Influence of airborne particle abrasion on dentin bonding effectiveness of a 2-step universal adhesive

OBJECTIVE

To determine the effect of airborne particle abrasion (APA) on micro-tensile bond strength (µTBS) to dentin using different air-abrasion/polishing powders.

METHODS

The bonding effectiveness of G2 Bond Universal (G2B), used in etch-and-rinse (E&R) and self-etch mode (SE), was tested on bur-cut dentin and dentin air abraded/polished using six different powders (aluminum oxide 29 µm (AO29) and 53 µm (AO53), aluminum trihydroxide (AT), sodium bicarbonate (SB), sodium bicarbonate soft (SBsoft) and bioactive glass (BG); Velopex). Adhesive-composite resin specimens were immersed in distilled water at 37 °C for one week and cut into microspecimens. Half of the specimens were subjected to 50,000 thermocycles (aged). Immediate and aged μTBS to dentin were measured. Statistical analysis was performed using linear mixed-effects (LME) modeling (p < 0.05).

RESULTS

Comparing the aged bond strengths to air-abraded/polished dentin with bur-cut dentin, pretreatment with SB and SBsoft in combination with G2B used in E&R mode, and BG air polishing in combination with both application modes (E&R, SE), resulted in a significantly higher bond strength. Dentin bond strength was only significantly lower when air abraded with AO29 and using G2B in SE mode. Aging did not significantly influence bond strength for both application modes (E&R, SE), except for AO29 and AT-treated dentin, where bond strengths decrea sed significantly using G2B in SE mode. In general, G2B reached significantly higher bond strengths on air-abraded/polished dentin in E&R mode than in SE mode.

CONCLUSION

Air-abrasion/polishing did not impair dentin bond strength using G2B, except when dentin was air abraded with AO29 and using G2B in SE mode. Air polishing positively influenced the bond strength to dentin in specific groups.

CLINICAL SIGNIFICANCE

APA is safe concerning bonding to dentin. The E&R application mode is preferred using G2B as adhesive on air-abraded/polished dentin. Air polishing with BG positively influenced dentin bond strength for both application methods.

The effect of repair protocols and chewing simulation on the microtensile bond strength of two resin matrix ceramics to composite resin

BACKGROUND

To assess the micro tensile bond strength (µTBS) of two resin matrix ceramic (RMC) blocks bonded to composite resin by using different repair protocols with and without chewing simulation (CS).

MATERIALS AND METHODS

Two resin matrix ceramic blocks (Vita Enamic and Lava Ultimate) were divided into 4 groups according to the surface treatments: Bur grinding (control), Bur grinding + silane, 9.5% HF acid etching, and 9.5% HF acid etching + silane. The single bond universal adhesive was applied on all specimens after the surface treatments according to the manufacturer's instructions, it was administered actively on the treated surface for 20 s and then light cured for 10 s, followed by incremental packing of composite resin to the treated surface. Each group was further divided into 2 subgroups (with/without chewing simulation for 500,000 cycles). A micro tensile bond strength test was performed for each group (n = 15). The effect of surface treatments on the materials was examined by using a scanning electron microscope (SEM). The micro tensile bond strength (MPa) data were analyzed with a three-way ANOVA, the independent t-test, and one-way ANOVA followed by the Tukey post-hoc test.

RESULTS

µTBS results were significantly higher for Lava Ultimate than Vita Enamic for all the surface treatment protocols with (p < 0.01). The chewing simulation significantly negatively affected the micro-tensile bond strength (p < 0.001). Bur grinding + saline exhibited the highest bond strength values for Lava Ultimate, both with and without chewing simulation. For Vita Enamic, bur grinding + saline and HF acid + saline showed significantly higher bond strength values compared to other surface treatments, both with and without chewing simulation (p ≤ 0.05).

CONCLUSION

Bur grinding + silane could be recommended as a durable repair protocol for indirect resin matrix ceramics blocks with composite resin material.

75 Years Ago: Discovery of Resin Adhesion to Acid-etched Enamel - A Comparison of the 1949 and 1955 Methods

PURPOSE

This paper describes previously unknown details about the discovery of resin adhesion to acid-etched human enamel.

MATERIALS AND METHODS

A literature review was performed through manual assessments. Primary sources revealing the discovery of resin curing on etched enamel were analyzed considering the research objectives and methodological procedure during that era, including the type of teeth used, preparatory measures, acid-etching process, type of resin and its application, and follow-up observations. Additionally, the political and economic contexts were examined.

