Degradation and Failure Phenomena at the Dentin Bonding Interface

Biomimetic mineralization effect of a self-etch adhesive loaded with amorphous fluorinated calcium phosphate nanoparticles

OBJECTIVES

The study investigated the biomimetic mineralization effect of a self-etch adhesive loaded with amorphous fluorinated calcium phosphate (AFCP) nanoparticles.

METHODS

In this study, fluoride was applied to synthesize AFCP nanoparticles, which were characterized by high resolution transmission electron microscope, selected area electron diffraction and Fourier-transform infrared spectroscopy. Subsequently, the self-etch adhesive (Clearfil S3 Bond) was mixed throughly with 20 wt% of AFCP. The single-layer reconstituted collagen fibrils and demineralized dentin were used to investigate the mineralization effects of AFCP nanoparticles as well as Clearfil S3 Bond loaded with AFCP. Moreover, the Cell Counting Kit-8 assay was conducted to evaluate the cytotoxicity of AFCP-loaded adhesive.

RESULTS

The AFCP nanoparticles were successfully synthesized and characterized as an amorphous phase, which demonstrated better effectiveness in collagen fibril mineralization compared to amorphous calcium phosphate nanoparticles. Both AFCP nanoparticles and adhesive loaded with AFCP induced intrafibrillar mineralization of single-layer collagen fibrils. The incorporation of AFCP nanoparticles into adhesive led to the formation of remineralized crystals within the demineralized dentin. Moreover, cytotoxicity tests confirmed the biocompatibility of the AFCP-loaded adhesive.

CONCLUSIONS

The incorporation of AFCP nanoparticles into the self-etch adhesive facilitated collagen fibril mineralization and remineralization of demineralized dentin.

CLINICAL SIGNIFICANCE

Incorporating fluoride, a commonly used anti-caries element, into the self-etch adhesive in the form of AFCP nanoparticles enables its biomimetic mineralization in restorative treatments, presenting a potential approach for developing a novel adhesive system to prevent dental caries clinically.

Effect of collagen crosslinkers on sodium hypochlorite treated dentin bond strength: a systematic review and meta-analysis

Introduction

The bond strength (BS) between composite resin and dentin is a crucial factor determining the long-term success of restorations. Sodium hypochlorite (NaOCl), a frequently used root canal irrigating agent, has been demonstrated to notably influence the properties of dentin, thereby affecting the BS. Moreover, the application of collagen crosslinkers has become a potential approach to improve the stability of the resin-dentin bond. Nevertheless, the effect of collagen crosslinkers on the bond strength (BS) between sodium hypochlorite (NaOCl) treated dentin and composite resin remains a topic of contention, and there is a lack of in-depth understanding in the existing literature. The purpose of this systematic review and meta-analysis was to analyze the current literature on the effect of collagen crosslinkers on the BS between sodium hypochlorite treated dentin and composite resin.

Methods

Databases including PubMed, EMBASE, Cochrane library, Scopus, Web of Science and SinoMed were searched. In vitro studies reported the effect of crosslinking agents on NaOCl-treated dentin BS were included. The reference lists of studies included via databases were manually searched for more studies that fulfilled the inclusion criteria. The initial search yielded 1,538 studies, and subsequent screening resulted in the inclusion of 14 studies. Most of studies (78.6%, 11/14) were categorized as having a "low" risk of bias. The studies included in the meta-analysis employed a range of cross-linking agents, including ethylenediaminetetraacetic acid (EDTA), phytic acid (IP6), proanthocyanidin (PA), rosmarinic acid (RA) and sodium ascorbate (SA). Subgroup comparisons were performed according to NaOCl exposure duration. Studies treated with different concentration of NaOCl were analyzed separately.

Results

For dentin exposed less than 1 min or NaOCl at lower concentration, significant positive effect cannot be observed when using collagen crosslinkers. For dentin exposed more than 1 min in NaOCl at concentrations greater than 2.5%, EDTA, PA and SA were observed to significantly improve the BS. RA is proved effective in improving the BS of dentin exposed to high concentrations NaOCl within a shorter duration. Current evidence is insufficient to conclude that IP6 has a positive effect in NaOCl-treated dentin bonding performance.

Conclusion

The effect of collagen crosslinkers on the BS of NaOCl treated dentin was influenced by the concentration of NaOCl and the duration of exposure.

Dual-functions of prime-and-rinse approach with MDP primer on the performance of modified self-etch adhesive

OBJECTIVES

This study introduced the prime-and-rinse approach with an methacryloyloxydecyl dihydrogen phosphate (MDP)-containing primer to augment the performance of modified self-etch adhesives loaded with amorphous fluorinated calcium phosphate (AFCP) nanoparticles.

