From Buonocore's Pioneering Acid-Etch Technique to Self-Adhering Restoratives. A Status Perspective of Rapidly Advancing Dental Adhesive Technology

Micro-shear bond strength of a novel resin-modified glass ionomer luting cement (eRMGIC) functionalized with organophosphorus monomer to different dental substrates

Objectives

This study aims to assess and compare the micro-shear bond strength (μSBS) of a novel resin-modified glass-ionomer luting cement functionalized with a methacrylate co-monomer containing a phosphoric acid group, 30 wt% 2-(methacryloxy) ethyl phosphate (2-MEP), with different substrates (dentin, enamel, zirconia, and base metal alloy). This assessment is conducted in comparison with conventional resin-modified glass ionomer cement and self-adhesive resin cement.

Materials and methods

In this in vitro study, ninety-six specimens were prepared and categorized into four groups: enamel (A), dentin (B), zirconia (C), and base metal alloys (D). Enamel (E) and dentin (D) specimens were obtained from 30 human maxillary first premolars extracted during orthodontic treatment. For zirconia and metal alloys, 48 disks were manufactured using IPS e.max ZirCAD through dry milling and Co-Cr powder alloy by selective laser milling. Each group was further subdivided into three subgroups (n = 8) according to the luting cement used: (1) Fuji PLUS resin-modified glass ionomer luting cement (FP) as a control cement, (2) modified control cement (eRMGIC), and (3) RelyX U 200 (RU 200) self-adhesive resin cement. The two-way analysis of variance and Tukey's HSD were used to assess the data obtained from measuring the μSBS of the samples.

Results

The results of this study showed that the mean μSBS values of eRMGIC were statistically higher compared to FP in all tested groups (p < 0.001). The mean μSBS results of eRMGIC were non-significantly different from those recorded by RU 200 for all substrates except for the dentin substrate, where the RU200 cement produced significantly higher strength (p < 0.001). The failure modes were limited to a combination of mixed and adhesive failures without pure cohesive failure.

Significance

The functionalization of FP with an organophosphorus co-monomer (2-MEP) directly affects the adhesion performance of the functionalized cement, which may be utilized to develop a new type of acid-base cement. It exhibited a performance comparable to that of resin-based cement and should serve well under different clinical conditions.

Theaflavin -3,3'-digallate/ethanol: a novel cross-linker for stabilizing dentin collagen

Objectives

To study the ability of theaflavin-3,3'-digallate (TF3)/ethanol solution to crosslink demineralized dentin collagen, resist collagenase digestion, and explore the potential mechanism.

Methods

Fully demineralized dentin blocks were prepared using human third molars that were caries-free. Then, these blocks were randomly allocated into 14 separate groups (n = 6), namely, control, ethanol, 5% glutaraldehyde (GA), 12.5, 25, 50, and 100 mg/ml TF3/ethanol solution groups. Each group was further divided into two subgroups based on crosslinking time: 30 and 60 s. The efficacy and mechanism of TF3's interaction with dentin type I collagen were predicted through molecular docking. The cross-linking, anti-enzymatic degradation, and biomechanical properties were studied by weight loss, hydroxyproline release, scanning/transmission electron microscopy (SEM/TEM), in situ zymography, surface hardness, thermogravimetric analysis, and swelling ratio. Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), and Raman spectroscopy were utilized to explore its mechanisms. Statistical analysis was performed using one and two-way analysis of variance and Tukey's test.

Results

TF3/ethanol solution could effectively crosslink demineralized dentin collagen and improve its resistance to collagenase digestion and biomechanical properties (p < 0.05), showing concentration and time dependence. The effect of 25 and 50 mg/ml TF3/ethanol solution was similar to that of 5% GA, whereas the 100 mg/mL TF3/ethanol solution exhibited better performance (p < 0.05). TF3 and dentin type I collagen are mainly cross-linked by hydrogen bonds, and there may be covalent and hydrophobic interactions.

Conclusion

TF3 has the capability to efficiently cross-link demineralized dentin collagen, enhancing its resistance to collagenase enzymatic hydrolysis and biomechanical properties within clinically acceptable timeframes (30 s/60 s). Additionally, it exhibits promise in enhancing the longevity of dentin adhesion.

Longitudinal bond strength of a universal adhesive and chemical dentin characterization under different acid etching protocols

OBJECTIVE

This study aimed to analyze the longitudinal bond strength of a universal adhesive and chemically characterize the dentin substrate under different acid etching protocols.

METHODOLOGY

Dentin samples were etched with polyacrylic acid 25% (PAA) for 10 seconds (n=3) and phosphoric acid 32% (PA) for 15 seconds (n=3) and analyzed by Fourier transform infrared spectroscopy - attenuated total reflectance (FTIR-ATR) before and after treatment. For collagen degradation, samples (n=12) were divided into 3 groups: PAA, PA, and Deionized water (control), and analyzed by the quantity of solubilized type I collagen C-terminal cross-linked telopeptides and solubilized C-terminal peptide in relation to total protein concentration (ICTPtp and CTXtp) and by their ultimate tensile strength (UTS). For the adhesive interface analysis, dentin samples (n=72) were divided into 3 groups: PAA, PA, and Self-etch (SE), and subdivided into 2 groups: 24 h (baseline) and 1 year. The following tests were performed: microtensile bond strength (μTBS) (n=48), scanning electron microscopy (SEM) (n=12), and nanoleakage (n=12).

RESULTS

The FTIR of PAA showed lower reduction of the peaks in the phosphate group when compared to PA. For ICTPtp, PA showed a significantly higher value. For CTXtp, PA and PAA groups failed to statically differ from each other. UTS was significantly lower for PA. For μTBS, storage time significantly affected bond strength. The results were unaffected by the etching protocol. For SEM, after 1 year, PA had little evidence of degradation in the upper third of the adhesive interface in comparison to the other groups. Nanoleakage showed no considerable silver impregnation after 1 year in the SE group.

CONCLUSION

The use of PAA prior to a universal adhesive (when compared to PA) represents a less aggressive type of etching to dentin. However, self-etching still seems to be the best option for universal adhesive systems that have functional monomers in their composition.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

A laboratory pilot study on voids in flowable bulk-fill composite restorations in bovine Class-II and endodontic access cavities after sonic vibration

This pilot study investigated whether sonic-powered application of a bulk-fill resin-based composite (RBC) in Class-II or endodontic access cavities reduces void formation. The crowns and roots of 60 bovine teeth with Class-II cavities (C) and endodontic access cavities (E) respectively, were assigned to ten groups (C1-C5, E1-E5). Cavities were filled with RBC (SDR flow + , one increment) using different application techniques: no adaptation (C1 + E1), spreading of RBC on the cavity surfaces with a dental explorer tip (C2 + E2), low (C3 + E3) or high frequency (C4 + E4) direct activation by inserting a sonic-powered tip into RBC and high frequency indirect activation with an ultrasonic insertion tip (C5 + E5). The restorations were light-cured and investigated for voids using microtomography. The number of voids and percentage of voids related to the volume were statistically analysed (α < 0.05). While most voids in Class-II restorations were observed in C4 (p ≤ 0.0031), no significant differences were found between the other groups (p > 0.05). The percentage of voids showed no differences in E1-E5 (p > 0.05). C4 showed a significantly higher percentage of voids compared to C2 (p < 0.001). There is no benefit in applying sonic vibration when filling Class-II or endodontic access cavities.

Effect of surface topography and wettability on shear bond strength of Y-TZP ceramic

Zirconia ceramics have been widely used as dental restorations due to their esthetic appearance and high flexural strength. The bonding of zirconia with resin cement should rely on both mechanical and chemical bonds. This study was performed to investigate the effect of zirconia surface topography and its wettability after surface pretreatments on the microshear bond strength (μSBS) of a resin cement. Zirconia slabs were prepared and randomly divided into 5 groups based on the surface treatment as follows: no treatment (control), air abrasion (AB), etching with hydrofluoric acid (F), the mixture of hydrofluoric acid and nitric acid (FN), or the mixture of hydrochloric acid and nitric acid (CN) for 10 min. The specimens were subjected to investigation of surface roughness characteristics [average roughness (Ra), peak-to-valley average distance (Rpv), skewness (Rsk), and kurtosis (Rku)] using atomic force microscopy (AFM) and measurements of surface contact angle (θc) and μSBS of a resin cement. In addition, the area % of the nanoscale surface irregularity (nSI%) was calculated from the AFM images. The effects of nSI%, Ra and θc on the μSBS were analyzed by multiple linear regression analysis (p < 0.05). Multiple regression analysis revealed that the nSI% was the most predominant factor for the μSBS (p < 0.001). A surface with larger nSI%, higher Ra and relatively lower θc was essential for establishing a reliable resin-zirconia bond.