RESULTS

In 1949, acid etching was found to promote adhesion with acrylic resin, a finding described again in 1955. The 1949 studies utilized nitric acid for enamel etching and the acrylate resin Paladon from the Kulzer company (Germany). Conversely, the 1955 investigations employed phosphoric acid and an unnamed acrylate, likely a self-curing resin supported by Kulzer in the late 1930s. Disparities in the 1949 and 1955 findings can be ascribed to varying objectives and test conditions amidst a turbulent political backdrop, significantly impacting the Kulzer company.

CONCLUSION

The discovery of resin adhesion to acid-etched enamel, approaching its 75th anniversary in 2024, is a landmark in 20th-century adhesive dentistry. Paladon represents a pioneering compound, exemplifying the influence of political, ideological, and economic factors on scientific advancements during that period.

Ultrathin Feldspathic Ceramic Veneers: A Pilot SEM Evaluation of Etched Intaglio Surfaces

Ultrathin ceramic veneers are a viable therapeutic option to manage esthetic challenges in the anterior zone. Proper conditioning of the intaglio surface of porcelain veneers is essential to achieve an adequate bonding. In clinical practice, this is typically done with chemical etching using an acid-containing agent, such as hydrofluoric acid. While it is well established that the etching effect is dependent on etching time and the acid concentration, little is known about the impact of etching time and the veneer fabrication method. The purpose of this pilot study was to evaluate, using scanning electron microscopy (SEM), the effect that different etching-time protocols have on the intaglio surface characteristics of ultrathin ceramic veneers fabricated with either the platinum foil technique or the refractory die technique. Several replicas of an ultrathin feldspathic ceramic veneer for a maxillary central incisor were fabricated. Individual specimens were processed according to different intaglio surface-etching protocols: no etching, etching for 90 seconds, etching for 120 seconds, and etching for 150 seconds (9.6% hydrofluoric acid used for all etching groups). It was observed that the 120-second etching protocol resulted in a favorable microroughness surface pattern in the platinum foil group. This pattern was comparable to that obtained by etching for 90 seconds with hydrofluoric acid the intaglio surface of veneers fabricated with the refractory die technique. Increasing the etching time to 150 seconds did not result in a more favorable roughness pattern.

To etch or not to etch, Part III: On the hydrophobic-rich content and fatigue strength of universal adhesives after long-term ageing

OBJECTIVES

To examine whether dentin-etching extension and/or the hydrophobic-rich content of hybrid layers would affect fatigue strengths of a mild universal adhesive after long-term aging.

METHODS

Twin-bonded resin-dentin interfaces were produced by etching sound midcoronal dentin beams with 32 % ortho-phosphoric acid for 15 s (OPA15s), 3 s (OPA3s) or 10 % meta-phosphoric acid for 15 s (MPA15s). Samples were bonded with a mild universal adhesive with or without additional coating using a solvent-free bisGMA-based bonding resin. Self-etch application served as control. Composite buildups were made with a nanofilled composite. Bar-shaped twin-bonded interfaces (0.9 × 0.9 × 12 mm) were aged for two years in artificial saliva at 37 ℃ and tested under 4-point flexure at quasi-static (n = 16) and cyclic loads (n = 35) until failure. The stress-life fatigue behavior was evaluated using the staircase method at 4 Hz. Crack initiation and fracture patterns were evaluated by SEM. Cyclic-loaded data was analyzed by Kruskal-Wallis on Ranks (α = 0.05).

RESULTS

Significantly higher fatigue life distributions and higher endurance limits were observed for less aggressive etch-and-rinse protocols (OPA3s and MPA15s) after long-term ageing. Hydrophobic-rich coating produced 20-32 % higher endurance limits, prevented micrometer-sized porosities at bonded interfaces, reduced etching-associated variability and lowered crack formation. Significance Long-term hydrolysis produces detrimental effects on the fatigue strength of resin-dentin interfaces. The bond-promotion effect of less aggressive etch-and-rinse protocols and the creation of hybrid layers with higher hydrophobic-rich content are critical to extend the durability of mild universal adhesives. Therefore, current oversimplification trends in adhesive dentistry may limit resin-dentin bonding performance.