METHODS

The modified self-etch adhesive was acquired by adding 20 wt% AFCP nanoparticles into Clearfil S3 Bond. An experimental primer containing 15 wt% MDP was prepared. The bond performance was assessed through micro-tensile bond strength (MTBS) tests. Additionally, a single-layer collagen model and demineralized dentin were used to investigate mineralization characteristics. Cytotoxicity was evaluated using a modified transwell insert model on human dental pulp stem cells.

RESULTS

The incorporation of AFCP nanoparticles into the Clearfil S3 Bond led to a significant reduction in MTBS. While the application of MDP primer could improve the bond performance of modified Clearfil S3 Bond. The MDP primer further augmented the mineralization of single-layer collagen model and demineralized dentin induced by modified self-etched adhesive. The relative cell viability was around 100 % in all groups in the study.

CLINICAL SIGNIFICANCE

These results indicated that the prime-and-rinse approach with MDP primer not only compensated for the reduced bond strength caused by the incorporation of AFCP nanoparticles but also enhanced mineralization capabilities and maintained biocompatibility, offering a promising strategy for improving the longevity of dental restorations.

Bonding Performance and Interfacial Ultra-Morphology/Nanoleakage of a Modern Self-Curing Bulk-Fill Restorative System: An In Vitro Study

OBJECTIVES

 The objective of this study was to evaluate the bonding performance and the interfacial ultramorphology of an innovative self-curing restorative system compared with a conventional light-curing resin composite applied on dentin in etch-and-rinse (ER) or self-etch (SE) mode.

MATERIALS AND METHODS

 Twenty cavities (class I) were prepared in sound dentin and restored using two materials: (1) CERAM (n = 10; CERAM.X ONE, Dentsply Sirona) in combination with a universal adhesive system (PBU [Prime & Bond Universal]), or (2) STELA (n = 10; Stela Automix, SDI) in combination with its adhesive primer. Half of the specimens from each group were bonded in ER or SE mode. Specimens underwent microtensile bond strength testing after 24 hours of storage in artificial saliva. Failure mode was determined using a stereomicroscope, and fractographic analysis was performed using scanning electron microscopy. The interfacial ultramorphology/nanoleakage of the resin-dentin slabs was analyzed through dye-assisted confocal microscopy.

STATISTICAL ANALYSIS

 For quantitative analysis, bond strength values (in MPa) were assessed for normality and variance using Kolmogorov-Smirnov and Levene's tests, followed by ANOVA based on restorative material and adhesive bonding protocol, with Fisher's least significant difference post hoc test (α = 5%).

RESULTS

 SE groups exhibited significantly lower bond strength (17.4 MPa for CERAM; 26.2 MPa for STELA) compared with ER groups (35.8 MPa for CERAM; 33.6 MPa for STELA) (p < 0.05). CERAM applied in SE mode showed significantly lower bond strength compared with STELA applied in SE mode. Furthermore, CERAM applied in SE mode was the only group presenting a pre-test failure rate (27%). The failure mode was predominantly mixed in ER groups and adhesive in SE groups. Nanoleakage was observed clearly in the CERAM groups applied in both ER and SE modes but was less evident in the STELA groups.

CONCLUSION

 The new self-curing material (STELA) used in SE or ER may represent a promising clinical option to provide adequate interfacial adaptation and strong bonding to dentin when restoring deep class I cavities. The use of conventional adhesives in deep class I cavities may generate resin-dentin interfaces characterized by gaps and leakages.

Evolution of Dental Resin Adhesives-A Comprehensive Review

This comprehensive review of dental resin adhesives explores their historical development, key components, recent innovations, and potential future directions, highlighting a dynamic and continually advancing field. From Buonocore's breakthrough acid-etching technique and Bowen's pioneering dental resin invention, successive generations of clinicians and scientists have pushed forward the technological and materials development for secure bonding, while preserving dental tissues. The review discusses the substantial advances in improving adhesive reliability, enabling more conservative treatment approaches. It also delves into enhancing fundamental adhesive components and their synergistic combinations. Recent innovations, including biostable and functional resins, nanotechnology, and bioactive components, address persistent challenges such as durability, antimicrobial efficacy, and therapeutic functionality. Emerging technologies, such as digital dentistry, artificial intelligence, and bioinspired adhesives, portend an exciting and promising future for dental adhesives. This review underscores the critical role of ongoing research in developing biocompatible, multifunctional, and durable adhesives. It aims to support dental professionals and researchers by providing a comprehensive understanding of the dynamic progression of dental adhesives, inspiring continued innovation and excellence in restorative dentistry.