Effect of etchant containing an Urushiol monomer from lacquer sap on dentin biostability and bonding performance

Objectives: This study aimed to evaluate the effectiveness of urushiol as an additive to surface acid etchant on dentin structure, by assessing the biostability of dentin, and determine the bonding strengths of dentin and enamel to the composite in the complicated oral microecology. Methods: Etchants with different concentrations of urushiol (0.5, 1, or 3 wt%) were formulated and tested for their bonding performance. Demineralized dentin beams that were etched with experimental etchants were incubated in simulated body fluid solutions by evaluating the weight decrement after 1 month. The effects of urushiol on dentin and matrix metalloproteinases were confirmed by scanning electron microscopy (SEM). Moreover, the antibiotic actions of urushiol on the common cariogenic bacteria Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii as well as the biofilm were evaluated, and its effect on bacterial morphology was observed by scanning electron microscopy. Finally, enamel and dentin specimens were prepared from human molars to determine the depth of demineralization by the etchants and the relationship with the resin bond strengths to enamel and dentin (μTBS) and the morphology of the bonding interface. Results: Urushiol could interact with dentine and inhibit collagenase activity, resulting in biostable dentine. The application of the etchants containing 0.5, 1, or 3 wt% urushiol significantly improved the durability of the dentin bonding interface with its instinctive antibacterial property (p < 0.05). Conclusion: Urushiol not only improves dentin stability by interacting with collagen and inactivating MMP activity but also plays a role in the antibacterial effects in the complicated oral microecology. The effectiveness of urushiol etchant prolongs the longevity of bonded dental restorations without compromising clinical operation time.

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

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

Effect of the Absence of HEMA on the Bonding Properties of Universal Adhesive Systems Containing 10-MDP: An In Vitro Study

OBJECTIVES

To evaluate the absence of 2-hydroxyethyl methacrylate (HEMA) on the adhesive properties with enamel and dentin of universal adhesive systems containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP).

METHODS AND MATERIALS

One hundred and twelve caries-free third molars were used to test adhesion to dentin (n=64) and enamel (n=48). For each substrate, teeth were divided into eight experimental groups: four different adhesives each using two adhesive strategies. The adhesives used were: (1) Scotchbond Universal (SBU, 3M Oral Care, St Paul, MN, USA) as a HEMA-containing universal adhesive; (2) Gluma Bond Universal (GBU, Kulzer, Hanau, Germany); (3) Solare Universal Bond (SUB, GC, Tokyo, Japan); and (4) Zipbond Universal (ZIP, SDI, Victoria, Australia) as HEMA-free universal adhesives. The adhesive strategies used were etch-and-rinse (ER) and self-etch (SE). For dentin tests, the occlusal third of the crown of all teeth was removed and an adhesive protocol was applied. After completing the restoration, specimens were sectioned into bonded sticks (0.8 mm 2) and tested for microtensile bond strength (μTBS), in situ degree of conversion (DC), and nanoleakage (NL) by scanning electron microscopy. For enamel tests, teeth were sectioned into four parts (buccal, lingual, and proximal), and an adhesive protocol was applied. After completing the restoration, the specimens were tested for their microshear bond strength (μSBS). For in situ degree of conversion (DC) and nanoleakage (NL) evaluation of enamel, the specimens were sectioned in slices to be evaluated. The data for each substrate were subjected to two-way ANOVA and Tukey's test (α=0.05) for each property evaluated.

RESULTS

The SBU and ZIP adhesives showed the highest μSBS, and DC (dentin and enamel) and lower NL (dentin) values compared to GBU and SUB (p=0.001). However, SBU showed better results in terms of μTBS and μSBS (SE strategy), and DC (dentin and enamel) than ZIP. Strategy ER presented higher values of μTBS and μSBS when compared to strategy SE (p=0.001), except for SBU.

CONCLUSION

The effect of the absence of HEMA in commercial universal adhesive systems on enamel and dentin adhesive properties appears to be material-dependent.

Various ways of pre-heating a bulk-fill thermoviscous composite in restoration in non-carious cervical lesions: 12-month randomized clinical trial

OBJECTIVE

The objective of the study is to evaluate through a randomized clinical trial the best method to preheat a composite resin, if using a Caps dispenser device associated with Caps Warmer (CD) or with a VisCalor Caps dispenser/warmer (VD) for restorations in non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

One hundred and twenty restorations were distributed to two groups (n = 60) according to the pre-heating way of thermoviscous bulk-fill composite resin. For the CD group, pre-heating was carried at 68 °C using a heating bench for 3 min. For the VD group, pre-heating was performed at 68 °C using a heating gun for 30 s. After that, pre-heated bulk-fill composites were directly inserted in the NCCLs. The total working time was recorded. The restorations were evaluated after 6 and 12 months of clinical performance according to the FDI criteria. Statistical analysis was performed using the Student's t test for unpaired samples for working time, and the Chi-square test for restoration clinical performance (α = 0.05).

RESULTS

Working time was shorter for VD with a statistically significant difference compared to CD (p = 0.01). Few restorations were lost or fractured after 12 months of clinical evaluation (p > 0.05). The retention rates were 96.7% (CI 95 %: 88.6-99.1%) for CD and 98.3% (CI 95 %: 91.1-99.7%) for VD. The other FDI parameters were considered clinically acceptable.

CONCLUSIONS

The different pre-heating ways did not influence the clinical performance of thermoviscous bulk-fill composite restorations in NCCLs after 12 months.

CLINICAL RELEVANCE

Regardless of the bulk-fill thermoviscous composite resin pre-heating ways, the restorations are clinically acceptable after 12 months.

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

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

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

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

Effect of an additional bonding resin on the 5-year performance of a universal adhesive: a randomized clinical trial

OBJECTIVES

To evaluate the effect of the application of an additional hydrophobic bonding resin on the clinical performance of a universal adhesive applied in etch-and-rinse (ER) or self-etch adhesive (SE) strategy in non-carious cervical lesions (NCCLs) after 5 years.

MATERIALS AND METHODS

Scotchbond Universal Adhesive (3M Oral Care) was applied in 134 NCCLs of 39 subjects using different adhesion approaches: 3-step ER (3-ER), 2-step ER (2-ER), 2-step SE (2-SE), and 1-step SE (1-SE). Enamel and dentin were acid etched prior to application of the universal adhesive for the 3-ER and 2-ER groups. An extra layer of a hydrophobic bonding resin was applied for groups 3-ER and 2-SE. All lesions were restored with Filtek Supreme XTE resin composite (3M Oral Care). Restorations were evaluated at baseline and at 5 years using the modified USPHS criteria. Mann-Whitney U and Wilcoxon tests were performed, and the survival rates (retention/fracture) were analyzed using Kaplan-Meier and log-rank tests (p < 0.05).

RESULTS

The recall rate was 66.7% at 5 years. The cumulative survival rate was 96.9% for 3-ER, 96.8% for 2-ER, 71.4% for 2-SE, and 81.3% for 1-SE strategies. The log-rank test was statistically significant (p = 0.006). Retention rates were 100% for both ER groups, 75% for 2-SE and 81.3% for 1-SE. At 5 years, 2- and 1-SE approaches showed similar retention rates, but lower than those for 3- and 2-ER. A significant decrease in retention rate was detected for 2-SE (p = 0.007) and 1-SE (p = 0.014) groups between baseline and 5 years. All groups, except 2-ER, showed an increase in marginal discoloration. For this parameter, significant differences were detected between 2-ER and 1-SE (p = 0.004).

CONCLUSIONS

The addition of a hydrophobic bonding resin to the recommended application sequence of Scotchbond Universal Adhesive did not improve its clinical performance in NCCLs after 5 years. Higher retention rates were measured when this adhesive was applied in ER mode.

TRIAL REGISTRATION

This manuscript is a 5-year follow-up of a randomized clinical trial that started in 2012 when there was no strong recommendation for registration in clinicaltrials.gov. The results after 36 months of clinical service were previously published in this journal.

Effects of Er: YAG, Er,Cr: YSGG, and Nd: YAG laser irradiation and adhesive systems on the immediate and long-term bond strength of dentin: a systematic review and meta-analysis

At present, lasers are increasingly used in the oral clinical field, and research and applications in dental hard tissue treatment are also increasing. The effect of laser etching dentin on the bonding strength of composite resin reported in the literature is still inconclusive. The purpose of this review was to evaluate whether laser etching can improve the immediate and long-term bonding strength of dentin and investigate the effect of different types of adhesives on the bonding strength of dentin. Two reviewers performed a literature search up from January 2012 to November 2021 in four databases: MEDLINE (PubMed), Web of Science, EMBASE, and the Cochrane Library. A total of 25 studies were included in the meta-analysis. The Cochrane Collaboration Bias Risk Assessment tool was used to evaluate the quality of the included literature, and an analysis was carried out using Review Manager Software version 5.3. The aging bond strength of dentin after erbium (Er): yttrium aluminum garnet (YAG) laser treatment was significantly lower than that of dentin in the bur group (P < 0.00001). At the same time, the bond strength of dentin immediately and aging after (Er), chromium-doped (Cr): yttrium scandium gallium garnet (YSGG) laser treatment was lower than that of dentin in the bur group (P < 0.05). There was no significant difference in the immediate and aging bonding strength among samples in the Er: YAG laser, Er, Cr: YSGG laser, and blank control groups (no laser or bur). The aging bond strength of samples after neodymium-doped (Nd): YAG laser treatment was higher than that of samples in the blank control group (P < 0.05); in addition, the performance of self-etching adhesive was slightly better than that of acid etching adhesive. Regardless of the applied surface treatment and the adhesive employed, dentin after aging showed significant bond degradation (P < 0.05). There was high heterogeneity of bond strength between different groups, and the small number of studies and the contradictory results may be the main reasons for this outcome.