Influence of Application Modes on Increasing Bond Strength Longevity of Self-etching and Universal Adhesive Systems to Enamel

The present study aimed to evaluate the influence of application mode on the short-term microshear bond strength longevity of self-etching and universal adhesive systems to enamel, the failure mode, and the resulting enamel surface micromorphology. Ninety enamel surfaces were obtained from sound third molars, planed, and randomly assigned to nine groups, according to the application mode and the adhesive system (n=10). There were three primer application modes: according to the manufacturer's recommended application time (control), using double the application time recommended for the primer and selective enamel etching. The adhesive systems used were: Clearfil SE Bond (Kuraray), FL-Bond II (SHOFU), and Futurabond U (Voco). At least two resin-bonded composite cylinders (Grandioso Light Flow, Voco) were placed on each enamel surface, and then evaluated for microshear bond strength at 24 hours and 180 days of storage in solution body fluid (SBF) at pH 7.4. Failure modes were evaluated with a stereoscopic microscope at 20× magnification. A micromorphological analysis of the enamel surface was performed under a scanning electron microscope at 5000× magnification before and after the treatments. Mixed models for repeated measures over time showed significant interaction among application modes, adhesive systems, and time periods (p=0.0331). The bond strength of FL-Bond II adhesive to enamel observed after performing selective enamel etching was significantly higher than that observed after applying the control treatment (p=0.0010) at both 24 hours and 180 days. However, no significant difference was observed between the application of this same adhesive at double the time recommended by the manufacturer and the other two application modes (p>0.05). There was also no significant difference in the microshear bond strength for the enamel treatments applied using Clearfil SE Bond and Futurabond U (p>0.05). A significant reduction in bond strength to enamel was observed at the 180-day storage time for all the adhesive systems when selective enamel etching was performed (p<0.0001). No significant association was observed between the adhesive system failure mode and the enamel treatments (p=0.1402 and p=0.7590 for 24 hours and 180 days, respectively). The most prevalent failure was the adhesive type.

Does the application of dimethyl sulfoxide improve resin bonding to eroded dentine? Four-year in vitro evaluation

OBJECTIVE

To evaluate the effect of dimethyl sulfoxide (DMSO) on the microtensile bond strength (µTBS) and nanoleakage (NL) of universal adhesives on eroded dentine, immediately and after four years of water storage.

METHODS

Sixty-four sound human molars were distributed into 16 groups according to (1) Dentine surface (sound and eroded dentine); (2) dimethyl sulfoxide application (with or without); (3) Application mode (etch-and-rinse or self-etch) and (4) Storage time (immediate and four years). One mild universal adhesive was used (Scotchbond Universal). The restoration was then performed with a composite resin and the specimens were sectioned into resin-dentine bonded sticks. Resin-dentine bonded sticks were tested (immediately and after four years of water storage) for µTBS (0.5 mm/min) or used to assess NL. Data on μTBS and NL were analyzed using four-way ANOVA and Tukey's test (α = 0.05).

RESULTS

Only the 3-way cross-product interaction 'substrate vs DMSO vs time' was statistically significant (p = 0.007). Eroded dentine showed a lower mean of µTBS and a higher mean of NL values than sound dentine. However, when DMSO was applied, no significant decrease of μTBS or NL values was observed after four years of water storage, regardless of adhesive strategies, or dentine evaluated, when compared to immediate results.

SIGNIFICANCE

Water-based DMSO pre-treatments not only prevent degradation of MDP-containing simplified adhesives but also serve as a potential alternative to improve long-term bonding properties to eroded dentine. The versatility of using a single pre-treatment for both self-etch or etch-and-rinse bonding to eroded dentin may facilitate future clinical applications.

Preheated Composite as an Alternative for Bonding Feldspathic and Hybrid Ceramics: A Microshear Bond Strength Study

PURPOSE

To evaluate the bond strength between alternative or conventional luting agents and indirect restorative materials.

MATERIALS AND METHODS

Blocks of a polymer-infiltrated ceramic network (PICN, Vita Enamic) and a feldspathic ceramic (FEL, Vita Mark II) were sliced and divided according to the luting agent: resin cement (PICN-RC, FEL-RC), flowable composite (PICN-FC, FEL-FC), or preheated composite (PICN-PH, FEL-PH). The ceramic surfaces were polished, etched with 5% hydrofluoric acid for 60 s, and then a silane layer was applied. Cylinders of the luting agents were built up on the ceramic surfaces. In half the samples, the microshear bond strength (µSBS) was tested after 24 h (baseline). The other half was tested after 5000 thermocycles (5°C-55°C) (aging). The failure modes were determined using a stereomicroscope, and the ceramic surfaces were analyzed using a scanning electron microscope. Data were statistically analyzed with two-way ANOVA.