Influence of Natural Dentin Biomodification Agent on Push-Out Bond Strength and Nanoleakage of Self-Adhesive Resin Cement Luting of Glass-Fiber Posts

OBJECTIVE

To evaluate the plant-derived compound lignin (LIG) as a pretreatment of intraradicular dentin in combination with EDTA on push-out bond strength (PBS) and nanoleakage of the glass fiber posts (GFPs) cemented using adhesive resin cement.

MATERIAL AND METHODS

Twenty-eight human incisor roots were prepared for GFP cementation and divided based on dentin pretreatment: (1) CONTROL: no pretreatment, (2) EDTA: 17% EDTA for 3 min, (3) EDTA-LIG: 17% EDTA and 2% lignin for 3 min, (4) EDTA-PAC: 17% EDTA and 2% lignin for 3 min. The GFPs were cemented using the self-adhesive resin cement Multilink Speed. The roots (n = 7) were sectioned into 1 mm-thick discs and subjected to PBS testing after 1 week or 6 months. Nanoleakage was analyzed by SEM. Statistical analysis was performed using two-factor ANOVA and Tukey's test (p < 0.05).

RESULTS

Higher PBS was identified for the CONTROL group (p < 0.001). After 6 months, the EDTA-LIG maintained the bond strength with a predominance of mixed failures, while the EDTA-PAC, EDTA, and CONTROL groups showed reduction of bond strength, with a predominance of adhesive failures along with severe silver infiltration in the interface.

CONCLUSION

LIG associated with EDTA as a pretreatment for intraradicular dentin shows significant potential for attaining stable bond strength and interfacial integrity of self-adhesive resin cement to intraradicular dentin.

Preservation Strategies for Interfacial Integrity in Restorative Dentistry: A Non-Comprehensive Literature Review

The preservation of interfacial integrity in esthetic dental restorations remains a critical challenge, with hybrid layer degradation being a primary factor in restoration failure. This degradation is driven by a combination of host-derived enzymatic activity, including matrix metalloproteinases (MMPs), bacterial proteases, and hydrolytic breakdown of the polymerized adhesive due to moisture exposure. This review examines the multifactorial mechanisms underlying hybrid layer degradation and presents current advancements in restorative materials aimed at counteracting these effects. Principal strategies include collagen preservation through the inhibition of enzymatic activity, the integration of antimicrobial agents to limit biofilm formation, and the use of ester-free, hydrolysis-resistant polymeric systems. Recent research highlights acrylamide-based adhesives, which exhibit enhanced resistance to acidic and enzymatic environments, as well as dual functionality in collagen stabilization. Furthermore, innovations in bioactive resins and self-healing materials present promising future directions for developing adhesives that actively contribute to long-term restoration stability. These findings underscore the importance of continuous advancements in adhesive technology to enhance the durability and clinical performance of dental restorations.

Synergistic effects of bacteria, enzymes, and cyclic mechanical stresses on the bond strength of composite restorations

Predicting how tooth and dental material bonds perform in the mouth requires a deep understanding of degrading factors. Yet, this understanding is incomplete, leading to significant uncertainties in designing and evaluating new dental adhesives. The durability of dental bonding interfaces in the oral microenvironment is compromised by bacterial acids, salivary enzymes, and masticatory fatigue. These factors degrade the bond between dental resins and tooth surfaces, making the strength of these bonds difficult to predict. Traditionally studied separately, a combined kinetic analysis of these interactions could enhance our understanding and improvement of dental adhesive durability. To address this issue, we developed and validated an original model to evaluate the bond strength of dental restorations using realistic environments that consider the different mechanical, chemical, and biological degradative challenges working simultaneously: bacteria, salivary esterases, and cyclic loading. We herein describe a comprehensive investigation on dissociating the factors that degrade the bond strength of dental restorations. Our results showed that cariogenic bacteria are the number one factor contributing to the degradation of the bonded interface, followed by cyclic loading and salivary esterases. When tested in combinatorial mode, negative and positive synergies towards the degradation of the interface were observed. Masticatory loads (i.e., cycling loading) enhanced the lactic acid bacterial production and the area occupied by the biofilm at the bonding interface, resulting in more damage at the interface and a reduction of 73 % in bond strength compared to no-degraded samples. Salivary enzymes also produced bond degradation caused by changes in the chemical composition of the resin/adhesive. However, the degradation rates are slowed compared to the bacteria and cyclic loading. These results demonstrate that our synergetic model could guide the design of new dental adhesives for biological applications without laborious trial-and-error experimentation.

