Effect of three different contamination removal methods on bond strength of a self-etching adhesive to dentin contaminated with an aluminum chloride hemostatic agent

A scoping review of the influence of clinical contaminants on bond strength in direct adhesive restorative procedures

OBJECTIVE

Clinical contamination during direct adhesive restorative procedures can affect various adhesive interfaces differently and contribute to bulk failure of the restorations. This review aims to summarise the current knowledge on the influence of a variety of clinical contaminants on the bond strength at various adhesive interfaces during adhesive restorative procedures and identify gaps in the literature for future research.

DATA AND SOURCES

An electronic database search was performed in PubMed and EMBASE to identify articles that investigated the influence of contaminants on direct restorative bonding procedures. A data-charting form was developed by two researchers to capture the key characteristics of each eligible study.

STUDY SELECTION

The initial search yielded 1,428 articles. Fifty-seven articles published between 1 Jan 2007 and 25 Oct 2023 were included in the final review. Thirty-three of the articles examined the influence of saliva contamination, twelve articles examined the influence of blood contamination, and twenty-five articles examined the influence of other contaminants.

CONCLUSION

Saliva contamination exerted less influence on the decrease in bond strength when self-etch systems were used, compared to when etch-and-rinse systems were used. Blood contamination adversely affected the bond strength at the interface between resin composite and dentine, and resin composite and resin-modified glass ionomer cement. Treating contaminated surfaces with water spray for 10-30 s followed by air drying could be effective in recovering bond strength following saliva and blood contamination.

CLINICAL SIGNIFICANCE

This scoping review provides a valuable overview of the range of potential clinical contaminants that can influence the bond strength between different interfaces in direct adhesive restorative procedures. Additionally, it identifies potential decontamination protocols that can be followed to restore and enhance bond strength.

Effect of contamination and decontamination methods on the bond strength of adhesive systems to dentin: A systematic review

INTRODUCTION

In a suitable condition, it is important to perform any dental restorative procedure using an operatory field isolated. Then, the aim of this study was to compare the bond strength of composite restorations to dentin affected by any contamination agent through a systematic review.

METHODS

This systematic review was performed following the PRISMA 2020 guidelines. The literature search was conducted until September 2022 by scanning the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts evaluated the bond strength of resin-based materials to permanent human dentin contaminated with blood or saliva were selected for full-text review. The risk of bias was assessed by the RoBDEMAT tool.

RESULTS

A total of 3750 papers resulted from the search from all databases. After the full-text reading, a total of 62 articles remained for the qualitative analysis. The contamination agents used were blood, saliva, and hemostatic agents. A great variety of protocols were used to contaminate the dentin surface, and the contamination process occurred in several steps of the bonding process, including before and after the etching process, after the primer application and after the adhesive application. Also, several decontamination procedures were tested, including reapplication of the etching material, rinsing with water, chlorhexidine or sodium hypochlorite and reapplication of the adhesive system.

CONCLUSION

Any contamination with blood or saliva impaired the bond strength of resin-based materials to dentin. Decontamination procedures including water-spray and reapplication of the bonding system could revert the impairment produced by the saliva or blood contamination. The use of hemostatic agents as a method of blood decontamination is not recommended.

CLINICAL SIGNIFICANCE

Clinicians should avoid contamination during a bonding procedure, otherwise, a reduction in the bond quality is expected.

Bonding Protocols to Reverse the Bond Strength of a Universal Adhesive to Hemostatic Agent-contaminated Dentin

OBJECTIVE

To evaluate the effect of different bonding protocols on the microtensile bond strength (μTBS) of a universal adhesive to dentin contaminated with a hemostatic agent.

