra-morphology interface analysis in 32 deciduous molars prepared and randomly allocated into the 16 groups.

RESULTS

Globally, SBS tests showed higher bond strength of CUBQ compared to CSEB2 (p < 0.001), as with an additional HBL application (p = 0.014) and delayed restoration (p < 0.001). SEM showed the interpenetration between adhesive systems and CSC forming a hybrid layer, whose depth and thickness depended on the restoration time and adhesive strategy.

CONCLUSIONS

The independent clinical variables adhesive system, application of an additional HBL and restoration time affected the bond performance and ultra-morphological interface between composite adhesive restoration and CSC.

ToF-SIMS Analysis of Demineralized Dentin Biomodified with Calcium Phosphate and Collagen Crosslinking: Effect on Marginal Adaptation of Class V Adhesive Restorations

This study aimed to assess the effect of biomodification before adhesive procedures on the tooth-restoration interface of class V restorations located in caries-simulated vs. sound dentin, and the quality of dentin surface by time-of-flight secondary ion mass spectrometry (ToF-SIMS). Class V cavities located on cervical dentin were prepared on the buccal surfaces of extracted human molars under the simulation of intratubular fluid flow. Two dentin types, i.e., sound and demineralized by formic-acid, were biomodified with 1% riboflavin and calcium phosphate (CaP) prior to the application of a universal adhesive (Clearfil Universal Bond) in etch and rinse or self-etch mode, and a conventional micro hybrid composite (Clearfil APX). Restorations were subjected to thermo mechanical fatigue test and percentages of continuous margins (% CM) before/after fatigue were compared. Bio modification of dentin surfaces at the molecular level was analyzed by Time-of-Flight Secondary Mass Spectometry (ToF-SIMS). % CM were still significantly higher in tooth-restoration interfaces on sound dentin. Meanwhile, biomodification with riboflavin and CaP had no detrimental effect on adhesion and in carious dentin, it improved the % CM both before and after loading. Etching carious dentin with phosphoric acid provided with the lowest results, leading even to restoration loss. The presence of molecule fragments of riboflavin and CaP were detected by ToF-SIMS, evidencing dentin biomodification. The adhesive interface involving carious dentin could be improved by the use of a collagen crosslinker and CaP prior to adhesive procedures.

Influence of Different Conditioning Treatments on the Bond Integrity of Root Dentin to rGO Infiltrated Dentin Adhesive. SEM, EDX, FTIR and MicroRaman Study

The present study aimed to synthesize and equate the mechanical properties and dentin interaction of two adhesives; experimental adhesive (EA) and 5 wt.% reduced graphene oxide rGO) containing adhesive. Scanning electron microscopy (SEM)-Energy-dispersive X-ray spectroscopy (EDX), Micro-Raman spectroscopy, push-out bond strength test, and Fourier Transform Infrared (FTIR) spectroscopy were employed to study nano-bond strength, degree of conversion (DC), and adhesive-dentin interaction. The EA was prepared, and rGO particles were added to produce two adhesive groups, EA-rGO-0% (control) and rGO-5%. The canals of sixty roots were shaped and prepared, and fiber posts were cemented. The specimens were further alienated into groups based on the root canal disinfection technique, including 2.5% sodium hypochlorite (NaOCl), Photodynamic therapy (PDT), and ER-CR-YSGG laser (ECYL). The rGO nanoparticles were flake-shaped, and EDX confirmed the presence of carbon (C). Micro-Raman spectroscopy revealed distinct peaks for graphene. Push-out bond strength test demonstrated highest values for the EA-rGO-0% group after NaOCl and PDT conditioning whereas, rGO-5% showed higher values after ECYL conditioning. EA-rGO-0% presented greater DC than rGO-5% adhesive. The rGO-5% adhesive demonstrated comparable push-out bond strength and rheological properties to the controls. The rGO-5% demonstrated acceptable DC (although lower than control group), appropriate dentin interaction, and resin tag establishment.