Effect of customized bioactive glass in experimental composites on dentin bond strength after 12 months of aging

OBJECTIVES

This study aimed to investigate the effect of a customized low-sodium bioactive glass (BG) fillers in experimental resin composites on their bond strength to dentin after 12 months of artificial aging. Specifically, it evaluated whether the bond strength was affected by different BG concentrations (0, 10, 20, 40 wt%) and artificial aging durations (1, 6, and 12 months).

MATERIALS AND METHODS

Experimental composites were prepared with 10, 20, and 40 wt% of a customized low-sodium fluoride-containing BG. The experimental composite with 0 wt% BG was used as a control, while Beautifil II (Shofu) was used as an external reference material. A universal adhesive system was applied to dentin substrates and composite build-ups were made. Bond strength was measured using a macro-shear bond strength test, and Weibull statistics were used to assess the reliability of the materials. Failure modes were analyzed to evaluate the type of the fracture.

RESULTS

After 12 months, the bond strength of all experimental composites remained stable and comparable to the control material, with statistically significant improvements between 6 and 12 months for all experimental materials. The bond strength was statistically similar across materials, except at the 12-month point, where the 20 wt% BG-composite showed significantly higher bond strength than the 40 wt% BG-composite. The frequency of mixed failures in composite increased after 12 months, particularly in experimental composites containing higher BG content.

CONCLUSIONS

The incorporation of a customized low- sodium BG into resin composites did not negatively impact their bond strength to dentin over 12 months. Instead, bond strength improved over time, and the composites remained mechanically stable, although a higher incidence of mixed failures was observed with increased BG content.

CLINICAL RELEVANCE

The customized low-sodium BG demonstrated stable bond strength over the 12-month period, offering a promising option for functional fillers in restorative composites without compromising the longevity of the adhesive-dentin interface.

Current approaches to produce durable biomaterials: Trends in polymeric materials for restorative dentistry applications

Dental caries continues to be a public health issue, especially more evident in underserved populations throughout the U.S. Unfortunately, especially with an aging population, hundreds of thousands of resin composite restorations are replaced each year due to recurring decay and fracture. According to several cohort studies, the average life span of this type of restoration is 10 years or less, depending on the caries risk level of the patient and the complexity of the restorative procedure. Any new material development must depart from the simple restoration of form paradigm, in which the filling is simply inert/biocompatible. This review will discuss novel antibiofilm structures, based on a targeted approach specifically against dysbiotic bacteria. Biofilm coalescence can be prevented by using glycosyl transferase - GTF inhibitors, in a non-bactericidal approach. On the tooth substrate side, MMP-inhibiting molecules can improve the stability of the collagen in the hybrid layer. This review will also discuss the importance of testing the materials in a physiologically relevant environment, mimicking the conditions in the mouth in terms of mechanical loading, bacterial challenge, and the presence of saliva. Ultimately, the goal of materials development is to achieve durable restorations, capable of adapting to the oral environment and resisting challenges that go beyond mechanical demands. That way, we can prevent the unnecessary loss of additional tooth structure that comes with every re-treatment. CLINICAL SIGNIFICANCE: While proper restorative technique and patient education in terms of diet and oral hygiene are crucial factors in increasing the longevity of esthetic direct restorations, materials better able to resist and interact with the conditions of the oral environment are still needed. Reproducing the success of dental amalgams with esthetic materials continues to be the Holy Grail of materials development.

Role of Metalloproteinases in Adhesion to Radicular Dentin: A Literature Review

INTRODUCTION

Root dentin is a porous and complex dental surface that may have irregularities and deposits of organic material. To achieve an effective bond between restorative materials and root dentin, it is necessary that the restorative materials adhere intimately to the dentin surface. Metalloproteinases (MMPs) are a group of proteolytic enzymes that perform an important role in degrading the extracellular matrix and remodeling connective tissue. The aim of this research was to determine the scientific evidence available on the role played by MMPs in adhesion to root dentin and their putative inhibitors.

MATERIALS AND METHODS

Several techniques have been used to evaluate the presence of MMPs in the root dentin of human and bovine teeth, such as Western blot, immunohistochemistry, immunofluorescence, and zymography, the latter also being used together with the EnzCheck assay to evaluate the inhibitory effect of adhesion protocols on the activity of root MMPs in vitro.

RESULTS

When analyzing the databases, 236 articles were found, 12 of which met the selection criteria. The variables analyzed were articles that evaluated different MMP inhibitors in root dentin.

CONCLUSIONS

In the adhesion to radicular dentin, MMPs have a crucial role in the degradation of the extracellular matrix of dentin and the remodeling of the dentin surface because excessive MMP activity can be harmful to dental health, since excessive degradation of the extracellular matrix of dentin can weaken the tooth structure and decrease fracture resistance. Therefore, it is important to monitor MMP activity during root dentin bonding procedures.