METHODS AND MATERIALS

Ninety-five extracted premolars were used in this study. For the μTBS test, 80 teeth were cut to expose mid-coronal dentin and randomly divided into two groups (uncontaminated dentin and hemostatic agent-contaminated dentin). Each group was further divided into five subgroups (n=8/group): 1) SE: no additional treatment, 2) ER: etching with 32% phosphoric acid, 3) CHX: rinsing with 0.2% chlorhexidine, 4) EDTA: rinsing with 17% EDTA, and 5) T40: application of universal adhesive for 40 seconds. A universal adhesive was applied followed by resin composite build-up. μTBS test was performed after 24 hours of water storage. Two-way analysis of variance (ANOVA) was calculated followed by the Duncan testing (α=0.05). The failure mode was analyzed using light microscopy. Additional teeth were prepared for energy-dispersive X-ray (EDX) analysis (n=1/group) and resin-dentin interface observation (n=2/group) using scanning electron microscopy.

RESULTS

Adverse effects of hemostatic agent contamination on the bonding performance of a universal adhesive was found in the SE, CHX, and T40 groups (p<0.05). Fewer and shorter resin tags were observed in the SE, CHX, and T40 groups. A higher percentage of adhesive failure and mixed failure was found in contaminated dentin. All bonding protocols revealed lower amounts of Al and Cl after dentin contamination, except for the SE group.

CONCLUSIONS

Hemostatic agent contamination adversely affected dentin bond strength. However, this bond strength could be reversed using the etch-and-rinse technique or rinsing with EDTA prior to adhesive application.

Use of final irrigant Potassium Titanyl Phosphate laser; Sapindus Mukorossi and Fotoenticine on the bond values of zirconia post-to-canal dentin

AIMS

Assessment of the efficacy of final root canal irrigants Sapindus mukorossi (SM), Potassium titanyl phosphate laser (KTPL), and Fotoenticine (FTC) on the push-out bond strength (PBS) of zirconia post.

MATERIALS AND METHODS

The root canal procedure was initiated using the 10 K file and the working length was determined on single-rooted human premolar teeth after decoration. The canals were then enlarged using ProTaper universal system and filled using single cone gutta-percha (GP) and AH Plus resin sealer. Post space was prepared by removing 10mm of GP from the canal. All the teeth were then allocated into four groups based on the final irrigating regime used (n=10) Group 1: 5.25% NaOCl+17% EDTA, Group 2: 5.25% NaOCl + KTPL, Group 3: 5.25% NaOCl + FTC and Group 4: 5.25% NaOCl+ SM. Zirconia posts were cemented in the canal space. The specimens were sectioned and implanted in auto-polymerizing acrylic resin. A universal testing machine and stereomicroscope at 40x magnification were used for PBS and failure mode analysis. ANOVA and Tukey post hoc test were used to make group comparisons(p=0.05).

RESULTS

Group 4 (5.25% NaOCl+ SM) coronal section displayed the highest PBS (9.29±0.24 MPa). However, group 3 (5.25% NaOCl+ FTC) apical third (4.08±0.14 MPa) showed the lowest bond values. Group 2 (5.25% NaOCl+ KTP laser) and Group 3 at all three-thirds unveiled no significant difference in PBS(p>0.05). However, Group 1 (5.25% NaOCl+17%EDTA) and Group 4 displayed comparable outcomes of bond strength(p>0.05) CONCLUSION: Sapindus mukorossi has the ability to be used as a final root canal irrigant alternative to EDTA. However, future studies are still required to conclude the outcomes of existing research.

Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration

PURPOSE

To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated.

MATERIAL AND METHODS

A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration.

RESULTS

NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single-step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion.

CONCLUSIONS

Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators.