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

CLINICAL RELEVANCE

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

SUMMARY

Bond Strength of Universal Adhesives to Dentin: A Systematic Review and Meta-Analysis

Currently, the availability of a wide variety of universal adhesives makes it difficult for clinicians to choose the correct system for specific bonding situations to dentin substrate. This study aimed to determine whether there are any alternative techniques or additional strategies available to enhance the bond strength of universal adhesives to dentin through a systematic review and meta-analysis. Two reviewers executed a literature search up to September 2020 in four electronic databases: PubMed, ISI Web of Science, Scopus, and EMBASE. Only in vitro studies that reported the dentin bond strength of universal adhesives using additional strategies were included. An analysis was carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The methodological quality of each in vitro study was assessed according to the parameters of a previous systematic. A total of 5671 potentially relevant studies were identified. After title and abstract examination, 74 studies remained in systematic review. From these, a total of 61 studies were included in the meta-analysis. The bond strength of universal adhesives to dentin was improved by the use of one of the following techniques: Previous application of matrix metalloproteinases (MMP) inhibitors (p < 0.001), prolonged application time (p = 0.007), scrubbing technique (p < 0.001), selective dentin etching (p < 0.001), non-atmospheric plasma (p = 0.01), ethanol-wet bonding (p < 0.01), prolonged blowing time (p = 0.02), multiple layer application (p = 0.005), prolonged curing time (p = 0.006), and hydrophobic layer coating (p < 0.001). On the other hand, the use of a shortened application time (p = 0.006), and dentin desensitizers (p = 0.01) impaired the bond strength of universal adhesives to dentin. Most of the analyses performed showed a high heterogenicity. The in vitro evidence suggests that the application of universal adhesives using some alternative techniques or additional strategies may be beneficial for improving their bonding performance to dentin. This research received no external funding. Considering that this systematic review was carried out only with in vitro studies, registration was not performed.

Adhesive Dentistry: Understanding the Science and Achieving Clinical Success

Successful adhesive dentistry begins with correct placement and polymerization of the bonding agent. Although numerous agents exist, all abide by certain key principles, including the newest group, the universal adhesives. Fundamental steps also exist in the application process that require the operator to understand the chemistry of the adhesive being used. Modalities exist that can help preserve the durability of the bond achieved, thus slowing down the degradation process. However, no material or agent can overcome poor technique. Thus, it is of the utmost importance that the practitioner respects the technique sensitivity of adhesives, and follows the manufacturer's instructions.

Catechin-based Dentin Pretreatment and the Clinical Performance of a Universal Adhesive: A Two-year Randomized Clinical Trial

CLINICAL RELEVANCE

At 24 months, the dentin pretreatment with epigallocatechin-3-gallate did not impair the clinical performance of the adhesive Single Bond Universal regardless of the bonding strategy used.

SUMMARY

Purpose: To evaluate the two-year effect of dentin pretreatment with epigallocatechin-3-gallate (EGCG) on the clinical performance of restorations of noncarious cervical lesions (NCCLs) with Single Bond Universal, applied in two different modes (self-etch and etch-and-rinse).Methods and Materials: In this randomized clinical trial, 33 volunteers were selected, and 156 NCCLs were assigned to four groups: ER, etch-and-rinse; ER-EGCG, 0.1% EGCG dentin pretreatment + etch-and-rinse; SE, self-etch; and SE-EGCG, 0.1% EGCG dentin pretreatment + self-etch. The NCCLs were restored with a nanofilled resin composite and evaluated at baseline and at six, 12, 18, and 24 months using FDI criteria for retention, marginal staining, marginal adaptation, caries, and postoperative sensitivity. Two evaluators were blinded to the treatments performed, and impressions were taken for resin replicas to allow indirect observations. Statistical analyses were performed with Kruskal-Wallis and McNemar tests with a significance level of 5%.Results: Six restorations (one from ER, two from SE, one from ER-EGCG, and two from SEEGCG) were lost at 24 months with no significant differences (p>0.05). The retention rates were 97.0% (ER and ER-EGCG), 94.1% (SE), and 94.2% (SE-EGCG). For marginal adaptation, a significant difference was detected between the baseline and 24 months for the SE group (p=0.0313). There were no statistical differences among all other evaluated criteria at 24 months, neither for each group at baseline nor for 24-month comparisons (p>0.05).Conclusions: The pretreatment with EGCG provided no benefit in the clinical performance of the adhesive regardless of the bonding strategy used. In addition, it adds an additional required step to the restorative procedure.