Constructing the Enamel-Like Dentin Adhesion Interface to Achieve Durable Resin-Dentin Adhesion

Enamel adhesion is acknowledged as durable; however, achieving long-lasting dentin adhesion remains a formidable challenge due to degradation of exposed collagen matrix after acid-etching of dentin. The idea of developing an enamel-like adhesion interface holds great promise in achieving enduring dentin adhesion. In this study, we constructed an enamel-like adhesion interface using a rapid remineralization strategy comprising an acidic primer and a rapid remineralization medium. Specifically, the acidic primer of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) and epigallocatechin-3-gallate (EGCG) nanocomplex (MDP@EGCG primer) was utilized to partially demineralize dentin within 30 s, and the MDP@EGCG nanocomplex showed a strong interaction with exposed collagen, enhancing collagen remineralization properties. Then, the rapid remineralization medium containing polyaspartate (Pasp) stabilized amorphous calcium and phosphorus nanoclusters (rapid Pasp-CaP) was applied to modified dentin collagen for 1 min, which caused rapid collagen remineralization within a clinically acceptable time frame. This strategy successfully generated an inorganic rough and porous adhesive interface resembling etched enamel, fundamentally addressed issues of collagen exposure, and achieved durable dentin adhesion in vitro and in vivo while also ensuring user-friendliness. It exhibited potential in prolonging the lifespan of adhesive restorations in clinical settings. In addition, it holds significant promise in the fields of caries and dentin sensitivity treatment and collagen-based tissue engineering scaffolds.

Engineering Interfacial Integrity with Hydrolytic-Resistant, Self-Reinforcing Dentin Adhesive

The leading cause of composite restoration failure is secondary caries, and although caries is a multifactorial problem, weak, damage-prone adhesives play a pivotal role in the high susceptibility of composite restorations to secondary caries. Our group has developed synthetic resins that capitalize on free-radical polymerization and sol-gel reactions to provide dental adhesives with enhanced properties. The resins contain γ-methacryloxypropyltrimethoxysilane (MPS) as the Si-based compound. This study investigated the properties of methacrylate-based resins containing methacryloxymethyltrimethoxysilane (MMeS) as a short-chain alternative. The degree of conversion (DC), polymerization kinetics, water sorption, mechanical properties, and leachates of MMeS- and MPS-resins with 55 and 30 wt% BisGMA-crosslinker were determined. The formulations were used as model adhesives, and the adhesive/dentin (a/d) interfaces were analyzed using chemometrics-assisted micro-Raman spectroscopy. The properties of the 55 wt% formulations were comparable. In the 30 wt% BisGMA formulations, the MMeS-resin exhibited faster polymerization, lower DC, reduced leachates, and increased storage and loss moduli, glass transition (Tg), crosslink density, and heterogeneity. The spectroscopic results indicated a comparable spatial distribution of resin, mineralized, and demineralized dentin across the a/d interfaces. The hydrolytically stable experimental short-chain-silane-monomer dental adhesive provides enhanced mechanical properties through autonomous strengthening and offers a promising strategy for the development of restorative dental materials with extended service life.

Promotion of Dentin Biomimetic Mineralization and Bonding Efficacy by Interfacial Control of an Experimental Citric Acid Dental Etching Agent

Resin-bonded restorations are the most important caries treatment method in clinical practice. Thus, improving the durability of dentin bonding remains a pressing issue. As a promising solution, guided tissue remineralization can induce the formation of apatite nanocrystals to repair defects in the dentin bonding interface. In this study, we present an experimental 20 wt % citric acid (CA) dental etching agent that removes the smear layer. After CA-etching, approximately 3.55 wt % residual CA formed a strong bond with collagen fibrils, reducing the interfacial energy between the remineralizing solution and dentin. CA helped achieve almost complete intrafibrillar and extrafibrillar mineralization after 24 h of mineralization. CA also significantly promoted poly(amidoamine)-induced dentin biomimetic mineralization. The elastic modulus and microhardness of remineralized dentin were restored to that of sound dentin. The remineralized interface reduced microleakage and provided a stronger, longer-lasting bond than conventional phosphate acid-etching. The newly developed CA dental etching agents promoted rapid dentin biomimetic mineralization and improved bonding efficacy through interfacial control, representing a new approach with clinical practice implications.