RESULTS

Thermocycling reduced the bond strength values of all experimental groups. Regarding FEL, the preheated composite obtained the highest results. Resin cement showed results similar to the flowable composite at baseline and after aging. The highest results of PICN were obtained from the preheated composite followed by resin cement and flowable composite. Significant differences among the three luting agents were observed before and after aging. The most frequent failures among the experimental groups were adhesive and cohesive in the ceramic.

CONCLUSION

Bond strength results indicate that the preheated composite can be an alternative for adhesive cementation when applied on the tested feldspathic ceramic or PICN.

Randomized Clinical Split-Mouth Study on Partial Ceramic Crowns Luted with a Self-adhesive Resin Cement with or without Selective Enamel Etching: Long-Term Results after 15 Years

PURPOSE

This follow-up of a randomized clinical split-mouth study aimed to investigate the influence of selective enamel etching on the long-term clinical performance of partial ceramic crowns (PCCs) luted with a self-adhesive resin cement.

MATERIALS AND METHODS

43 patients received two PCCs (Vita Mark II; Cerec 3D) each for the restoration of extensive lesions with multiple cusp coverage, inserted with a self-adhesive resin cement (RelyX Unicem, RXU). Using a split-mouth design, one PCC received additional selective enamel etching (RXU+E) and one did not (RXU-E). Patients were clinically evaluated at baseline and after up to 15 years (median observation period 176 months) using modified USPHS and FDI criteria. The data were analyzed non-parametrically (chi-squared tests, α = 0.05). Clinical survival of all restorations after 15 years was evaluated using the Kaplan-Meier analysis.

RESULTS

After 15 years, 19 patients were available for clinical assessment (recall rate: 56%). Kaplan-Meier analysis showed a cumulative survival of 78.1% for RXU+E and of 42.9% for RXU-E, indicating a significantly higher survival rate for RXU+E (p = 0.004). Regarding the clinical performance of PCCs available for the 15-year evaluation, no statistically significant differences were found between RXU+E and RXU-E using modified USPHS and FDI criteria. Both groups revealed significant deterioration over time regarding surface luster, marginal adaptation, and marginal discoloration. RXU+E resulted in significantly inferior anatomic form over time and a significant improvement in post-operative hypersensitivity compared to baseline.

CONCLUSION

For posterior PCCs, selective enamel etching can be recommended based on higher survival rates after 15 years. Clinically, deterioration due to aging is similar in both groups.

Scanning electron microscope analysis to evaluate the effect of pretreatment with ozone and sodium hypochlorite on pits and fissures of primary teeth

Introduction

The cornerstone of preventative therapy is made up of pit and fissure sealants and fluorides. Resin sealants have been shown to help reduce fissure decay in both primary and permanent teeth. Etching of primary molars is not effective due to prismless enamel, higher organic content, and diversity in fissure shape. Methods of pretreatment of pits and fissures have been hypothesized to promote microporosities in etched enamel and hence sealant adherence. Examining the etching pattern and surface roughness of the enamel surface can be used to gauge these.

Objective

This study aimed to evaluate the effect of pretreatment with ozone gas and 5.25% sodium hypochlorite solution on pits and fissures of primary teeth to check for the etching pattern and surface roughness.

Materials and Methods

Thirty noncarious primary molars were sectioned to retain the crowns, and randomly divided into three groups, sodium hypochlorite, ozone gas, and control. Each sample was pretreated with the agent, washed, followed by etching with 37% phosphoric acid. Samples were sectioned and subjected to scanning electron microscope analysis to evaluate the etching pattern and surface roughness.

Results

Comparison of the etching pattern in three groups showed a statistically insignificant difference (P=0.364). Surface roughness was highest in the hypochlorite group followed by ozone and control which showed a statistically significant difference (P = 0.001). The surface area between the three groups showed a statistically insignificant difference.

Conclusion

Sodium hypochlorite is a better pretreatment agent compared to ozone gas and acid etching alone. However, as all results were not statistically significant further research must be carried out to prove the effectiveness of these agents.

Evaluation of the masking efficacy of caries infiltration in post-orthodontic initial caries lesions: 1-year follow-up

OBJECTIVES

This study aimed to qualitatively and quantitatively assess the masking efficacy and color stability of resin infiltration on post-orthodontic ICL after 1 year.