Primer application technique and remaining dentin thickness affected microtensile bond strength of contemporary dentin adhesives under simulated pulp pressure

OBJECTIVES

To evaluate the effect of application techniques, type of adhesives and remaining dentin thicknesses on microtensile bond strength (µTBS) of 3 adhesive systems.

MATERIALS AND METHODS

112 flat occlusal dentinal surfaces of third molar were randomly allocated into 16 groups based on 2 remaining dentin thicknesses (RDT), 2 application techniques, and 3 adhesive systems (Optibond FL, OFL; Clearfil SE Bond, CSE; and Single Bond Universal, SB); SB was applied in either etch-and-rinse (ER) or self-etch (SE) mode. Simulated pulpal pressure was performed during restorative procedure and water storage. The stick-shaped specimens from each tooth underwent µTBS testing. The data were evaluated using a paired t test and ANOVA followed by a post hoc test. The fractured specimens were evaluated for mode of failure using a stereomicroscope.

RESULTS

The mean µTBS values were significantly affected by RDT, application technique, and types of adhesives. Neither RDT nor application technique affected µTBS of SB in ER mode, whereas application technique affected both conventional and universal self-etch adhesives. RDT also influenced µTBS of OFL.

CONCLUSIONS

RDT and application technique differently affected the µTBS of dentin bonding which was product-related. Etch-and-rinse systems had higher bond strength to superficial than to deep dentin, whereas self-etch systems were more sensitive to both RDT and application technique.

CLINICAL RELEVANCE

The universal adhesive is less sensitive to intrinsic wetness and can be used according to manufacturer's instructions.

Eighteen-month clinical evaluation of a new universal adhesive applied in the "no-waiting" technique: a randomized clinical trial

OBJECTIVE

The aim of this double-blind, randomized clinical trial was to evaluate the 6- and 18-month clinical performances of a new universal adhesive applied in the "no-waiting" (NW) technique to non-carious cervical lesions (NCCLs) using two evaluation criteria.

MATERIALS AND METHODS

One hundred and seventy-six restorations were assigned to four groups according to the adhesive system, adhesive strategy, and application mode: Prime&Bond Active (PB) applied using the etch-and-rinse (ER) and self-etch (SE) strategies with 20 s applications and Clearfil Universal Bond Quick (CQ) applied using the ER and SE strategies with the NW technique. The composite resin restorations were evaluated at baseline and after 6 and 18 months using the World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. The Friedman repeated measures analysis of variance and Wilcoxon test were used for statistical analyses (α = 0.05).

RESULTS

No significant differences were observed among any of the groups or criteria after 6 months (p > 0.05). After 18 months, 10 restorations were lost (p > 0.05) (2 with PB-ER [95.5%; 95%CI: 92-100%], 4 with PB-SE [90.9%; 95%CI: 82-98%], 0 with CQ-ER [100%; 95%CI: 92-100%], and 4 with CQ-SE [90.9%; 82-98%]). The restorations performed with the SE strategy showed more marginal discrepancies than those performed with the ER strategy, mainly when the FDI criteria were used (p < 0.05). Those that used the PB-SE showed fewer marginal discrepancies than those that used the CQ-SE (FDI; p < 0.05). A few restorations showed marginal discrepancies after the USPHS analysis (p > 0.05).

CONCLUSIONS

The results when using the CQ-SE and -ER strategies with the NW technique were similar to those when using the PB-SE and -ER strategies in standard applications to non-carious cervical lesions after 6 and 18 months of clinical evaluation.

CLINICAL RELEVANCE

After 6 and 18 months, the application of Clearfil Universal Bond Quick with the "no-waiting" technique showed similar clinical performance compared to the standard application of Prime & Bond Active applied using the standard application time (20 s).

TRIAL REGISTRATION

ClinicalTrials.gov identifier RBR-5f9gps.

Bond Strength Survival of a Novel Calcium Phosphate-Enriched Orthodontic Self-Etching System after Various Ageing Protocols: An In Vitro Study

Objective

This study aimed to evaluate the orthodontic bond strength and enamel-preserving ability of a hydroxyapatite nanoparticles-containingself-etch system following exposure to various ageing methods.

Materials and Methods

Hydroxyapatite nanoparticles (nHAp) were incorporated into an orthodontic self-etch primer (SEP, Transbond™ plus) in three different concentrations (5%, 7%, and 9% wt) and tested versus the plain SEP (control) for shear bond strength (SBS), adhesive remnant index (ARI) scores, and enamel damage in range-finding experiments using premolar teeth. The best-performing formulation was further exposed to the following four artificial ageing methods: initial debonding, 24 h water storage, one-month water storage, and one-month acid challenge. A field-emission scanning electron microscope (FE-SEM) was used to examine the integrity of debonded enamel surfaces and calcium-phosphates (CaPs) reprecipitation.

Results

The best-performing formulation (7% nHAp-SEP) resulted in significantly lower SBS (p < 0.001) than the control SEP following the four artificial ageing methods. Nevertheless, it survived the ageing protocols and yielded clinically acceptable SBS with the advantages of leaving minimal adhesive residue, preserving enamel integrity and smoothness, and inducing CaP reprecipitation as confirmed by FE-SEM images.

Conclusions

A newly developed SEP produced adequate orthodontic bond strengths and left unblemished debonded enamel surfaces with minimal remnant adhesive and remineralisation potential, thereby suggesting simpler and safer bonding/debonding procedures.

Development of a remineralizing calcium phosphate nanoparticle-containing self-etching system for orthodontic bonding

Objectives

This study aimed to incorporate hydroxyapatite nanoparticles (nHA) or amorphous calcium phosphate nanoparticles (nACP) into a self-etch primer (SEP) to develop a simplified orthodontic bonding system with remineralizing and enamel preserving properties.

Materials and Methods

nHA and nACP were incorporated into a commercial SEP (Transbond™ plus) in 7% weight ratio and compared with the plain SEP as a control. Shear bond strengths (SBS), enamel damage, and adhesive remnant index (ARI) scores were evaluated at 24 h and post 5000 thermocycling. Field-emission scanning electron microscope (FESEM) was used to inspect the distribution of the nanoparticles in the experimental SEPs and evaluate the enamel surface integrity both before bracket bonding and post bracket debonding. Phase determination and remineralizing capability of the modified SEP were characterized by X-ray diffraction and Raman spectroscopy, respectively.

Results

The addition of nHA or nACP to the SEP significantly reduced the SBS, ARI, and enamel damage (p < 0.05) as compared to the control SEP; however, only nHA-SEP survived the thermocycling protocol and yielded acceptable SBS (13.38 MPa). Enamel remineralizing ability of the developed nHA-SEP was confirmed by both FESEM images and Raman phosphate map.

Conclusions

Incorporating nHA into SEP resulted in clinically acceptable bond strengths with remineralizing ability.

Clinical relevance

The newly developed nHA-SEP has unprecedented ability to simultaneously etch, prime, and remineralize the enamel in a single step leaving immaculate enamel surface with the potential of saving cost and time at the post-debonding step.

Effect of adhesive strategy on resin cement bonding to dentin

OBJECTIVE

The cement bonding strategy and the polymerization mode can influence the prognosis of indirect restorations. The microtensile bond strength (μTBS) and dentin endogenous enzymatic activity of a dual-cure resin cement (PV5) used in combination with two dentin surface conditioners (accelerator-enhancer primer, TP or universal adhesive, UA) were evaluated.

MATERIALS AND METHODS

PV5 was used to lute composite overlays after dentin treatment with TP or UA. The resin cement was self-cured, SC (1 h at 37 °C) or dual-cured, DC (20 s light-cure followed by 15 min self-cure at 37°C). The μTBS test, fractographic analysis, and the in situ zymography evaluations were performed after 24 h (T₀ ) or 1 yr (T₁₂ ) of artificial storage. Data were statistically analyzed (α = 0.05).

RESULTS

TP/DC obtained the highest adhesive strengths (45 ± 9 and 36.6 ± 8), while UA/SC (17 ± 8 and 11 ± 4) the lowest, both at T₀ and T₁₂ , respectively. DC resulted in superior bonding values than the SC, independent of the dentin surface treatment (p < 0.05). The type of adhesive, curing mode and aging influenced the gelatinolytic activity (p < 0.05).