Effect of Dentin Contamination with Hemostatic Agents and Cleaning Techniques on Bonding with Self-Adhesive Resin Cement

BACKGROUND Dentin contamination with hemostatic agents before bonding indirect restorations negatively affects the bond strength. However, the consensus on which materials could be used to clean contamination of hemostatic agents has not been explored. The aim of this study was to assess the effect of Katana Cleaner applied on the surface of dentin contaminated with hemostatic agents on the shear bond strength (SBS) of self-adhesive resin cement by comparing it with three other surface cleaners. MATERIAL AND METHODS Ninety dentin specimens were divided into a no contamination group (control) (n=10), 4 groups contaminated with 25% aluminum chloride (Viscostat Clear) (n=40), and 4 groups contaminated with 20% ferric sulfate (Viscostat) (n=40). Subsequently, 4 different cleaners were used for each contamination group (water rinse, phosphoric acid, chlorhexidine, and Katana Cleaner). Then, self-adhesive resin cement was directly bonded to the treated surfaces. All specimens were subjected to 5000 thermal cycles of artificial aging. The shear bond strength was measured using a universal testing machine. RESULTS Two-way analysis of variance showed that the contaminant type as the main factor was statistically non-significant (p=0.655), cleaner type as the main factor was highly significant (p<0.001), and interaction between the contaminant and cleaner was non-significant (p=0.51). The cleaner type was the main factor influencing the bond strength. Phosphoric acid and chlorhexidine showed better performance than Katana Cleaner. CONCLUSIONS Cleaning dentin surface contamination with phosphoric acid and chlorhexidine had better performance than with Katana Cleaner.

Evaluation of the Genotoxic Effects of Grape Seed Extract and Marine Collagen Peptide on the Fibroblast Cell Line: An In Vitro Study

Introduction Collagen plays a vital role in maintaining the structural integrity of dentin, and its modification with bioactive compounds can enhance its mechanical properties and bonding capabilities. Aim This study aimed to evaluate the genotoxic effects of grape seed extract (GSE) and marine collagen peptide (MCP) on dental pulp-derived primary cells. Methodology Human dental pulp stem cells were isolated, cultivated, and then treated with GSE and marine collagen peptides. DNA fragmentation was assessed using DAPI (4',6-diamidino-2-phenylindole) staining. Statistical analysis was performed using SPSS version 20 (IBM Corp., Armonk, NY, USA). Results The results showed that GSE exhibited a minimum level of cell death compared to marine collagen peptides. The viable cell count increased steadily over three days in all groups, with the control group showing the highest number of viable cells. The differences in viable cell count among the groups were statistically significant. Conclusion This study suggests that GSE and marine collagen peptides are highly biocompatible with dental pulp cells and could be considered for further clinical studies.

Equivalence study of the resin-dentine interface of internal tunnel restorations when using an enamel infiltrant resin with ethanol-wet dentine bonding

This preregistered ex vivo investigation examined the dentinal hybrid layer formation of a resinous infiltrant (Icon), with reference to both thickness (HLT) and homogeneity when combined with modified tunnel preparation (occlusal cavity only) and internal/external caries infiltration. The adhesives Syntac and Scotchbond MP were used as controls (Groups 1 and 3) or in combination with Icon (Groups 2 and 4). A split-tooth design using healthy third molars from 20 donors resulted in 20 prepared dentine cavities per experimental group. The cavity surfaces (n = 80) were etched (37% H3PO4), rinsed, and air-dried. Rewetting with ethanol was followed by application of the respective primers. After labeling with fluorescent dyes, either Syntac Adhesive/Heliobond or Scotchbond MP Adhesive was used alone or supplemented with Icon. HLT, as evaluated by scanning electron microscopy, did not significantly differ (P > 0.05), and confocal laser scanning microscopy revealed homogeneously mixed/polymerized resin-dentine interdiffusion zones in all groups. Icon can be successfully integrated into an ethanol-wet dentine bonding strategy, and will result in compact and homogeneous hybrid layers of comparable thickness considered equivalent to the non-Icon controls, thus allowing for preservation of the tooth's marginal ridge and interdental space in the case of internal/external infiltration of proximal caries.

Clinical benefits of immediate dentin sealing: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The clinical complications, success, and survival rates of indirect restorations delivered with the immediate dentin sealing protocol are unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to find and collect evidence on the clinical complication, success, and survival rates of indirect restorations delivered with immediate dentin sealing.

MATERIAL AND METHODS

Electronic databases were searched for clinical studies on immediate dentin sealing up to December 2023, without language or time limitations. The records were included if they were clinical trials evaluating the clinical complication and survival rates of indirect restorations bonded to tooth substrate sealed immediately after preparation with suitable resin bonding. The extracted data were analyzed via Review Manager 5.4 for meta-analysis (α=.05).