MATERIALS AND METHODS

In 17 adolescents, 112 ICL (ICDAS-1: n = 1; ICDAS-2: n = 111) in 112 teeth were treated by resin infiltration (Icon, DMG) 3 to 12 months after bracket removal. The etching procedure was performed up to 3 times. Standardized digital images were taken before treatment (T0), 7 days (T7) and 12 months (T365) after treatment. Outcomes included the evaluation of the color differences between infiltrated and healthy enamel at T0, T7, and T365 by quantitative (colorimetric analysis (ΔE), ICDAS scores) and qualitative methods (5-point Likert scale (deteriorated (1), unchanged (2), improved, but not satisfying (3), improved and no further treatment required (4), completely masked (5)).) Differences between time points were analyzed by using Friedman test (ΔΕ) and chi-square tests (ICDAS).

RESULTS

The median color difference (25th/75th percentiles) between carious and healthy enamel at baseline (ΔΕ0) was 10.2(7.7/13.6). A significant decrease was observed 7 days after treatment (ΔΕ7 = 3.1(1.8/5.0); p < 0.001; ICDAS; p < 0.001). No significant changes based on ΔΕ (p = 1.000), and ICDAS grade (p = 0.305) were observed between T7 and T365 (ΔΕ12 = 3.4 (1.8/4.9)). Furthermore, at T365 four experienced dentists classified 55% and 39% of the lesions as "improved and no further treatment required" and "completely masked," respectively (Fleiss kappa: T365 = 0.851 (almost perfect)).

CONCLUSION

Resin infiltration efficaciously masked post-orthodontic ICL 7 days and 12 months after treatment. These results for most of the teeth could not only be observed by quantitative but also by qualitative analysis.

CLINICAL RELEVANCE

Resin infiltration efficaciously masks post-orthodontic initial carious lesions. The optical improvement can be observed directly after treatment and remains stable for at least 12 months.

Pre-cementation treatment of glass-ceramics with vacuum impregnated resin coatings

OBJECTIVE

The study aimed to investigate the effectiveness of a vacuum impregnation process to eliminate the porosity at the ceramic-resin interface to optimize the reinforcement of a glass-ceramic by resin cementation.

METHODS

100 leucite glass-ceramic disks (1.0 ± 0.1 mm thickness) were air-abraded, etched with 9.6 % HF acid, and silanated. Specimens were randomly allocated to 5 groups (n = 20). Group A received no further treatment (uncoated control). Groups B and D were resin-coated under atmospheric pressure, whereas groups C and E were resin-coated using vacuum impregnation. The polymerized resin-coating surfaces of specimens in groups B and C were polished to achieve a resin thickness of 100 ± 10 µm, while in groups D and E no resin-coating modification was performed prior to bi-axial flexure strength (BFS) determination. Optical microscopy was undertaken on the fracture fragments to identify the failure mode and origin. Comparisons of BFS group means were made by a one-way analysis of variance (ANOVA) and post-hoc Tukey test at α = 0.05.

RESULTS

All resin-coated sample groups (B-E) showed a statistically significant increase in mean BFS compared with the uncoated control (p < 0.01). There was a significant difference in BFS between the ambient and vacuum impregnated unpolished groups (D and E) (p < 0.01), with the greatest strengthening achieved using a vacuum impregnation technique.

SIGNIFICANCE

Results highlight the opportunity to further develop processes to apply thin conformal resin coatings, applied as a pre-cementation step to strengthen dental glass-ceramics.

Resin Cement/Enamel Interface: A Morphological Evaluation of the Acid-Base Resistant Zone, Enamel Etching Pattern, and Effect of Thermocycling on the Microshear Bond Strength

PURPOSE

To evaluate the effects of etching mode (self-etch and etch-and-rinse) on acid-base resistant zone (ABRZ) formation at the resin cement/enamel interface and enamel etching pattern, as well as the effects of thermocycling (0, 5000, and 10,000 cycles) on the enamel microshear bond strength (μSBS) mediated by dual-cure resin cements (DCRC).

MATERIALS AND METHODS

Two DCRC were used in 4 groups: Panavia V5 in self-etch (V5NE) and etch-and-rinse mode (V5E); and Estecem II in self-etch (ENE) and etch-and-rinse mode (EE). For ABRZ observation, the bonded interface was subjected to a demineralizing solution. The morphological attributes of the interface and etching patterns were observed using FE-SEM. For μ-SBS, cylinders with a 0.79-mm internal diameter and 0.5-mm height were made with DCRC and tested in shear after 0, 5000, and 10,000 thermal cycles (TC) (5°C and 55°C) (n = 10).