Universal adhesive application to contaminated/non-contaminated dentin with three different protocols: An in vitro shear bond strength and SEM analysis

This study aimed to comparatively evaluate the shear bond strength (SBS) of a universal adhesive to contaminated/non-contaminated dentin when applied with three different protocols. One-hundred-eighty dentin samples were divided randomly into 12 groups (n=15). The groups were created by combining four dentin contamination conditions (non-contaminated or contaminated with blood, hemostatic, or blood+hemostatic) with three application protocols for Single Bond Universal (no-preconditioning or preconditioning with the 35% phosphoric or 1% gallic acid). Following thermal cycling, the SBS test was performed. Data were analyzed using two-way-ANOVA and Tukey's HSD (p<0.05). Dentin surfaces subjected to phosphoric acid, gallic acid, or hemostatic were examined using scanning electron microscope (SEM) analysis. SBS results were influenced by both the dentin contamination (p<0.001) and application protocol (p<0.001). A significant interaction was found between the two factors (p=0.005). The highest bonding performance to contaminated dentin -at all contamination conditions- was achieved with the gallic acid preconditioning.

The effects of different surface contaminators on the shear bond strength of a universal adhesive system to dentin: an experimental study

Background. Contamination of dentin surface is one of the common problems in restorative dentistry. The aim was to investigate the effects of different surface contaminators on the dentin shear bond strength (SBS) of universal adhesive system (UAS) applied in etch-and-rinse (ER) and self-etch (SE) strategies.

Methods. One hundred forty-four maxillary anterior sound human teeth were divided into six groups based on the types of surface contaminators: no surface contaminator (control) and experimental groups contaminated with blood, saliva, aluminium chloride (ALC), ferric sulphate (FS), and caries disclosing agent (CDA). Then, each group was further subdivided into two, based on the application strategy of UAS (ER and SE). After applying the adhesive according to the manufacturer’s instructions, and bonding cylindrical composite samples, the SBS was measured. The data were analysed using two-way ANOVA, Tukey’s HSD test and t test (P < 0.05).

Results. The SBS in all contaminated groups, except for CDA, was significantly lower in both ER and SE strategies compared to control group (P < 0.05). A comparison between the application strategies revealed that ER and SE were only significantly different in the FS contaminated group (P < 0.05).

Conclusion. All tested contaminators, except CDA, significantly decreased SBS of UAS in both ER and SE strategies.

Comparative evaluation of the effect of decontamination protocol on the shear bond strength of eighth generation bonding agent to contaminated dentin: an in vitro study

Introduction

This in vitro study aims to evaluate and compare the effect of decontamination protocol - based on sodium hypochlorite - NaOCl, as a decontaminating agent, followed by the application of a collagen cross-linking agent like sodium ascorbate or Proanthocyanidin on the shear bond strength of eighth generation bonding agent to contaminated dentin (saliva, blood and blood followed by hemostatic agent).

Methods

The buccal surfaces of extracted premolars were flattened to expose the dentine. The teeth were then randomly divided into 3 groups based on the contaminant used (saliva, blood and blood followed by hemostatic agent). Decontamination protocol was carried out with sodium hypochlorite followed by application of either of the two collagen cross-linking agents (sodium ascorbate/proanthocyanidin) in each group. FuturaBond DC (eighth generation) bonding agent was used to bond composite to dentin surfaces which was subjected to shear bond strength testing. Data was analyzed by one-way ANOVA and Tukey test.

Results

All the groups (contaminated with saliva, blood, or hemostatic agent) showed a decrease in shear bond strength of composite resin to dentin. The shear bond strength of composite resin to dentin was least affected by contamination with saliva followed by contamination with blood and was most affected by contamination with a hemostatic agent.

The decontamination protocol carried out showed that the combination of NaOCl and Proanthocyanidin improved the shear bond strength of composite to dentin significantly more than the combination of NaOCl and sodium ascorbate or of sodium hypochlorite used alone.