RESULTS

A total of 11 studies were included in this review. The clinical complication rate was lower for immediately sealed dentin than for protocols without dentin sealing. The survival rate of restorations luted with the immediate dentin sealing protocol was higher (96.4% to 100%) than that of immediate dentin sealing (81.8% to 96.7%), negatively correlated with the observation time. The intensity and incidence of postoperative sensitivity were statistically significantly lower for restorations with immediate dentin sealing than for those without dentin sealing or conventionally cemented (P<.05).

CONCLUSIONS

Immediate dentin-sealed indirect restorations had fewer clinical complications and higher success and survival rates than those delivered without dentin sealing. To avoid postoperative sensitivity or reduce its intensity, dentin surfaces should be sealed immediately after preparation. More long-term randomized clinical trials are recommended to confirm these evidence-based conclusions.

Prolonged polymerization of a universal adhesive in non-carious cervical lesions: 36-month double-blind randomized clinical trial

OBJECTIVE

To evaluate the effect of prolonged (P) polymerization time of a universal adhesive system applied in etch-and-rinse (ER) or self-etch (SE) strategies on the clinical performance of restorations in non-carious cervical lesions (NCCLs), after 36 months of clinical service.

METHODS

A total of 140 restorations were randomly placed in 35 subjects according to the polymerization time groups: ER (10 s); ER-P (40 s); SE (10 s); and SE-P (40 s) at 1,200 mW/cm2. Composite resin was placed incrementally. The restorations were evaluated immediately and after 6, 12, 18, and 36 months using the FDI criteria. Data were analyzed using the Kaplan-Meier survival test for retention loss, and the Kruskal-Wallis' test for secondary outcomes (α = 0.05).

RESULTS

After 36 months, 19 restorations were lost: ER 6, ER-P 2, SE 9, SE-P 2. The retention rates were 82.3% for ER; 94.1 % for ER-P; 73.5 % for SE; and 94.1 % for SE-P, with a significant difference between ER vs. ER-P and SE vs. SE-P, as well as ER vs. SE-P and ER-P vs. SE (p < 0.0001). Minor defects were observed in 18 restorations for the marginal staining criteria: ER 5, ER-P 2, SE 8, SE-P 3; and in 33 restorations for the marginal adaptation criteria: ER 11, ER-P 4, SE 12, and SE-P 6 (p > 0.05). No restorations showed recurrence of caries or postoperative sensitivity.

CONCLUSIONS

A prolonged polymerization time of 40 s improves the clinical performance of the universal adhesive for both adhesive strategies evaluated, even after 36 months.

CLINICAL SIGNIFICANCE

Prolonging the polymerization time of a universal adhesive from 10 to 40 s has been shown to improve its clinical performance when used in NCCLs.

Multifunctional Dental Adhesives Formulated with Silane-Coated Magnetic Fe3O4@m-SiO2 Core-Shell Particles to Counteract Adhesive Interfacial Breakdown

The process of bonding to dentin is complex and dynamic, greatly impacting the longevity of dental restorations. The tooth/dental material interface is degraded by bacterial acids, matrix metalloproteinases (MMPs), and hydrolysis. As a result, bonded dental restorations face reduced longevity due to adhesive interfacial breakdown, leading to leakage, tooth pain, recurrent caries, and costly restoration replacements. To address this issue, we synthesized and characterized a multifunctional magnetic platform, CHX@SiQuac@Fe3O4@m-SiO2, to provide several beneficial functions. The platform comprises Fe3O4 microparticles and chlorhexidine (CHX) encapsulated within mesoporous silica, which was silanized by an antibacterial quaternary ammonium silane (SiQuac). This platform simultaneously targets bacterial inhibition, stability of the hybrid layer, and enhanced filler infiltration by magnetic motion. Comprehensive experiments include X-ray diffraction, FT-IR, VSM, EDS, N2 adsorption-desorption (BET), transmission electron microscopy, scanning electron microscopy, thermogravimetric analysis, and UV-vis spectroscopy. Then, CHX@SiQuac@Fe3O4@m-SiO2 was incorporated into an experimental adhesive resin for dental bonding restorations, followed by immediate and long-term antibacterial assessment, cytotoxicity evaluation, and mechanical and bonding performance. The results confirmed the multifunctional nature of CHX@SiQuac@Fe3O4@m-SiO2. This work outlined a roadmap for (1) designing and tuning an adhesive formulation containing the new platform CHX@SiQuac@Fe3O4@m-SiO2; (2) assessing microtensile bond strength to dentin using a clinically relevant model of simulated hydrostatic pulpal pressure; and (3) investigating the antibacterial outcome performance of the particles when embedded into the formulated adhesives over time. The results showed that at 4 wt % of CHX@SiQuac@Fe3O4@m-SiO2-doped adhesive under the guided magnetic field, the bond strength increased by 28%. CHX@SiQuac@Fe3O4@m-SiO2 enhanced dentin adhesion in the magnetic guide bonding process without altering adhesive properties or causing cytotoxicity. This finding presents a promising method for strengthening the tooth/dental material interface's stability and extending the bonded restorations' lifespan.