Tensile Strength and Failure Types of Direct and Indirect Resin Composite Copings for Perio-Overdentures Luted Using Different Adhesive Cementation Modalities

Perio-overdenture design helps to reduce periodontal diseases and secondary caries on abutment teeth. Composite copings can be cemented adhesively to the abutment teeth with different techniques. In this study, direct/indirect resin composite copings for perio-overdentures, luted using different adhesive cementation modalities were compared. Human teeth (N = 40) were prepared to receive spherical attachment copings and randomly divided into four groups: (1) resin-composite copings bonded directly (DC), (2) composite copings made indirectly, luted with dual-polymerized resin cement (ICV), (3) composite copings made indirectly, bonded with resin composite (ICT), (4) composite copings made indirectly, bonded with resin composite after the immediate dentin sealing method (IDS). Specimens were tested for tensile failure and one-way ANOVA (alpha = 0.05) was performed and the two-parameter Weibull modulus, scale (m) and shape (₀) were calculated. Mean tensile load (N) was significantly higher for Group IDS (238 ± 81) than for the other groups (144 ± 53–184 ± 46) (p < 0.05). Group IDS (0.54 ± 0.25 mm) showed significantly higher deformation (mm) than other groups (0.2 ± 0.1–0.32 ± 0.15) (p < 0.05). Weibull distribution presented lower shape (₀) for DC (3.33) compared to other groups (3.57–4.99). Cohesive coping failures were more frequent in Group IDS (60%) and mixed failures in other groups (40–60%). In conclusion, IDS copings could be preferred over other fabrication and adhesion modalities.

Evaluation of the Physicochemical and Antibacterial Properties of Experimental Adhesives Doped with Lithium Niobate

The aim of the present study was to formulate dental adhesives with different concentrations of LiNbO₃ and to evaluate their physicochemical and antibacterial properties. A dental adhesive was formulated using methacrylate monomers and photoinitiators and used as a control filler-free group. Subsequently, three experimental adhesives doped with LiNbO₃ at different concentrations (1 wt.%, 2 wt.%, and 5 wt.%) were also formulated. All the experimental adhesives were assessed to evaluate the degree of conversion (DC), softening in solvent, immediate and long-term microtensile bond-strength (μ-TBS), radiopacity, ultimate tensile strength, and antibacterial activity. The incorporation of 1 wt.% of LiNbO₃ had no negative effect on the DC of the adhesive resin compared to the control group (p > 0.05). We observed a decrease in the percentage of softening in solvent in the group LiNbO₃ at 1 wt.% (p < 0.05). The addition of LiNbO₃ increased the radiopacity at a concentration above 2 wt.%, and there was also an increase in cohesive strength (p < 0.05). The immediate μ-TBS increased for LiNbO₃ at 5 wt.% (p < 0.05), and there was no statistical difference for the other groups compared to the control (p > 0.05). After six months, the group with 5 wt.% still presented the highest μ-TBS (p < 0.05). The adhesives showed no antimicrobial activity (p > 0.05). LiNbO₃ was successfully incorporated in dental adhesives, increasing the radiopacity and their resistance to degradation. Although LiNbO₃ offered no antibacterial properties, the reliability of LiNbO₃ incorporation in the adhesive encourages new tests to better investigate the antimicrobial action of LiNbO₃ through temperature variation.

Interfacial fracture toughness of self-adhesive and conventional flowable composites to dentin using different dentin pretreatments

AIM

The aim of the present study was to investigate the effect of different dentin pretreatments on the interfacial fracture toughness of a self-adhesive flowable composite to dentin compared with that of a conventional flowable composite.

METHODS

Caries-free human molars were sectioned to expose the underlying dentin and were randomly divided into seven groups (N = 12) of dentin pretreatments bonded to a self-adhesive flowable composite (Vetise Flow, VF) or a conventional flowable composite (Clearfil Magesty Flow, CM). For VF; Control group (group C-VF), there was no pretreatment, self-etching primer (SP), oxalate dentin desensitizer (OX), and chlorhexidine gluconate (CH) were used. For CM; SP (group SP-CM), OX followed by SP (OX-CM), and CH followed by SP (CH-CM) were used. The interfacial fracture toughness was measured using a universal testing machine. Data were analyzed by Kruskal-Wallis test and analysis of variance.

RESULTS

For VF, the fracture toughness of SP-VF was significantly higher than that of other groups. For CM, a significantly higher fracture toughness for SP-CM than that of OX-CM was found. For all dentin pretreatments, the fracture toughness values were significantly higher for CM compared with the VF.

CONCLUSIONS

The self-adhesive flowable composite had reduced bonding efficacy to dentin compared with that of the conventional flowable composite, regardless of the type of dentin pretreatment.