The Effect of Hemostatic Agents on the Retention Strength of Zirconia Crowns Luted to Dentin Abutments

The purpose of this study was to investigate whether hemostatic agents (HA) show an effect on the retention strength (RS) of zirconia crowns luted to dentin abutments after cleaning with an air/water spray. Human molars (N = 60/n = 12) were prepared and zirconia crowns were milled. Prior to luting (Scotchbond Universal/RelyX Ultimate), molars were pretreated using HA: i. 25% AlCl₃ (VSC), ii. 20% Fe₂(SO₄)₃ (VS), iii. 15.5% Fe₂(SO₄)₃ (AS), iv. 12.7% iron ion solution (ASX) and v. no pretreatment (control). Mastication simulation and pull-out tests were performed. Failure types were defined: cohesive 1-tooth root; cohesive 2-tooth crown; adhesive 1-cement on tooth; adhesive 2-cement on tooth and crown; mixed-adhesive/cohesive. Data were analyzed using 1-way ANOVA, post-hoc Scheffé, Pearson's chi-square-test and Ciba⁻Geigy table (p = 0.05). No RS differences between the tested groups were observed (p = 0.200). ASX fractured more cohesive 2 than the control group. VSC showed more cohesive 2 than adhesive 1 fractures. VS showed more adhesive 2 than mixed fractures. AS showed more cohesive 2 than adhesive 1 and more adhesive 2 than mixed fractures. ASX showed predominantly cohesive 2 fractures. RS was not affected when HA were cleaned off by 30 s of air/water spray prior to luting. HA still seem to weaken the dentin abutment, making it prone to cohesive fractures.

Effect of hemostatic agent on marginal gaps of class V giomer restorations

Background

Contamination of dentin with hemostatic agents might exert a deleterious effect on adhesive procedures on dentin. The present study was undertaken to investigate the effect of aluminum chloride hemostatic agent on marginal gaps in Cl V giomer restorations.

Material and Methods

Fifty sound bovine permanent incisors were selected for the purpose of this in vitro study and Cl V cavities were prepared on their buccal surfaces; the gingival margins of the cavities were placed in dentin. The tooth samples were randomly assigned to two groups (n=25). The samples in groups 1 and 2 underwent a restorative procedure without and with the application of aluminum chloride hemostatic agent in the cavity, respectively, before application of the adhesive. BeautiBond one-step self-etch adhesive and Beautifil II giomer restorative material were used for the restoration of the cavities in both groups. The samples were thermocycled and sectioned, followed by measuring the gap sizes at gingival margins in µm under a stereomicroscope. The marginal gaps were compared with Mann-Whitney U test. Statistical significance was set at P<0.05.

Results

The results showed significant differences in the mean marginal gaps between the two groups under study (P<0.001); the mean marginal gaps were higher in group 2 (with hemostatic agent) compared to those in group 1 (without hemostatic agent) (P<0.0005).

Conclusions

Contamination with aluminum chloride hemostatic agent in giomer restorations gave rise to higher gingival margin gaps.

Key words:Dental adhesives, giomer restorative material, hemostatic agent, marginal adaptation.

Sealing of adhesive systems in ferric sulfate-contaminated dentinal margins in class V composite resin restorations

Background. Hemostatic agents are applied to prepare an isolated bleeding-free condition during dental treatments and can influence adhesive restorations. This study evaluated the effect of a hemostatic agent (ViscoStat) on microleakage of contaminated dentinal margin of class V composite resin restorations with three adhesives. Methods. Sixty freshly extracted human molars were selected and class V cavities (3×3×1.5 mm) were prepared on buccal and lingual surfaces. Gingival margins of the cavities were placed below the cementoenamel junction. The teeth were divided into six groups randomly. The adhesives were Excite, AdheSE and AdheSE One. In three groups, the gingival walls of the cavities were contaminated with ViscoStat and then rinsed. The cavities were restored with composite resin and light-cured. After storage in distilled water (37°C) for 24 hours and polishing, the samples were thermocycled and sealed with nail varnish. Then they were stored in 1% basic fuchsin for 24 hours, rinsed and mounted in self-cured acryl resin, followed by sectioning buccolingually. Dye penetration was observed under a stereomicroscope and scored. Data were statistically analyzed with Kruskal-Wallis and Mann-Whitney U tests. P<0.05 was set as the level of significance. Results. Only in the Excite group, contamination did not have adverse effects on dentin microleakage (P > 0.05). In the contaminated groups, Excite had significantly less microleakage than the others (P = 0.003). AdheSE and AdheSE One did not exhibit significant difference in microleakage (P > 0.05). Conclusion. ViscoStat hemostatic agent increased dentinal microleakage in AdheSE and AdheSE One adhesives with no effect on Excite.