RESULTS

The formation of an enamel ABRZ was observed in all groups with different morphological features between self-etch and etch-and-rinse groups. A funnel-shaped erosion beneath the interface was present using V5NE and ENE modes where enamel was dissolved, while ABRZ formation was confirmed and no funnel-shaped erosion was noticed using V5E and EE. No significant differences in μSBS were observed between resin cements. However, significantly lower µSBSs were recorded when the self-etching mode was used. Thermocycling resulted in a significant reduction in µSBS for all groups.

CONCLUSION

Selective enamel etching should be recommended to improve the interfacial quality when dual-cure resin luting cements are used.

Aesthetic caries infiltration - Long-term masking efficacy after 6 years

OBJECTIVES

This study aimed to evaluate the masking efficacy of caries infiltration technique of initial caries lesions (ICL) six years after debonding and single treatment.

METHODS

In 10 adolescents, 74 ICL (ICDAS 2) in 74 teeth were treated by resin infiltration (Icon, DMG) at a mean (SD) of 1.2 (1.2) months after bracket removal. The etching procedure was performed up to 3 times. Standardized digital images were taken before treatment (T₀), seven days (T₇) and 6 years (T₂₁₉₀) after treatment. Outcomes included the evaluation of the color differences between carious and healthy enamel at T₀, T₇ and T₂₁₉₀ by quantitative colorimetric analysis (ΔE), ICDAS scores, quantitative light-induced fluorescence (QLF; ΔF,ΔQ,WS Area) and qualitative visual evaluation (5-point Likert-scale [deteriorated (1), unchanged (2), improved, but not satisfying (3), improved and no further treatment required (4), completely masked (5)).

RESULTS

The median color difference ΔΕ₀ (25^th/75^th percentiles) at T₀ was 10.3 (8.56/13.0). At T₇ a significant decrease was observed (ΔΕ₇=3.7 (2.0/5.8); p<0.001; Friedmann-test; ICDAS p<0.001; Chi-square test). No significant changes based on ΔΕ (p=0.972; Friedmann-test) and ICDAS grading (p=0.511, chi-square test) were observed between T₇ and T₂₁₉₀ (ΔΕ₂₁₉₀=2.9 (1.8/4.2)). Furthermore, at T₂₁₉₀ four experienced dentists classified 50% and 37% of the lesions as "improved and no further treatment required" and "completely masked", respectively (Fleiss kappa: T₂₁₉₀: 0.782 (substantial agreement)).

CONCLUSION

Aesthetic caries infiltration can effectively mask post-orthodontic initial caries lesions for at least 6 years. These results for most of the teeth could not only be observed by quantitative but also by qualitative analysis.

CLINICAL SIGNIFICANCE

Resin infiltration efficaciously masks post-orthodontic initial carious lesions. The optical improvement can be observed directly after treatment and remains stable for at six years.

Ceramic surface conditioning, resin cement viscosity, and aging relationships affect the load-bearing capacity under fatigue of bonded glass-ceramics

This study aimed to evaluate the influence of ceramic surface treatments, resin cement viscosities, and storage regimens on the fatigue performance of bonded glass-ceramics (lithium disilicate, LD; feldspathic, FEL). Ceramic discs (Ø = 10 mm; thickness = 1.5 mm) were allocated into eight groups per ceramic (n = 15), considering three factors: "ceramic surface treatment" in two levels - 5% hydrofluoric acid etching and silane-based coupling agent application (HF), or self-etching ceramic primer (E&P); "resin cement viscosity" in two levels - in high or low viscosity; and "storage regimen" in two levels - baseline, 24 h to 5 days; or aging, 180 days + 25,000 thermal cycles. Adhesive luting was performed onto glass fiber-reinforced epoxy resin discs (Ø = 10 mm; thickness = 2 mm) and the bonded assemblies were subjected to cyclic fatigue tests: initial load = 200 N; step-size = 25 N (FEL) and 50 N (LD); 10,000 cycles/step; 20 Hz. Scanning electron microscopy (SEM) inspections were performed. Regarding the LD ceramic, the fatigue behavior was reduced after aging for HF_HIGH and E&P_LOW conditions, while stable performance was observed for HF_LOW and E&P_HIGH. Regarding the FEL results, aging negatively affected HF_HIGH, E&P_HIGH, and E&P_LOW, being that only the HF_LOW condition presented a stable behavior. The failure initiated from defects on the etched surface of the ceramics, where the cross-sectional analysis commonly revealed unfilled areas. Long-term aging might induce a decrease in mechanical behavior. The 'ceramic microstructure/surface conditioning/resin cement viscosity relationships' modulate the fatigue performance of lithium disilicate and feldspathic glass-ceramics.