Effect of Polymeric Microparticles Loaded With Catechin on the Physicochemical Properties of an Adhesive System

The objective of this study was to synthesize and characterize epigallocatechin-3-gallate (EGCG)-loaded/poly(D-L lactide-co-glycolide) acid (PLGA) microparticles, evaluate their effects on degree of conversion and release assay of adhesives, and subsequently to examine the resin-dentin bond strength of two EGCG formulations (free EGCG or loaded into PLGA microparticles) applied as a pretreatment or incorporated into an adhesive system. The formulations were prepared according to a PLGA:EGCG ratio of 16:1 using the spray-drying technique. The size and polydispersity index were determined by light scattering in aqueous dispersion. The degree of conversion (%DC) and release assay were assessed by Fourier transform infrared spectroscopy and ultraviolet-visible spectrophotometer, respectively. Subsequently, 45 third molars were divided into five groups (n=9) according to the different EGCG application modes and prepared for bond strength testing in a universal testing machine. Results demonstrated no statistically significant difference among the DC means after the PLGA microparticles were loaded with EGCG. For the release assay, the 1.0% PLGA/EGCG group presented better results after being elected for use in the bond strength test. The resin-dentin bond strengths of the experimental groups after 12 months of water storage were significantly higher than in the control group. EGCG could improve the durability of the resin-dentin bond over time and promote a new era for adhesive dentistry with the concept of controlled release.

Full-mouth Rehabilitation of Hypocalcified-type Amelogenesis Imperfecta With Chairside Computer-aided Design and Computer-aided Manufacturing: A Case Report

BACKGROUND

This case report describes the complete full-mouth treatment of hypocalcified amelogenesis imperfecta (AI) by chairside computer-aided design and computer-aided manufacturing (CAD/CAM).

CASE SUMMARY

After several years of interrupted dental care, a 17-year-old female patient presented with pain and also esthetic and functional discomfort. With loss of enamel and dyschromia affecting all teeth, the diagnosis was hypocalcified AI. Affected tissues were eliminated, gingivectomy with laser was performed, an indented jig was used to record the centric relationship during optical impressions, and 28 full ceramic crowns were created by chairside CAD/CAM in four sessions. The patient reported rapid pain relief and an overall improvement of well-being.

CONCLUSION

AI sequelae can be treated promptly and conservatively with chairside CAD/CAM, obtaining esthetic and functional results.

Universal dental adhesives: Current status, laboratory testing, and clinical performance

Increasing demand for simplified and user-friendly adhesive systems has led to the development of a new class of adhesives termed as Universal Adhesives (UAs). The term "Universal" reflects manufacturers' claims that these adhesives can be applied with any adhesion strategy and offer the versatility of use with a variety of direct and indirect restorative materials. The aim of this review was to synthesize the literature regarding the current status of UAs, their adhesion potential to various substrates and their performance in different restorative situations. In vitro studies, clinical trials and systematic reviews were identified utilizing controlled vocabulary and keyword searches in Medline and EMBASE databases. About 282 studies (272 in vitro studies; 11 clinical studies) were included. Available laboratory and clinical evidence does not support the claim that UAs can be used with any adhesive strategy. Although, they can chemically bond to various tooth and direct/indirect restorative substrates, the stability of this bond is material-dependent and subject to hydrolytic degradation. Hence, additional measures are still needed to ensure long-term durability. which undermines the versatility of UAs. The lack of long-term data regarding the clinical performance of UAs further complicates clinical decision-making. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2121-2131, 2019.

Effect of Er:YAG laser irradiation and chitosan biomodification on the stability of resin/demineralized bovine dentin bond

OBJECTIVE

The purpose of this study was to evaluate the effect of Er:YAG laser for selective removal of carious lesion, followed by biomodification with chitosan on the microtensile bond strength (µTBS), adhesive interface, dry mass loss and hydroxyproline release (HYP).

METHODS

Artificial lesions were created in 104 bovine dentin blocks. Blocks were divided according to caries removal method: bur or Er:YAG laser. Seventy-six blocks were acid etched and subdivided according to dentin biomodification: no chitosan and 2.5% chitosan. Composite resin restorations were performed. Blocks were sectioned into beams and stored in water. After 24 h, 6 and 12 months, beams were submitted to μTBS test (n = 10) and analysis of adhesive interface by SEM (n = 3). The other 28 blocks were sectioned into beams and initial dry mass (DM) was determined (n = 7). Beams were stored and after 7 days, DM was redetermined. HYP release (n = 7) was evaluated by ELISA. Data were analyzed by ANOVA and Bonferroni's tests (α = 0.05).

RESULTS

After 24 h, the highest µTBS was found for bur (p < 0.001). After 6 months, methods were similar (p = 0.432). After 12 months, laser-irradiated dentin showed the highest µTBS values (p = 0.025). Chitosan promoted higher µTBS values after 6 (p = 0.011) and 12 months (p < 0.001) preserving adhesive interface. Dry mass loss and HYP release were not influenced (p > 0.05) by caries removal method or by dentin biomodification.