Marginal integrity of low-shrinkage and methacrylate-based composite resins: Effect of three different hemostatic agents

Background

Moisture control is very important in restorative procedures in dentistry. Use of hemostatic agents helps control moisture; however, they might result in changes on enamel and dentin surfaces, affecting composite resin bond quality. The aim of this in vitro study was to evaluate the marginal microleakage of two different composite resins with the use of three different hemostatic agents.

Material and Methods

Standardized Class V cavities were prepared on the buccal and lingual surfaces of 48 premolars with cervical margins 1 mm apical to the cementoenamel junction (CEJ). The samples were randomly divided into 8 groups. In groups 1 to 4, an etch-and-rinse adhesive (Adper Single Bond) was applied as the bonding system, followed by exposure to different hemostatic agent: group 1: no hemostatic agent (control); group 2: ViscoStat; group 3: ViscoStat Clear; and group 4: trichloracetic acid, as hemostatic agents. The cavities were restored with Z-250 composite resin. In group 5 to 8 Silorane System Adhesive (Filtek P90 Adhesive) was applied as a bonding agent, followed by exposure to different hemostatic agents in a manner similar to that in groups 1to 4. The cavities were restored with Filtek P90, a low-shrinkage composite resin. The samples in each group were evaluated for dye penetration under a stereomicroscope at ×36 after 24 hours and a 500-round thermocycling procedure at enamel and dentin margins. Statistical analysis was carried out using Kruskal-Wallis and Mann-Whitney tests (α=0.05).

Results

Z-250 composite resin exhibited significantly higher dentin microleakage scores compared to Filtek P90 (P = 0.004). Trichloracetic acid increased dentin microleakage with Filtek P90 (P=0.033).

Conclusions

Under the limitations of this in vitro study, application of hemostatic agents did not affect microleakage of the two tested composite resins except for trichloracetic acid that increased marginal microleakage when used with Filtek P90.

Key words:Composite resin, dental leakage, hemostatics, silorane system adhesive.

Haemostatic agents on the shear bond strength of self-adhesive resin

Background

Dentin surface contaminated with haemostatic agents can interfere with the bonding of self-adhesive resin cement. Therefore the purpose of this study was to evaluate the effect of various haemostatic agents such as Aluminium chloride, Ferric sulphate and Tannic acid on the shear bond strength of self-adhesive resin luting agent.

Material and Methods

The buccal surfaces of extracted premolars were flattened to expose the dentine. The teeth were then randomly divided into four groups. In Group I Aluminium Chloride was applied on the flattened dentinal surface, in Group II Ferric Sulphate was applied to exposed dentin surface, in Group III tannic acid was applied on to the dentinal surface, and the control group, i.e. Group IV was rinsed with saline. After the surface treatment, all the teeth were air dried. Then a predetermined dimension of RelyX™ U200 self-adhesive resin cement was bonded to the pretreated dentin surfaces. The samples were then stored under 370C in distilled water for 24 hours under 100 % humidity. Following this each sample was tested for shear bond strength with an Instron testing machine at a crosshead speed of 1mm/min.

Results

There was significant difference in the shear bond strength of control and tannic acid contaminated group (p<0.05), whereas there was no significant differences between the shear bond strength between control and aluminium chloride and ferric sulphate groups (p>0.05).

Conclusions

The usage of haemostatic agent can negatively affect the bond strength of self-adhesive resin cement (Rely X) on to the dentin surface. As per the study Tannic acid significantly weakened the bond between the self-adhesive resin and dentin.

Key words:Aluminium chloride, Ferric sulphate, haemostatic agent, self-adhesive resin cement, shear bond strength, Tannic acid.