CONCLUSIONS

The dual-cure resin cement used in combination with its accelerator-enhancer primer showed superior bonding performances with respect to universal adhesive. Dual-curing the resin cement was determinant to enhance bonding capability over time, independent of the adhesive strategy.

CLINICAL RELEVANCE

Clinicians must be aware to faithfully follow manufacturer's recommendation regarding the adhesive strategy suggested with the resin cement used.

Effects of carbodiimide combined with ethanol-wet bonding pretreatment on dentin bonding properties: an in vitro study

Purpose

This study evaluated the combined effects of Carbodiimide (EDC) and ethanol-wet bonding (EWB) pretreatment on the bond strength and resin-dentin surface.

Methods

Phosphoric acid-etched dentin specimens were randomly divided into five groups based on the following pretreatments: deionized water (control), EWB, 0.3M EDC in water (EDCw), EDC water solution combined EWB (EDCw + EWB), and 0.3M EDC in ethanol (EDCe). A scanning electron microscope (SEM) was used to observe the morphology of collagen fibrils on the demineralized dentin matrix in each group after pretreatment. The adhesives Prime & Bond NT (PB) (Dentsply De trey, Konstanz, Germany) or Single bond 2 (SB) (3M ESPE, St. Paul, MN, USA) was applied after pretreatments, and a confocal laser scanning microscope (CLSM) was used to evaluate the quality of resin tags. The degree of conversion (DC) of the adhesive was investigated by Fourier transform infrared spectroscopy (ATR-FTIR). The dentin was first bonded with resin and bathed in water at 37 °C for 24 h. Half of them were subjected to 10, 000 cycles in a thermocycler between 5 °C and 55 °C before a microshear bond strength (µSBS) test. The statistical methods were Analysis of Variance (ANOVA) and a Tukey post hoc test at α = 0.05.

Results

The µSBS was significantly affected by pretreatments (p < 0.001), adhesives (p < 0.001), and aging conditions (p < 0.001) as revealed by the three-way ANOVA. The EDCw, EDCw + EWB, and EDCe groups significantly increased the µSBS; the EDCw + EWB and EDCe groups produced the highest µSBS. In the EDC-containing groups, the SEM showed at the collagen fibrils in the dentin matrix formed a three-dimensional network structure in the tubules after cross-linking into sheets, and the hybrid layer formed thicker resin tags under a CLSM. In the EDC-containing groups, the CLSM observed an increase in the length of resin tags. PB showed a higher DC and bonding strength than SB, and the five pretreatment groups tested did not affect the DC of the two adhesives.

Conclusions

In etch-and-rinse bonding system, EDC combined with EWB pretreatment can improve the quality of the hybrid layer and enhance the mechanical properties of demineralized dentin matrix. Pretreatment with EDC-ethanol solution may be a new clinically friendly option for enhancing dentin bonding durability.

Adhesive Strength in Dentin Conditioned with 18% Ethylenediaminetetraacetic Acid versus 35% Phosphoric Acid: In Vitro Study with 1-Year Artificial Aging

The success and longevity of a resin composite restoration is determined by its good bonding to the tooth structure, with the adhesion being a challenge to dentin due to its complexity and structural heterogeneity. The present study aimed to compare the adhesive strength of dentin conditioned with 18% ethylenediaminetetraacetic acid (EDTA) versus 35% phosphoric acid (H3PO4) in human premolars. Materials and Methods: This in vitro experimental study was performed on 40 human premolars. The occlusal thirds were sectioned and randomly placed into four groups according to the type of dentin conditioning: Group 1 (control), Group 2 (18% EDTA), Group 3 (35% H3PO4) and Group 4 (18% EDTA plus 35% H3PO4). Then, 10,000 thermocycles between 5 +/− 2 °C and 55 +/− 2 °C were applied. Adhesive strength was tested by shearing with a digital universal testing machine at a crosshead speed of 0.75 mm/min. The values obtained were analyzed in megapascals (MPa). The mean and standard deviation were used as measures of central tendency and dispersion. In addition, a one-factor intergroup ANOVA test was applied with Tukey’s post hoc test considering a significance level of p < 0.05. Results: The 18% EDTA and 18% EDTA plus 35% H3PO4 showed significantly higher adhesive strength compared to the control group that did not receive dentin conditioning (p = 0.047 and p < 0.001, respectively). However, the group conditioned with 18% EDTA did not present significant differences compared to the group conditioned with 35% H3PO4 (p = 0.997). In addition, the group conditioned with 18% EDTA plus 35% H3PO4 showed significantly higher adhesive strength compared to the groups conditioned with 18% EDTA (p = 0.002) and 35% H3PO4 (p = 0.001). Conclusion: The adhesion of bulk fill resin composite to dentin was favorable when preconditioning was performed using 18% EDTA followed by 35% H3PO4. In contrast, when both etchants were used separately, the bulk fill resin composite showed similar bond strength values in both cases, but significantly lower compared to their sequential application.

Comparative Assessment of Different Pre-Treatment Bonding Strategies to Improve the Adhesion of Self-Adhesive Composites to Dentin

The aim of this study is to compare the adhesive interface formed in dentin, using self-adhesive composites applied with different bonding strategies, by testing the microtensile bond strength (μTBS) and ultramorphology through the use of light microscopy. Permanent, sound human molars were randomly allocated to six experimental groups. The groups included a negative control group, where only etching was performed via EtchOnly; a positive control group where an adhesive was applied, OptiBondFL (OBFL); and an experimental group where a primer was applied using a co-curing strategy together with a composite (Primer_CoCuring). The samples were sectioned into microspecimens for μTBS (n = 8) and into 1-mm thick slabs for light microscopy using Masson’s trichrome staining protocol (n = 3). The statistical analysis included a two-way ANOVA for μTBS data and Tukey’s HSD was used as a post-hoc test (significance level of 5%; SPSS v. 26.0). The results of the μTBS revealed that the self-adhesive composite (F = 6.0, p < 0.018) and the bonding strategy (F = 444.1, p < 0.001) significantly affected the bond strength to dentin. However, their interactions were not significant (F = 1.2, p = 0.29). Etching dentin with no additional treatment revealed the lowest μTBS (VF_EtchOnly = 2.4 ± 0.8 MPa; CC_EtchOnly = 2.0 ± 0.4 MPa), which was significantly different from using a primer (VF_CoCu = 8.8 ± 0.8 MPa; CC_CoCu = 6.3 ± 1.0 MPa) or using the full adhesive (VF_OptiBondFL = 22.4 ± 0.3 MPa; CC_OptibondFL = 21.2 ± 0.4 MPa). Microscopy images revealed that the experimental Primer_CoCuring was the only group with no collagen fibers exposed to the dentin−composite interface. Overall, the use of a primer, within the limitations of this study, increased the bonding of the self-adhesive composite and provided sufficient infiltration of the collagen based on light-microscopic imaging.

Push-out bond strength of fiber posts to irradiated and non-irradiated intraradicular dentin

OBJECTIVES

The aim of this study is to evaluate the influence of ionizing radiotherapy on the resin-dentin interface in endodontically treated teeth restored with fiber posts using a dual-cure resin cement performed with the etch-and-rinse (ER) and self-etch (SE) approaches in terms of push-out bond strength (MPa), and to analyze the post/cement/dentin interface using scanning electron microscopy (SEM).

MATERIALS AND METHODS

Seventy-six single-rooted human teeth were used and randomly assigned into two main groups (n = 38): one non-irradiated group (NoRad) and one group subjected to a cumulative radiation dose of 60 Gy (Rad). All root canals were instrumented and were further subdivided into two subgroups (n = 19) following the adhesive approach: ER (RadER; NoRadER) and SE (RadSE; NoRadSE) used for fiber post luting with the universal adhesive and dual cure resin cement. Each root was sectioned perpendicularly to its long axis and sections from the middle third of the roots were chosen for SEM analysis and push-out bond strength test. Two-way ANOVA with post hoc Tukey tests and a dummy variable linear regression analysis were used for data analysis.

RESULTS

Regardless of the adhesive approach, push-out bond strength in irradiated teeth resulted in significantly lower values than non-irradiated teeth (p = 0.0001). There were no significant differences between the ER and SE approaches in non-irradiated teeth (p = 0.955), whereas the ER approach showed significantly higher bond strengths than the SE approach in irradiated teeth (p = 0.0001).

CONCLUSIONS

Ionizing radiotherapy resulted in dentin structure disruption and negatively affected the push-out bond strength of fiber posts to intraradicular dentin. The reduction in bond strength was also more significant with the SE approach than with the ER approach.

CLINICAL RELEVANCE

The alterations resulting from root dentin irradiation seem to influence adhesive systems bond strength to dentin, as these changes contribute to lower push-out bond strength in irradiated groups before fiber post luting. Thus, clinicians should prepare patients with a reasonable restorative treatment plan prior to radiotherapy and simultaneously initiate a preventive program during radiotherapy.