CONCLUSION

The bond strength to demineralized dentin reduced over 50% in all groups after water storage. From 6 months of water storage, Er:YAG laser irradiation and biomodification with chitosan maintained the stability of the resin-dentin bonds, but did not influence dry mass loss and HYP release.

Clinical, double blind, randomized controlled trial of experimental adhesive protocols in caries-affected dentin

OBJECTIVE

To evaluate the clinical performance of posterior resin composite restorations regarding experimental and regular adhesive protocols in caries affected-dentin (CAD).

MATERIAL AND METHODS

A total of 92 class I and class II cavities with carious lesions were selected and randomly assigned to the following groups: (1) bioactive glass-ceramic powder/two-step etch and rinse system, (2) control/two-step etch and rinse system, (3) bioactive glass-ceramic powder/two-step self-etching system, and (4) control/two-step self-etching system. Two operators carried out the adhesive protocols and restored the cavities with a nano-hybrid resin composite. Participants were followed up at 1 week and 6, 12, and 18 months for clinical evaluation performed by two blinded examiners and calibrated according to FDI criteria. Data were analyzed using Kruskal-Wallis and Dunn tests with a confidence of 95%.

RESULTS

The clinical performance of resin composite restoration was not affected by the experimental use of an adhesive protocol including a bioactive glass-ceramic powder for 18 months post-procedure. However, there was a significant difference between group 2 and group 4 (p < 0.05) for marginal adaptation (18 months). Group 2 was significantly different from group 3 (p < 0.05) for fracture of material/retention (18 months) and marginal adaptation (1 week); group 2 showed a better performance.

CONCLUSION

Adhesive protocols can alter the clinical performance of posterior restorations in terms of marginal adaptation and the fracture of material/retention in CAD.

CLINICAL SIGNIFICANCE

Adhesive protocols may influence the success of resin composite restorations in CAD; this is important because failure can lead to caries, re-incidence, and/or clinical re-work.

Effect of laser heat treatment on Pull-out bond strength of fiber posts treated with different silanes

Background

This study evaluated the effect of three different silanes and post-silanization treatments on the retentive strength of fiber posts luted with an etch-and-rinse resin cement.

Material and Methods

One hundred intact maxillary central incisors were randomly divided into 10 groups after endodontic treatment and post space preparation (n=10). The fiber posts were etched using 24% hydrogen peroxide. Posts of the control group did not receive silane. In nine experimental groups, each of the three silanes used, Scotchbond Universal adhesive, Bis-Silane and Porcelain Primer, was subjected to three treatments: air-drying at 25°C, warm air-drying and CO2 laser heat treatment. After cementation of the treated posts using One-Step Plus/Duo-Link cement, the specimens were stored for one weak and then subjected to pull-out bond strength (PBS) testing. The data in Newton (N) were analyzed using two-way ANOVA and Tukey tests (α=0.05).

Results

PBS was significantly affected by silane type and post-silanization treatment (p<0.001). The interaction of the two factors was not statistically significant (p=0.15). The effect of Porcelain Primer on PBS was significantly higher than those of universal adhesive (p<0.001) and Bis-Silane (p=0.01), with similar results for the two latter. Warm air-drying and laser treatment significantly increased PBS (p<0.001). The lowest and highest PBS was obtained in the control (no silane) group (190.9±31) and laser-treated/ Porcelain Primer group (377.1±50), respectively.

Conclusions

Warm air-drying and CO2 laser heat treatment had a significantly beneficial effect on retentive strength of fiber posts. Porcelain Primer was significantly more effective than universal adhesive and Bis-Silane.

Key words:Laser heat treatment, Pull-out bond strength, fiber post.

Effect of rubbing force magnitude on bond strength of universal adhesives applied in self-etch mode

This study investigated the effect of rubbing force magnitude on dentin bond strengths of multi-mode adhesives applied in self-etch mode. Seventy-two extracted human molar teeth were used. Two different universal adhesives Single Bond Universal (SB) and Clearfil Universal (CL) were applied onto dentin surfaces in three different modes: without rubbing (NR), rubbing with 40 gf (gram-force) (40) or 80 gf (80) load. Teeth were restored with a resin composite. Half of the specimens were subject to thermal aging (10,000 cycles). Microtensile bond strength was measured and data were statistically analyzed with two-way analysis of variance and Tukey's test (α=0.05). Baseline bond strength values for CL adhesive were improved by rubbing (40 and 80 gf) as compared to no rubbing (p<0.05). Rubbing did not significantly improve bond strength values for SB, regardless of aging (p>0.05). Rubbing improves bonding performance of some universal adhesives to dentin when applied in self-etch mode.