The loss of resin cement adhesion to ceramic influences the fatigue behavior of bonded lithium disilicate restorations

When partial and/or non-retentive preparation, such as those for occlusal veneers, is indicated, a proper and stable adhesion is essential. Therefore, the aim of this in vitro study was to evaluate the effect of loss of adhesion in different regions of the bonding interface on the fatigue behavior of simplified lithium disilicate restorations. For this, lithium disilicate (IPS e.max CAD) discs (1 mm thick and Ø = 10 mm) were fabricated, polished with #400-, #600-, #1200-grit silicon carbide (SiC) papers, and crystallized. As substrate, fiber-reinforced resin epoxy discs (2.5 mm thick and Ø = 10 mm) were fabricated and polished with #600-grit SiC paper. The ceramic bonding surface was treated with 5% hydrofluoric acid and a silane-containing primer (Monobond N), while the substrate was etched with 10% hydrofluoric acid followed by the application of the bonding system primers (Primer A + B). A lacquer (nail polish) was used to simulate the loss of adhesion in specific areas according to the study design to compose the testing groups: bonded (control; did not received nail polish application); - non-bonded (loss of adhesion in the whole specimen area); - margin (loss of adhesion in the ceramic margin); - center (loss of adhesion in the ceramic central area). The adhesive area of partially bonded groups was 50% of the adhesive surface. Then, the discs (n = 12) were bonded to the respective substrate using a resin cement (Multilink N), light-cured, water-stored for 90 days, and subjected to thermocycling (25,000 cycles, 5° to 55 °C) before testing. A cyclic fatigue test was run (20 Hz, initial load of 200 N for 5000 cycles, 50 N step size for 10,000 cycles each until specimen failure), and the fatigue failure load and number of cycles for failure were recorded. As complementary analysis, finite element analysis (FEA) and scanning electron microscopy analysis were performed. Kaplan-Meier log-rank (Mantel-Cox) was conducted for survival analysis. The results showed that as the loss of adhesion reaches the central area, the worse is the fatigue behavior and the higher is the stress peak concentration in the ceramic bonding surface. The bonded specimens presented better fatigue behavior and stress distribution compared to the others. In conclusion in a non-retentive preparation situation, proper adhesion is a must for the restoration fatigue behavior even after aging; while the loss of adhesion reaches central areas the mechanical functioning is compromised.

The Role of Duration of Chlorhexidine Gluconate 2% Application on the Shear Bond Strength of a Total Etch Bonding Agent: A Comparative Study

Introduction

Matrix metalloproteinases enzymes (MMPs) can degrade the hybrid layer which can cause failure of composite restorations. Chlorhexidine gluconate 2% can reduce MMPs activity and increase the bond strength of the resin to dentin.

Purpose

This study aims to determine the role of the duration of chlorhexidine gluconate 2% application on shear bond strength of a total-etch bonding agent.

Methods

A total of 36 freshly extracted maxillary premolars were removed occlusally by one-third of the crown using a carborundum disc until the dentin was exposed. Specimens were divided into four groups n(9). The dentin surfaces were etched for 5s. Group A is the control group. In group B, chlorhexidine gluconate 2% was applied for 30s. In group C, chlorhexidine gluconate 2% was applied for 60s. In group D, chlorhexidine gluconate 2% was applied for 90s. The universal adhesive was applied afterwards and then followed by composite to the dentin surface. All specimens were stored in artificial saliva at 37°C for 24 hours. The shear bond strength was tested using a universal testing machine.

Results

There was an increase in the shear bond strength of the bonding agent along with the additional application duration of chlorhexidine gluconate 2%. All groups gave higher MPa values than the control group. The shear bond strength in group A (control) was 12.64 MPa; Group B (30s of chlorhexidine) was 16.93 MPa; Group C (60s chlorhexidine) was 18.23 MPa; group D (90s of chlorhexidine) was 18.47MPa.

Conclusion

Duration of chlorhexidine gluconate 2% application affects the shear bond strength of the bonding agent with the total-etch system. The effective duration of chlorhexidine gluconate 2% for the restorative procedure is 60 seconds.