Influence of Irradiance and Exposure Times on the Mechanical and Adhesive Properties of Universal Adhesives with Dentin

OBJECTIVES

This study evaluated the influence of irradiance/exposure time on the Knoop hardness (KHN) and polymer cross-linking density (PCLD), as well as microtensile bond strength (μTBS), nanoleakage (NL), and in situ degree of conversion (DC) of universal adhesives.

METHODS AND MATERIALS

Two universal adhesive systems, Clearfil Universal Bond Quick (CUQ) and Scotchbond Universal Adhesive (SBU), were light-cured using various irradiance/exposure times: 1400 mW/cm2 for 5 s (1400*5); 1400 mW/cm2 for 10 s (1400*10); 3200 mW/cm2 for 5 s (3200*5); and 3200 mW/cm2 for 10 s (3200*10). Adhesive disks from each group were used to measure PCLD by KHN. One hundred and twenty-eight human molars were randomly assigned to 16 groups according to the following variables: adhesive system vs adhesive strategies vs radiance/exposure times. After restoration, specimens were sectioned into resin-dentin sticks and tested for μTBS, NL, and DC. The data from PCLD (%), KHN, μTBS (MPa), NL (%), and DC (%) data were subjected to ANOVA and Tukey's test (α=0.05).

RESULTS

Significant reductions in KHN, μTBS, and DC (p=0.00001) values and an increase in NL and PCLD (p=0.00001) values were observed for 3200*10 when compared with other groups. Higher KHN, μTBS, and DC (p=0.000001) values were observed for 3200*5 in comparison with the other groups. The 1400*5 (7 J/cm2) and 1400*10 (14 J/cm2) groups showed intermediate values (p=0.000001).

CONCLUSION

Although similar results in terms of hardness, polymer cross-linking density and nanoleakage were observed when 5 seconds at 3200 mW/cm2 and 10 seconds at 1400 mW/cm2 groups were compared, the use of higher irradiance (3200 mW/cm2) for only 5 seconds showed better results in terms of bond strength and degree of conversion for both universal adhesives to dentin. The prolonged exposure time (10 seconds) at the higher irradiance (3200 mW/cm2) showed the worst results.

Collagen-depletion strategies in dentin as alternatives to the hybrid layer concept and their effect on bond strength: a systematic review

Strategies aiming to improve the longevity of resin-dentin adhesive interface developed so far have only been able to retard the problem. Different approaches are thus needed. The objective of this review was to determine whether the use of collagen-depletion strategies after acid-etching procedures may improve the bond strength of resin-based materials to dentin. A systematic review was planned following 2021 PRISMA statement guidelines, with a search strategy performed in five electronic databases: PubMed/Medline, Scopus, EMBASE, SciELO and IADR Abstract Archive (last search: 17/01/2022). Inclusion criteria encompassed studies which evaluated a collagen-depletion strategy in acid-etched human dentin and tensile/shear bond strength tests. Risk of bias assessment was carried out by two reviewers, working independently on an adapted five-domain risk of bias (RoB) checklist for laboratory studies. Results were synthesized qualitatively, as a meta-analysis was not possible due to limited number of studies and their RoB. A total of eight studies were eligible for inclusion in the systematic review after inclusion/exclusion criteria application. Out of these, two evaluated the effect of using NaOCl followed by an antioxidant, and the remaining six evaluated different enzymatic treatments (bromelain, chondroitinase ABC, papain, and trypsin). None of the studies reported a decrease of bond strength when a collagen-depletion strategy was used, in comparison to traditional hybrid layers (control). All enzymatic treatment studies which respected the inclusion criteria improved the bond strength to dentin. Some specific collagen-depletion strategies seem to play a favorable role in improving immediate bond strengths to dentin. Further research with sound methodology is required to consolidate these findings, since limitations in RoB and a low number of studies were found. The assessment of further proteolytic agents and long-term outcomes is also required.

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.

Development of an Antibacterial Dentin Adhesive

Nisin is a peptide that possesses potent antibacterial properties. This study evaluated the antibacterial activity of a nisin-doped adhesive against Streptococcus mutans, as well as its degree of conversion and microtensile bond strength (μTBS) to dentin. Nisin was added to the adhesive Adper Single Bond 2 (3M ESPE), resulting in four groups: Control Group (Single Bond 2); Group 1% (1 wt% nisin-incorporated), Group 3% (3 wt% nisin-incorporated) and Group 5% (5 wt% nisin-incorporated). Antibacterial activity against S. mutans was evaluated using colony-forming unit counts (CFU). The degree of conversion was tested using FTIR. Forty human teeth were restored for μTBS evaluation. Data were statistically analyzed with ANOVA and Tukey tests at α = 0.05. The nisin-doped adhesives, for all concentrations, exhibited a significant inhibition of the growth of S. mutans (p < 0.05); Incorporation of 5% and 3% nisin decreased the degree of conversion of the adhesive (p < 0.05). The μTBS (in MPa): Control Group—38.3 ± 2.3A, Group 1%—35.6 ± 2.1A, Group 3%—27.1 ± 1.6B and Group 5%—22.3 ± 1.0C. Nisin-doped adhesives exerted a bactericidal effect on S. mutans. The μTBS and degree of conversion of adhesive were not affected after incorporation of 1% nisin.

Effect of adhesive coating on calcium, phosphate, and fluoride release from experimental and commercial remineralizing dental restorative materials

This study investigated the potential of adhesive coating for hindering the reactivity of ion-releasing dental restorative materials. Experimental composites were prepared by replacing 10 or 20 wt% of reinforcing fillers with two types of bioactive glass. A glass ionomer, a giomer, and an alkasite were used as representatives of commercial ion-releasing materials. Restorative material specimens were coated with an etch-and-rinse adhesive, 1-step self-etch adhesive, 2-step self-etch adhesive, or left uncoated. The specimens were immersed in a lactic acid solution and ion concentrations were measured in 4 days intervals for 32 days (atomic absorption spectrometry for calcium, UV–Vis spectrometry for phosphate, ion-selective electrode for fluoride, and pH-meter for pH values). The adhesive coating reduced ion release between 0.3 and 307 times, in a significantly material- and adhesive-dependent manner. Fluoride release was most highly impaired, with the reduction of up to 307 times, followed by phosphate and calcium release, which were reduced up to 90 and 45 times, respectively. The effect of different adhesive systems was most pronounced for phosphate release, with the following rankings: uncoated ≥ 2-step self-etch adhesive ≥ 1-step self-etch adhesive ≥ etch-and-rinse adhesive. The differences among adhesives were less pronounced for calcium and fluoride. It was concluded that the resinous adhesive layer can act as a barrier for ion release and diminish the beneficial effects of remineralizing restorative materials.

Evaluation of the Effect of Anti-COVID-19 Mouthwashes on Shear Bond Strength of Composite Resin Restorations to Dentin and Enamel: An “In Vitro Study”

Objectives

Given the high prevalence of the coronavirus and the high risk of virus transfer to dentists, the use of mouthwashes, which can potentially eliminate this virus, is suggested before dental procedures. Since these mouthwashes may affect the bond strength of composite resin restorations to teeth, this study was conducted to investigate the effect of recommended mouthwashes on the shear bond strength of composite resin restorations to dentin and enamel in selective etch and rinse and two-step self-etch bonding systems.

Methods

Five groups of posterior teeth (n = 15) were selected for five groups of cetylpyridinium chloride 0.07%, povidone-iodine 1%, hydrogen peroxide 1%, and chlorhexidine 0.2% as mouthwash and distilled water as the control group. The buccal enamel and lingual dentin of each tooth were rinsed after immersion in a mouthwash. After 20 seconds of enamel acid-etching and 15 seconds of dentin priming, they were impregnated with an adhesive, and composite cylinders were placed on the dentin and enamel surfaces of the tooth. The shear bond strength test was performed after 24 hours, and results were analyzed by ANOVA and paired t-test (α = 0.05).

Results

The mean shear bond strength of enamel to composite was significantly (p < 0.05) higher than that of dentin to composite in each study group, but no significant difference was found between the mean shear bond strength of composite to enamel (p = 0.199) and to dentin (p = 0.335) after the use of mouthwashes and that of the control group.

Conclusion

The use of mouthwashes used in this study did not have negative effects on the shear bond strength of composite to enamel and dentin.