Effect of crosslinkers on bond strength stability of fiber posts to root canal dentin and in situ proteolytic activity

STATEMENT OF PROBLEM

Improved stability of the adhesive interface can be obtained using crosslinkers. However, research on the use of crosslinkers in root dentin is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of crosslinkers on the proteolytic activity of root dentin and on the bond strength of resin-cemented fiber posts.

MATERIAL AND METHODS

Single root canals were obtained from premolars (n=48) and endodontically treated before being divided into 4 groups: deionized water (control), 0.5 mol/L carbodiimide, 5% proanthocyanidin, or 5% glutaraldehyde. After removing the canal sealer, the dentin was etched with phosphoric acid, followed by water rinsing and the application of the crosslinkers for 60 seconds. Fiber posts were cemented using an adhesive (Single Bond 2) and resin cement (RelyX ARC). The roots were then transversally sectioned to obtain 1 mm thick specimens from the cervical, middle, and apical thirds and then aged for 24 hours or 9 months. Nine roots per group were used for the push-out test and 3 for determining the proteolytic activity of the root dentin by in situ zymography. Bond strength data were submitted to a mixed-model ANOVA and Bonferroni tests (α=.05).

RESULTS

Only proanthocyanidin negatively affected the 24-hour bond strength. After 9 months, a significant decrease in bond strength was seen for all groups, except for the crosslinked treated specimens from the cervical third of the root canal. Intense gelatinolytic activity was detected in the control group after 24 hours but was inhibited in the crosslinker-treated groups. Proteolytic activity was also not detected after 9 months for the groups treated with the crosslinkers, irrespective of the root canal third. Conversely, proteolytic activity increased for the specimens from the control group.

CONCLUSIONS

Although no proteolytic activity was detected in the hybrid layers along the entire root canal, dentin biomodification with crosslinkers was effective in preventing bond strength loss only in the cervical third.

Effect of antibacterial/adhesive approaches on bonding durability of fiber posts cemented with self-etch resin cement

BACKGROUND

Longevity of post-retained restoration is highly depended on bonding stability of fiber post (FP) to root dentin. This study evaluated the effect of different antibacterial/adhesive approaches on bonding durability of FPs luted into root canal with a self-etch cement.

MATERIAL AND METHODS

Seventy-two human maxillary central incisor roots were divided into six groups after endodontic treatment, based on the antibacterial/adhesive treatments as follows: 1)ED primer II (ED, control); 2) Clearfil Protect Bond (PB); 3) 2% chlorhexidine (CH) pretreatment + ED primer II (CH+ED); 4) CH-incorporated into ED primer II (CH in ED); 5) CH pretreatment + Clearfil SE Bond (CH+SE); and 6)CH-incorporated into SE primer (CH in SE). The FPs were then cemented using PanaviaF2.0. After micro-slicing the bonded root dentin, a push-out bond strength (PBS) test was performed immediately or after two years of water storage. Data were analyzed using ANOVA and post hoc Tukey tests (α=0.05).

RESULTS

The effects of antibacterial/adhesive approach, time and interaction between the main factors were significant (p=0.01). There was no significant difference between the immediate groups, except between the CH+ED group (the lowest PBS) and PB and CH in SE groups (the highest PBS) (p≤0.03). After aging, the same difference was observed (p≤0.02); the control group exhibited a significantly lower PBS compared to the other groups (p≤0.01), except for CH+ED. Aging significantly decreased PBS of all the groups (p≤0.01); the control group exhibited the highest reduction.

CONCLUSIONS

CH incorporated into self-etch primers or in pretreatment step prior to two-step self-etch adhesive and antibacterial adhesive could improve bond stability of self-etch cemented fiber post. However, none of these was capable of inhibiting bond degradation over time. Key words:Push-out bond strength, Fiber post, Chlorhexidine.

Adhesive Durability Inside the Root Canal Using Self-adhesive Resin Cements for Luting Fiber Posts

OBJECTIVES

The aim of the study was to investigate the effects of various self-adhesive resin cements on the push-out bond strengths and nanoleakage expression at the luting interfaces of fiber posts immediately and after one year of aging.