The Impact of Different Surface Treatments on Topography and Bond Strength of Resin Cement to Lithium Disilicate Glass Ceramic

OBJECTIVE

To evaluate the influence of different surface treatments on topography, surface roughness, surface energy, and microtensile bond strength stability of resin cement to lithium disilicate glass ceramic.

METHODS AND MATERIALS

Seventy disc-shaped specimens of IPS e.max Press were divided into seven groups according to the surface treatment: NT - non-treated (control); FSil - hydrofluoric acid (HF) + silane; FPSil - HF + phosphoric acid (HP) + silane; FUSil - HF + ultrasonic bath (U) + silane; FPUSil - HF + HP + U + silane; MEP - Monobond Etch and Prime (MEP); and MEPH - MEP + heating. Topography and surface roughness were evaluated using a 3D laser confocal microscope (3DLCM) and scanning electron microscopy (SEM) and surface energy with a goniometer. The microtensile bond strength (μTBS) was evaluated after storage in distilled water at 37°C for 24 hours and after thermocycling (5,000 cycles, 5°-55° C, 30-second dwell time). Data were analyzed using one-way ANOVA (surface roughness and surface energy), two-way ANOVA (μTBS), Tukey's HSD post-hoc test, and Student t-test (α=0.05).

RESULTS

FUSil, FPSil, and FSil presented similar and highest surface roughness, whereas NT, FPUSil, MEP, and MEPH showed similar, and lowest, roughness values (p<0.05). FPUSil, FPSil, FUSil, and FSil presented a similar and highest surface energy. NT, MEP, and MEPH showed similar and lowest surface energy.

CONCLUSION

Only FSil, FPSil, and MEPH maintained bond strength stability after thermocycling, with FPSil leading to less bond strength reduction, suggesting this protocol is more reliable for bonding resin cements to lithium disilicate glass ceramics.

Biaxial flexure strength and physicochemical characterization of a CAD/CAM lithium disilicate ceramic: effect of etching time, silane, and adhesive applications

OBJECTIVE

To evaluate the effect of different acid etching time and bonding agent (silane and/or adhesive system) on biaxial flexural strength and physico-chemical properties of a lithium disilicate ceramic.

MATERIAL AND METHODS

One hundred twenty ceramic discs were made and divided into 8 groups (n = 15) according to factors "etching time" (20 and 120 s) with hydrofluoric acid (HF) and "bonding agent" (C, no bonding agent; S, silane, A, adhesive; and SA, silane + adhesive). After surface treatment, a resin cement layer was applied to the surface and all specimens were subjected to biaxial flexural strength (BFS) test with treated surfaces loaded in tension (1 mm/min). The Weibull analyses and complementary analyses were also performed. Statistical analysis was done with 2-way ANOVA and the Tukey test (α = 0.05).

RESULTS

ANOVA revealed that the factors "etching time" (p = 0.0003) and "bonding agent" (p = 0.007) were statistically significant. In the overall analysis, the HF120S group (272.02 ± 35.30A MPa) presented significantly higher BFS than that of HF120C (218.45 ± 17.15CD MPa) and HF20S (228.40 ± 37.83BCDMPa). On the other hand, the HF20A group (208.92 ± 31.16D MPa) had significantly lower BFS than HF120S (272.02 ± 35.30A), HF120A (254.42 ± 26.87ABC) and HF120SA (259.30 ± 36.55AB) groups (Tukey). The Weibull modulus (m) of all groups was significantly different from each other (p = 0.000).

CONCLUSIONS

Regardless of etching time, the application of silane alone is sufficient to increase the flexural strength of glass ceramic, eliminating the need for the application of adhesive systems. Moreover, if only silane or adhesive is applied, 120-s HF application should increase the flexural resistance of the lithium disilicate ceramic.

CLINICAL SIGNIFICANCE

Applications of adhesive systems after silanization can be suppressed from the surface treatment protocol of glass ceramics, since it does not improve their mechanical strength.

Effects of Surface Pretreatments on Bond Strength and Morphology of Aprismatic Enamel

PURPOSE

To evaluate the effect of different pretreatment protocols and adhesives on the shear bond strength and surface morphology of aprismatic enamel.