Improving Properties of an Experimental Universal Adhesive by Adding a Multifunctional Dendrimer (G-IEMA): Bond Strength and Nanoleakage Evaluation

A vast number of adhesive formulations exist currently. However, available adhesives still have several drawbacks such as increased hydrophilicity, polymerization deficiency, potential cytotoxicity and limited monomer interdiffusion within dentin. To improve material properties, a Bisphenol A-free adhesive containing a novel dendrimer G(2)-isocyanatoethyl methacrylate (G-IEMA) in replacement of Bis-GMA was made and tested. Sound human molars were sectioned to expose mid-coronal dentin, which was bonded using four adhesives—Futurabond, Scotchbond Universal and experimentals EM1 and EM2. The experimental adhesive EM2 contained G-IEMA, while EM1 had Bis-GMA. Groups were further allocated to two different adhesive strategies: etch-and-rinse (20 s etching) or self-etch. Immediate (24 h) microtensile bond strength to dentin (n = 5) was tested using a universal testing machine (1 mm/min, 5 kN; Shimadzu AGS-X Autograph, Tokyo, Japan), while the ultrastructure of the interface (n = 2) was assessed using scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). Nanoleakage expression was evaluated using silver nitrate penetration and posterior SEM-EDS analysis (n = 3). Linear mixed models/Generalized models were used for inferential statistics (5% significance level). Bond strength results did not depend on the adhesive choice, although differences were found between strategies (p < 0.001). Regarding nanoleakage, when applied in an etch-and-rinse mode, experimental adhesives scored lower nanoleakage means than Futurabond and Scotchbond Universal. The novel adhesive shows interesting interfacial properties, with favorable nanoleakage results and a bond strength to dentin that matches current commercial adhesives.

Effect of Erbium, Chromium-doped: Yttrium, Scandium, Gallium and Garnet Laser Tooth Preparation on Gap Formation of Universal Adhesive Bonded to Enamel and Dentin: A Micro-CT and SEM Study

Introduction: The presence of gaps at the bonding interface of resin composite restorations is known to have an impact on restoration longevity. This study aimed to evaluate the effect of erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er, Cr:YSGG) laser irradiation on gap formation at the tooth–resin interface and to compare the reliability of micro-computed tomography (µCT) and scanning electron microscopy (SEM) scans for gap formation assessment. Methods: Thirty standardized non-retentive class V cavities were prepared on sound human premolars using either an Er,Cr:YSGG laser or a round carbide bur (n=15 for each). A universal adhesive and A nano-filled resin composite were applied in accordance with the manufacturer’s recommendations. After water storage for 24 hours at 37°C, the teeth were subjected to thermocycling. Gap formation assessments were performed by µCT (Skyscan 1173 µCT, Brucker, Belgium) and SEM (JEOL JSM-6610LV, Japan), and SPSS version 24.0 (IBM Inc., Chicago, USA) was used to analyze the data at P value<0.05. Descriptive statistics were used to describe the gap formation percentages. To compare the impact of both preparation and assessment methods, a non-parametric Mann–Whitney U test was used. Results: In enamel, similar gap formation values were detected for the two preparation methods (bur and laser). However, the laser-prepared group showed higher gap formation values in dentin. Additionally, higher gap formation values were reported for both preparation methods when µCT was used for assessment. Conclusion: Cavity preparation using a Waterlase laser led to higher gap formation percentages at the dentin–resin interface. In addition, SEM assessment is more reliable for assessing the tooth–resin interface.

In Vitro Performance of Different Universal Adhesive Systems on Several CAD/CAM Restorative Materials After Thermal Aging

OBJECTIVE

To evaluate the microshear bond strength (mSBS) of 10 universal adhesive systems applied on five different CAD/CAM restorative materials, immediately and after thermal aging.

METHODS AND MATERIALS

Five CAD/CAM materials were selected: 1) feldspathic glass ceramic (FeCe); 2) pre-polymerized reinforced resin composite (ReRC); 3) leucite-reinforced glass ceramic (LeGC); 4) lithium disilicate (LiDi); and 5) yttrium-stabilized zirconium dioxide (ZiDi). For each material, 15 blocks were cut into four rectangular sections (6 × 6 × 6 mm; n=60 per group) and processed as recommended by the respective manufacturer. For each indirect material, the following adhesive systems were applied according to the respective manufacturer's instructions: 1) AdheSE Universal [ADU]; 2) All-Bond Universal [ABU]; 3) Ambar Universal [AMB]; 4) Clearfil Universal Bond [CFU]; 5) Futurabond U [FBU]; 6) One Coat 7 Universal [OCU]; 7) Peak Universal Bond [PUB]; 8) Prime&Bond Elect [PBE]; 9) Scotchbond Universal Adhesive [SBU]; 10) Xeno Select [XEN, negative control]. After the application of the adhesive system, cylinder-shaped transparent matrices were filled with a dual-curing resin cement (NX3) and light cured. Specimens were tested in shear mode at 1.0 mm/ min (mSBS), after 24 hours and 10,000 thermal cycles (TC). All data were submitted to statistical analysis (α=0.05).

RESULTS

For FeCe, there was no significant decrease in mean mSBS for AMB, FBU, and SBU after TC when compared at 24 hours. For ReRC, AMB and SBU showed higher mean mSBS when compared to CFU and XEN, after 24 hours and TC. For LiDi, FBU and OCU showed higher mean mSBS when compared to CFU and XEN, after 24 hours and TC. For LeGC, AMB and PUB showed higher mean mSBS when compared to XEN, after 24 hours and TC. For ZiDi, OCU and SBU showed higher mean mSBS when compared to XEN, after 24 hours and TC. In addition, PBE and XEN showed the lowest mean mSBS after TC with higher percentage of bond strength reduction.

CONCLUSIONS

The mean mSBS among the different universal adhesives varied widely for each CAD/ CAM material used. In addition, most universal adhesives underwent a statistically significant bond strength reduction after TC.

How Water Content Can Influence the Chemomechanical Properties and Physical Degradation under Aging of Experimental Adhesives

Objective

To evaluate the physicochemical (sorption (SOR), solubility (SOL), and degree of conversion (DC)) and mechanical (flexural strength (FS), modulus of elasticity (ME), and compressive strength (CS)) properties of adhesives with different water contents (D₂O).

Materials and Methods

An adhesive was formulated: 55 wt% BisGMA, 45 wt% HEMA, 0.5 wt% camphorquinone, 0.5 wt% EDMAB, and 1.0 wt% DPIHP. D₂O was added into the adhesives (0 wt%, 10 wt%, and 16 wt%). DC was monitored through the FTIR. FS, ME, CS, SOR, and SOL were tested. The adhesive samples were aged in deionized water, ethanol, and acetone. Data were submitted to ANOVA and Tukey's tests (5%).

Results

For DC, the 0 wt% group showed a significant reduction (68.09 ± 0.14_A) compared with the 10 wt% (87.07 ± 0.81_B) and 16 wt% groups (89.87 ± 0.24_B); 10 wt% showed the highest FS (MPa) mean values (141.6 ± 6.71_B) compared with the 0 wt% (109.4 ± 20.5_A) and 16 wt% (107.8 ± 15.8_A). For the CS (MPa) and ME (GPa), the 16 wt% showed the lowest mean values (98.8 ± 18.0_B and 2.2 ± 0.3_B, respectively) compared with the 10 wt% and 0 wt%. For the SOR, 16 wt% of water showed the highest mean values and the ethanol showed the lowest mean values of SOL regardless of water content.

Conclusion

The amount of water content and the types of aging solvents significantly affect the adhesive properties.

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.

Riboflavin and Its Effect on Dentin Bond Strength: Considerations for Clinical Applicability-An In Vitro Study

Bioactive collagen crosslinkers propose to render the dentin hybrid layer less perceptive to hydrolytic challenge. This study aims to evaluate whether bond strength of dental resin composite to dentin benefits from riboflavin (RB)-sensitized crosslinking when used in a clinically applicable protocol. A total of 300 human dentin specimens were prepared consistent with the requirements for a macro-shear bond test. RB was applied on dentin, either incorporated in the primer (RBp) of a two-step self-etch adhesive or as an aqueous solution (RBs) before applying the adhesive, and blue light from a commercial polymerization device was used for RB photoactivation. Bonding protocol executed according to the manufacturer’s information served as control. Groups (n = 20) were tested after 1 week, 1 month, 3 months, 6 months or 1 year immersion times (37 °C, distilled water). The different application methods of RB significantly influenced bond strength (p < 0.001) with a medium impact (η²_p = 0.119). After 1 year immersion, post hoc analysis identified a significant advantage for RB groups compared to RBp (p = 0.018), which is attributed to a pH-/solvent-dependent efficiency of RB-sensitized crosslinking, stressing the importance of formulation adjustments. We developed an application protocol for RB-sensitized crosslinking with emphasis on clinical applicability to test its performance against a gold-standard adhesive, and are confident that, with a few adjustments to the application solution, RB-sensitized crosslinking can improve the longevity of adhesive restorations in clinics.