METHODS AND MATERIALS

One hundred forty-four extracted human anterior teeth were endodontically treated. After post space preparation, fiber posts were luted using five commercially available self-adhesive resin (SAR) cements and a core build-up material applied with a self-etch adhesive (BF: Bifix SE/Rebilda Post, VOCO; CSA: Clearfil SA Cement/Rely X Fiber Post, 3M ESPE; RX: RelyX Unicem 2/Rely X Fiber Post, 3M ESPE; SPC: Speed Cem/FRC Postec, Ivoclar Vivadent; SMC: Smart Cem/X Post, Dentsply; RB: Rebilda DC-Futurabond/Rebilda Post; n=22). For each group, half of the specimens were subjected to thermocycling (TC) (5°C-55°C, 10,000 cycles) and stored humid for one year at 37°C. Push-out bond strength data of six slices (thickness 1 mm) per root and nanoleakage expression of representative specimens were evaluated after 24 hours (baseline) and after TC and storage for one year (aging), respectively.

RESULTS

Bond strength differed significantly among resin cements (p<0.0005) and the location inside the root canal (p<0.0005), but not by aging (p=0.390; repeated-measures analysis of variance). SMC (14.6±5.8 MPa) and RX (14.1±6.8 MPa) revealed significantly higher bond strength compared to BF (10.6±5.4 MPa) and RB (10.0±4.6 MPa) but differed not significantly from SPC (12.8±4.8) MPa; CSA (6.1±4.6 MPa) revealed significantly lower bond strength compared to all other investigated materials (p<0.05; Tukey Honestly Significantly Different). Qualitative nanoleakage analysis revealed more silver deposits at the interface in all groups after aging. For CSA, a large amount of silver deposits inside the cement was also observed at baseline and after aging.

CONCLUSIONS

Fiber post luting using SAR cements demonstrated reliable bond strengths. Product-specific differences and initial degradation effects could be demonstrated.

Effect of dimethyl sulfoxide on bond durability of fiber posts cemented with etch-and-rinse adhesives

PURPOSE

This study was undertaken to investigate whether use of an adhesive penetration enhancer, dimethyl sulfoxide (DMSO), improves bond stability of fiber posts to root dentin using two two-step etch-and-rinse resin cements.

MATERIALS AND METHODS

Forty human maxillary central incisor roots were randomly divided into 4 groups after endodontic treatment and post space preparation, based on the fiber post/cement used with and without DMSO pretreatment. Acid-etched root dentin was treated with 5% DMSO aqueous solution for 60 seconds or with distilled water (control) prior to the application of Excite DSC/Variolink II or One-Step Plus/Duo-link for post cementation. After micro-slicing the bonded root dentin, push-out bond strength (P-OBS) test was performed immediately or after 1-year of water storage in each group. Data were analyzed using three-way ANOVA and Student's t-test (α=.05).

RESULTS

A significant effect of time, DMSO treatment, and treatment × time interaction were observed (P<.001). DMSO did not affect immediate bonding of the two cements. Aging significantly reduced P-OBS in control groups (P<.001), while in DMSO-treated groups, no difference in P-OBS was observed after aging (P>.05).

CONCLUSION

DMSO-wet bonding might be a beneficial method in preserving the stability of resin-dentin bond strength over time when fiber post is cemented with the tested etch-and-rinse adhesive cements.

Collagen cross-linkers on dentin bonding: Stability of the adhesive interfaces, degree of conversion of the adhesive, cytotoxicity and in situ MMP inhibition

OBJECTIVE

To investigate the effect of collagen cross-links on the stability of adhesive properties, the degree of conversion within the hybrid layer, cytotoxicity and the inhibition potential of the MMPs' activity.

METHODS

The dentin surfaces of human molars were acid-etched and treated with primers containing: 6.5wt% proanthocyanidin, UVA-activated 0.1wt% riboflavin, 5wt% glutaraldehyde and distilled water for 60s. Following, dentin was bonded with Adper Single Bond Plus and Tetric N-Bond; and restored with resin composite. The samples were sectioned into resin-dentin "sticks" and tested for microtensile bond strength (μTBS) after immediate (IM) and 18-month (18M) periods. Bonded sticks at each period were used to evaluate nanoleakage and the degree of conversion (DC) under micro-Raman spectroscopy. The enzimatic activity (P1L10 cross-linkers, P1L22 MMPs' activities) in the hybrid layer was evaluated under confocal microscopy. The culture cell (NIH 3T3 fibroblast cell line) and MTT assay were performed to transdentinal cytotoxicity evaluation. Data from all tests were submitted to appropriate statistical analysis (α=0.05).