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

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

Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength

The aim of this in vitro study was to assess the effect of two different adhesive application methods on shear dentin bond strength (ISO 29022) using three various adhesive systems. A mid-coronal section of 77 intact third human molars with fully developed apices was made to create flat bonding substrates. The materials used in the study were Excite F (Ivoclar Vivadent), Prime&Bond Universal (Dentsply Sirona) and G-Premio Bond (GC). The application of each adhesion system was performed in two different ways. In the first group, the bonding agent was light cured immediately after the application (conventional method), while in the second group the adhesive and composite were cured concurrently (“co-curing” method). A total of 180 specimens were prepared (3 adhesives × 2 method of application × 30 specimens per experimental group), stored at 37 °C in distilled water and fractured in shear mode after 1 week. Statistical analysis was performed using ANOVA and Weibull statistics. The highest bond strength was obtained for Prime&Bond conventional (21.7 MPa), whilst the lowest bond strength was observed when co-curing was used (particularly, Excite F 12.2 MPa). The results showed a significant difference between conventional and co-curing methods in all materials. According to reliability analysis, the co-curing method diminished bond reliability. Different application techniques exhibit different bond strengths to dentin.

Microleakage in class II restorations of two bulk fill resin composites and a conventional nanohybrid resin composite: an in vitro study at 10,000 thermocycles

Background

The contraction presented by resin composites causes an increase in stress at the tooth-resin interface, causing micro-gaps that allow microleakage. This study aims to evaluate the degree of in vitro marginal microleakage in class II restorations with two bulk fill resin composites compared to a conventional nanohybrid resin composite.

Methods

The present study was an in vitro experimental design. A total of 30 standardized class II cavities were prepared in 15 human molars (mesially and distally). These cavities were later distributed in 3 groups according to the type of resin. Groups A and B were restored with bulk fill resin composites (Filtek—3 M/ESPE and Tetric N-Ceram—Ivoclar/Vivadent respectively) in a single increment of 4 mm. Group C was restored with the Filtek Z350 XT – 3 M/ESPE resin composite and two increments of 2 mm. Later, the restorations were subjected to 10,000 thermocycles between 5 °C to 55 °C and immersed in a silver nitrate solution (1 M for 24 h). The crowns were then sectioned mesiodistally and observed under the stereomicroscope to determine the degree of marginal microleakage at the occlusal and cervical areas. The results were analyzed with the Kruskal–Wallis and the Mann–Whitney U statistical tests.

Results

There were no statistically significant differences regarding the degree of microleakage between the three types of resin composites in the occlusal and cervical areas (p > 0.05). Similarly, there were no significant differences after comparing each resin type in its occlusal and cervical area (p > 0.05).

Conclusion

Filtek Bulk Fill and Tetric N-Ceram Bulk Fill resin composites showed no statistically significant differences with the conventional nanohybrid resin composite Filtek Z350XT at both occlusal and cervical areas.

Placement of Posterior Composite Restorations: A Cross-Sectional Study of Dental Practitioners in Al-Kharj, Saudi Arabia

Dental practitioner-related factors can affect the quality of composite restorations. This study aimed to investigate the clinical techniques used by dental practitioners (DPs) while placing direct posterior composite restorations. Methods: A questionnaire survey that sought information related to the placement of posterior composite restorations was delivered to 161 DPs working in the Al-Kharj area, Saudi Arabia. The collected data were statistically analyzed using Pearson’s Chi-square test and Fisher’s exact test considering the DP’s working sector and the answered questions. Results: A total of 123 DPs completed the survey (76.4% response rate). There was a statistically significant difference between DPs working in the private sector and those working in the governmental sector in 7 out of 17 questionnaire items namely: preparing a minimum depth of 2 mm, (p = 0.001); mechanical means of retention, (p = 0.003); operative field isolation, (p = 0.004); adhesive strategy, (p < 0.001); light-curing unit used, (p = 0.013); the use of radiometer, (p = 0.023), and dental matrix selection, (p < 0.001). Conclusion: The clinical techniques applied by DPs working in the private sector in Al-Kharj, Saudi Arabia when placing posterior composite restorations, including the specifications of cavity preparation, operative field isolation, and selection of the dental matrix system, may be substandard compared to those applied by DPs working in the governmental sector.

Determination of Dental Adhesive Composition throughout Solvent Drying and Polymerization Using ATR-FTIR Spectroscopy

The of this study aim was to develop a rapid method to determine the chemical composition, solvent evaporation rates, and polymerization kinetics of dental adhesives. Single-component, acetone-containing adhesives One-Step (OS; Bisco, Anaheim, CA, USA), Optibond Universal (OU; Kerr, Brea, CA, USA), and G-Bond (GB; GC, Tokyo, Japan) were studied. Filler levels were determined gravimetrically. Monomers and solvents were quantified by comparing their pure Attenuated Total Reflectance-Fourier Transform Infra-Red (ATR-FTIR) spectra, summed in different ratios, with those of the adhesives. Spectral changes at 37 °C, throughout passive evaporation for 5 min, then polymerisation initiated by 20 s, and blue light emitting diode (LED) (600 mW/cm²) exposure (n = 3) were determined. Evaporation and polymerisation extent versus time and final changes were calculated using acetone (1360 cm^-1) and methacrylate (1320 cm^-1) peaks. OS, OU, and GB filler contents were 0, 9.6, and 5.3%. FTIR suggested OS and OU were Bis-GMA based, GB was urethane dimethacrylate (UDMA) based, and that each had a different diluent and acidic monomers and possible UDMA/acetone interactions. Furthermore, initial acetone percentages were all 40-50%. After 5 min drying, they were 0% for OS and OU but 10% for GB. Whilst OS had no water, that in OU declined from 18 to 10% and in GB from 25 to 20% upon drying. Evaporation extents were 50% of final levels at 23, 25, and 113 s for OS, OU, and GB, respectively. Polymerisation extents were all 50 and 80% of final levels before 10 and at 20 s of light exposure, respectively. Final monomer polymerisation levels were 68, 69, and 88% for OS, OU, and GB, respectively. An appreciation of initial and final adhesive chemistry is important for understanding the properties. The rates of evaporation and polymerisation provide indications of relative required drying and light cure times. UDMA/acetone interactions might explain the considerably greater drying time of GB.

Bond Strength of Self-Adhesive Flowable Composites and Glass Ionomer Cements to Primary Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

Background: Conventional composites are largely used in pediatric restorative dentistry and demonstrate successful clinical outcomes. However, the need for simplification of operative steps in young or uncooperative children demands reliable alternatives. Therefore, the aim of the present systematic review and meta-analysis was to evaluate the in vitro bond strength of glass ionomer cements (GICs) and self-adhesive flowable composites (SFCs) on deciduous teeth. Methods: A comprehensive literature search according to the PRISMA checklist was manually and electronically performed by two independent reviewers through the following databases: MEDLINE/PubMed, Google Scholar, Scopus, and Embase, to include in vitro studies comparing GICs and SFCs bond strength values of restorations on primary teeth. In addition, three groups of meta-analyses were conducted using random-effects models. Results: Three articles meeting the inclusion criteria were selected and subjected to both qualitative and quantitative assessment. No statistically significant difference was found between SFC versus GIC; however, both groups significantly differed with conventional flowable composites (CFs). Conclusions: Despite the absence of significant difference in bond strength values, SFCs may be considered a valid alternative to GICs in the restoration of deciduous teeth, although CFs proved better in vitro performances.

Effects of Adper™ Scotchbond™ 1 XT, Clearfil™ SE Bond 2 and Scotchbond™ Universal in Odontoblasts

This study aimed to assess the cytotoxicity of commercially available adhesive strategies-etch-and-rinse (Adper™ Scotchbond™ 1 XT, 3M ESPE, St. Paul, MN, USA, SB1), self-etch (Clearfil™ SE Bond 2, Kuraray Noritake Dental Inc., Tokyo, Japan, CSE), and universal (Scotchbond™ Universal, 3M Deutschland GmbH, Neuss, Germany, SBU). MDPC-23 cells were exposed to adhesives extracts in different concentrations and exposure times. To access cell metabolic activity, viability, types of cell death, and cell cycle, the MTT assay, SRB assay, double labeling with annexin V and propidium iodide, and labeling with propidium iodide/RNAse were performed, respectively. Cultures were stained with May-Grünwald Giemsa for qualitative cytotoxicity assessment. The SB1, CSE, and SBU extracts determined a significant reduction in cell metabolism and viability. This reduction was higher for prolonged exposures, even for less concentrated extracts. CSE extracts significantly reduced the cell's metabolic activity at higher concentrations (50% and 100%) from 2 h of exposure. After 24 and 96 h, a metabolic activity reduction was verified for all adhesives, even at lower concentrations. These changes were dependent on the adhesive, its concentration, and the incubation time. Regarding cell viability, SBU extracts were the least cytotoxic, and CSE was significantly more cytotoxic than SB1 and SBU. The adhesives determined a reduction in viable cells and an increase in apoptotic, late apoptosis/necrosis, and necrotic cells. Moreover, on cultures exposed to SB1 and CSE extracts, a decrease in the cells in S and G2/M phases and an increase in the cells in G0/G1 phase was observed. Exposure to SBU led to an increase of cells in the S phase. In general, all adhesives determined cytotoxicity. CSE extracts were the most cytotoxic and were classified as having a higher degree of reactivity, leading to more significant inhibition of cell growth and destruction of the cell's layers.