RESULTS

All cross-linking primers reduced the degradation of μTBS compared with the control group after 18M (p>0.05). The DC was not affected (p>0.213). The NL increased after 18M for all experimental groups, except for proanthocyanidin with Single Bond Plus (p>0.05). All of the cross-link agents reduced the MMPs' activity, although this inhibition was more pronounced by PA. The cytotoxicity assay revealed reduced cell viability only for glutaraldehyde (p<0.001).

SIGNIFICANCE

Cross-linking primers used in clinically relevant minimized the time degradation of the μTBS without jeopardizing the adhesive polymerization, as well as reduced the collagenolytic activity of MMPs. Glutaraldeyde reduced cell viability significantly and should be avoided for clinical use.

Effect of Bleaching Agents on the Nanohardness of Tooth Enamel, Composite Resin, and the Tooth-Restoration Interface

This in vitro study aimed to evaluate the nanohardness of tooth enamel, composite resin, dental adhesive, and enamel hybrid layer exposed to 35% hydrogen peroxide-based bleaching agents and analyze the tooth-restoration interface using scanning electron microscopy (SEM). This study used 40 crowns of bovine incisors, which were embedded in epoxy resin. A 2 × 2 × 2-mm cavity was prepared in the medial third of the flattened buccal surface of each tooth and restored (two-step etch-and-rinse Adper Single Bond 2 + nanocomposite resin Filtek Z350 XT). The specimens were polished and divided into four groups (n=10), corresponding to each bleaching agent used (TB: Total Blanc Office, pH=7.22–6.33; HPB: Whiteness HP Blue, pH=8.89–8.85; HP: Whiteness HP, pH=6.65–6.04; PO: Pola Office, pH=3.56–3.8), applied in accordance with manufacturer protocols. The nanohardness of the substrates was measured before and immediately after the bleaching procedure and after 7-day storage in artificial saliva with an Ultra-Microhardness Tester (DUH-211S, Shimadzu). Loads used were 100 mN for tooth enamel and composite resin and 10 mN for adhesive and enamel hybrid layer. For SEM analysis, epoxy replicas were prepared through high-precision impressions of the specimens. For nanohardness, the statistical tests two-way analysis of variance and Tukey (p&lt;0.05) revealed that the agent with the lowest pH value (PO) was the only one to decrease the nanohardness of enamel and the enamel hybrid layer immediately after its application; however, after 7-day storage in artificial saliva, the nanohardness levels of these substrates returned to their original values. SEM analysis revealed small gaps between tooth enamel and adhesive after the exposure to all bleaching agents; however, the most evident gap in the tooth-restoration interface was observed immediately after application of agent PO. No bleaching agent used changed the nanohardness of the composite resin and adhesive layer.

Influence of a hydrophobic resin coating on the immediate and 6-month dentin bonding of three universal adhesives

OBJECTIVE

To test the influence of a hydrophobic resin coating (HC) on the immediate (24h) and 6-month (6m) microtensile dentin bond strengths (μTBS) and nanoleakage (NL) of three universal adhesives applied in self-etch (SE) or in etch-and-rinse (ER) mode.

METHODS

Sixty caries-free extracted third molars were assigned to 12 experimental groups resulting from the combination of the factors "adhesive system" (Scotchbond Universal Adhesive [SBU], 3M ESPE; All-Bond Universal [ABU], Bisco Inc.; and G-Bond Plus [GBP], GC Corporation); "adhesive strategy" (SE or ER); "hydrophobic resin coating" [HC] (with or without Heliobond, Ivoclar Vivadent); and "storage time" (24h or 6m). Specimens were prepared for μTBS testing - (24h) half of the beams were immediately tested under tension; and (6m) the other half was stored in distilled water (37°C) for 6m prior to testing. For each tooth, two beams were randomly selected for NL evaluation for both evaluation times. Data were analyzed for each adhesive system using three-way ANOVA and Tukey's post-hoc test (α=0.05).

RESULTS

μTBS: (24h): In SE mode, HC resulted in statistically greater mean μTBS for all adhesives. (6m): When HC was not used the mean μTBS for SBU/ER, ABU/ER, GBP/ER and SBU/SE decreased significantly. NL: (24h): SBU/ER, ABU/ER and GBP/SE resulted in a significant reduction in NL when HC was applied. (6m): No significant reduction was observed for SBU/ER or for SBU/SE regardless of the use of HC.

SIGNIFICANCE

The application of a hydrophobic resin coating improved the 24h and the 6m performances of all three adhesives systems in SE mode.