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

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

Application Modes Affect Two Universal Adhesive Systems' Nanoleakage Expression and Shear Bond Strength

Objectives

The aim of this study was to evaluate the shear bond strength and the nanoleakage expression of CLEARFIL Universal Bond Quick and Tetric N-Bond adhesive systems bonded to dentin.

Materials and Methods

100 freshly extracted human premolar teeth were utilized. The teeth were sectioned to expose dentin. All dentin specimens were assigned into 4 experimental groups; 2 groups had Universal Bond Quick (Universal_self group) and Tetric N-Bond (Tetric_self group) applied in the self-etch mode, while 2 groups had Universal Bond Quick (Universal_total group) and Tetric N-Bond (Tetric_total group) applied in the total-etch mode. n = 15 for shear bond strength and n = 10 for nanoleakage experiment. One-way ANOVA and Kruskal-Wallis test were utilized to analyze the shear bond strength test and the nanoleakage expression, respectively.

Results

The highest significant bond strength value was recorded by the Tetric_self specimens (p < 0.05) when compared to the remaining three groups. There were no statistically significant differences between the shear bond strength values recorded in the Tetric_total, Universal_self, and Universal_total groups (p < 0.05). Both bonding systems applied in the self-etch mode (Universal_self, Tetric_self) had no silver nitrate deposits in the hybrid layer and the hybrid layer-adhesive interface (p < 0.001); however, both bonding systems applied in the total-etch mode (Universal_total, Tetric_total) had silver nitrate deposits in the hybrid layer, the hybrid layer-adhesive interface, and the bonding layer (p < 0.001).

Conclusion

Applying the Universal Bond Quick and Tetric N-Bond in the self-etch mode exhibited better results in terms of nanoleakage expression. Universal Bond Quick showed the stability of the shear bond strength to dentin when applied using the total-etch or self-etch modes. Tetric N-Bond showed significant deterioration in bond strength when applied in the total-etch mode and exhibited the highest bond strength when applied in the self-etch mode.

Status of decontamination methods after using dentin adhesion inhibitors on indirect restorations: An integrative review of 19 publications

The purpose of this review was to assess the literature regarding the decontamination of resin cement before the luting procedure in order to provide clinicians with a comparative overview of decontamination effects. A total of 19 articles were selected for inclusion in this review. The results indicated that bonding effectiveness is reduced due to residual adhesion inhibitors such as saliva, blood, hemostatic agents, and temporary/provisional cement. Self-etching and self-adhesive systems tend to be more negatively affected by adhesion inhibitors than do etch and rinse systems. Cleaning with an ultrasonic scaler or rotating brush have demonstrated conflicting effects in several studies. Some studies have reported that phosphoric acid has negative effects and recommend mild acid for decontamination. The application of phosphoric acid followed by sodium hypochlorite has been shown to help avoid negative effects. Alumina blasting has been investigated as a mechanical cleaning method in a relatively large number of experiments, most of which have confirmed its effectiveness. An intraoral cleaner containing functional monomers that has become commercially available in recent years is a promising method in clinical practice because it can easily and effectively remove temporary adhesive material. In addition, adhesion inhibitors can be easily removed from resin-coated dentin surfaces.

Bonding Performance of Universal Adhesives Applied to Nano-Hydroxyapatite Desensitized Dentin Using Etch-and-Rinse or Self-Etch Mode

The study assessed the bonding performance of three universal adhesives on desensitized dentin with etch-and-rinse mode or self-etch mode after nano-hydroxyapatite (nHAp)-based desensitizers application. Simulated sensitive dentin specimens were prepared and separated into four groups: no treatment as the negative control, groups desensitized by Biorepair toothpaste, Dontodent toothpaste, or nHAp paste. Three universal adhesives of All-Bond Universal, Single Bond Universal, and Clearfil Universal Bond with etch-and-rinse or self-etch mode were bonded to the desensitized dentin specimens separately, followed by resin composite build-ups. Micro-tensile bond strength was measured using a micro-tensile tester. The wettability of desensitized dentin was evaluated by the contact angle of the adhesives. Resin infiltration was observed by confocal laser scanning microscopy. Dentin tubular occlusion and nanoleakage were observed by scanning electron microscope. The results showed that the etch-and-rinse or self-etch mode of each adhesive showed similar bond strength when bonding to nHAp-based desensitized dentin. The dentin surface was partially covered by desensitizers after desensitization. Compared with the self-etch mode, stronger demineralization and more reopened dentin tubules were observed in the etch-and-rinse mode after acid etching; longer resin tags and more nanoleakage in the resin-dentin interface were observed when using the etch-and-rinse mode. When bonding to nHAp-based desensitized dentin with universal adhesives, no significant difference in bond strength was found between self-etch mode or etch-and-rinse mode; while the latter produced more nanoleakage in the resin-dentin interfaces.

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

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

Rheological Properties, Surface Microhardness, and Dentin Shear Bond Strength of Resin-Modified Glass Ionomer Cements Containing Methacrylate-Functionalized Polyacids and Spherical Pre-Reacted Glass Fillers

The aim of this study was to prepare experimental resin-modified glass ionomer cements (RMGICs) containing low levels of hydroxyethyl methacrylate (HEMA) for pulp protection. Liquid and powder phases of the experimental RMGICs were polyacid functionalized with methacrylate groups and spherical pre-reacted glass fillers (SPG). Two types of liquid phase containing 0 wt. % HEMA (CM liquid) or 5 wt. % HEMA (CMH liquid) were formulated. The experimental RMGICs were prepared by mixing SPG fillers with CM liquid (F1) or CMH liquid (F2). Rheological properties were examined using a strain-controlled rheometer (n = 5). The Vickers microhardness (n = 5) and dentin shear bond strength (SBS) (n = 10) of the materials were tested. Commercial pulp protection materials (Vitrebond and TheraCal LC) were used as comparisons. The viscosity and surface microhardness of F1 (22 m Pa·s, 18 VHN) and F2 (18 m Pa·s, 16 VHN) were significantly higher than those of Vitrebond (6 mPa·s, 6 VHN) and TheraCal (0.1 mPa·s, 7 VHN). The SBS of F1 (10.7 MPa) and F2 (11.9 MPa) was comparable to that of Vitrebond (15.4 MPa) but higher than that of TheraCal LC (5.6 MPa). The addition of 5 wt. % HEMA showed no significant effect on viscosity, surface microhardness, or SBS of the experimental RMGICs. The experimental materials showed higher viscosity and microhardness but similar SBS when compared with the commercial RMGIC.

The "Pre-Finishing" Approach in Direct Anterior Restorations. A Case Series

In esthetic restorations of anterior teeth the clinician has to manage several aspects in order to have a predictable outcome. A deep knowledge of the anatomy as well as the adhesive procedures and the optical properties of resin-based composites are mandatory to achieve esthetic results. Contemporary restorative materials present either several shades and different translucency properties and therefore they are able to mimic teeth’s optical behavior thus providing a natural aspect to anterior restorations. The wrong thickness of different composite layers may provide unpleasant results such as low value (grayish) restorations that often requires reintervention. A precise step-by-step procedure is therefore mandatory to provide the proper shade at the correct place. There is therefore the need of some corrections and adjustments during the layer procedure in order to avoid errors in shade positioning that could affect final result. The authors present a case series (six clinical cases) treated with the proposed technique with up to five years follow-up.

Universal adhesive: the effect of different simulated pulpal pressure fluids and bonding modes to dentin

The aim of this study was to evaluate the effect of SPP with either fetal bovine serum (FBS) or deionized water (DW) on the bond strength (μTBS) of a Universal adhesive to dentin, in both etch-and-rinse (ER) and self-etch (SE) modes. The kinematic viscosity (cSt) of FBS and DW was measured at 25 °C ± 0.1 ºC. Seventy-two sound human molars were sectioned and randomly divided into three groups according to the SPP conditions: (1) Control (0 cm H₂O), (2) SPP (15 cm H₂O) with FBS, (3) SPP (15 cm H₂O) with DW. Each group was subdivided (n = 10) based on the bonding modes: ER (37% phosphoric acid + ScothBond Universal Adhesive) or SE (ScothBond Universal Adhesive). Samples were then submitted to μTBS. Data were analyzed by Student's t test, two-way ANOVA and Tukey tests (p < 0.05). The cSt results showed that DW (23.59 ± 0.39) had significantly higher values than FBS (22.33 ± 0.06). With regard to SPP, the control group (36.1 MPa) had significantly higher values of μTBS when compared to the SPP using FBS (31.06 MPa) and SPP with DW (26.55 MPa). According to ANOVA, the bonding modes and the interaction of simulated pulpal pressure (SPP) did not statistically influence the results (p < 0.05). The presence of SPP reduced the bond strength of Universal adhesive to dentin. DW during SPP had significantly reduced bonding values when compared to FBS. Bonding strategies were not affected by SPP when evaluated in a short period of time (24 h).