MATERIALS AND METHODS

Human maxillary incisors (N = 120) were assigned to five different groups according to pretreatment: 1) no treatment; 2) glycine; 3) sodium bicarbonate; 4) Al2O3 and 5) extra-fine bur. Then the teeth were divided into three subgroups, according to the adhesive applied: 3-step etch-and-rinse (ER), universal adhesive in ER mode, and universal adhesive in self-etch (SE) mode. Shear bond strength (SBS) testing was performed with a universal testing machine. For SEM observation, fifteen human molars were collected and analyzed after pretreatment with/without etching with 37% H3PO4 for 30s.

RESULTS

Al2O3 showed higher SBS than all other groups considered. Comparable SBS values were obtained for other pretreatments. Universal adhesive in E&R mode performed better than did 3-step E&R and universal adhesive in SE mode. SEM images showed visible differences in enamel surface roughness.

CONCLUSIONS

Airborne-particle abrasion with Al2O3 followed by etching with H3PO4 increased SBS on aprismatic enamel. The combination of airborne-particle abrasion with alumina powder followed by 15 s of H3PO4 etching and application of a universal adhesive in E&R mode proved to be the most effective adhesive protocol.

Effect of enamel-surface modifications on shear bond strength using different adhesive materials

BACKGROUND

This study aimed to investigate the effect of enamel-surface modifications on the shear bond strength between ceramic brackets bonded using different adhesive materials and the enamel surface and to identify the most suitable clinical adhesive and bonding method. Whether the non-acid-etching treatment met the clinical bond strength was also determined.

METHODS

A total of 108 extracted premolars were divided into nine groups (n = 12) based on the different enamel-surface modification techniques (acid etching, deproteinization, and wetting). Group 1 was bonded with Transbond™ XT adhesive, whereas groups 2-9 were bonded with resin-modified glass ionomer cement (RMGIC). The treatment methods for each group were as follows: groups 1 and 2, acid etching; group 3, acid etching and wetting; group 4, acid etching and deproteinization; group 5, acid etching, deproteinization, and wetting; group 6, deproteinization; group 7, deproteinization and wetting; group 8, without treatment; and group 9, wetting. The samples' shear bond strength was measured using an universal testing machine. Adhesive remnant index (ARI) was examined using a stereomicroscope. The enamel-surface morphology was observed with a scanning electron microscope. One-way ANOVA with Tukey's post-hoc test and chi-square test were used for statistical analysis, and p < 0.05 and α = 0.05 were considered statistically significant.

RESULTS

The ARIs of groups 1-5 and 6-9 were statistically significant (p = 0.000). The enamel surface of groups 1-5 was demineralized, and only a tiny amount of protein remained in groups 7 and 8, whereas a thick layer of protein remained in groups 8 and 9.

CONCLUSIONS

RMGIC adhesive did not damage the enamel surface and achieved the required clinical bond strength. The enamel surface was better treated with 5.25% sodium hypochlorite preferably under non-acid-etching conditions.

Influence of Simulated Oral Conditions on Different Pretreatment Methods for the Repair of Glass-Ceramic Restorations

PURPOSE

The present study investigated the influence of simulated intraoral conditions (increased temperature and humidity) on two different surface pretreatment methods to repair a lithium-disilicate glass-ceramic (LDS).

MATERIALS AND METHODS

A total of 540 rectangular lithium-disilicate glass-ceramic bars were manufactured (3 x 7 x 9 mm; IPS e.max CAD, Ivoclar Vivadent). Further specimen preparation was performed in an incubator with controlled relative humidity (RH) and temperature to simulate three different environmental settings: laboratory conditions (LC, n = 180, 23°C, 50% RH), rubber-dam conditions (RC, n = 180, 30°C, 50% RH) or oral conditions (OC, n = 180, 32°C, 95 ± 5% RH). One-third of the bars under each condition (n = 60) were grit blasted (GBL) with alumina (35 µm at 1 bar pressure for 10 s and a working distance of 4 ± 1 cm) and primed (60 s, Monobond Plus, Ivoclar Vivadent). Another third (n = 60) were pretreated with a self-etching glass-ceramic primer (MEP, Monobond Etch & Prime, Ivoclar Vivadent). One group without surface pretreatment (n = 60, NoPT) served as a control. All pretreated surfaces were coated with Heliobond (Ivoclar Vivadent). Two bars from the same pretreatment method were luted perpendicular to each other with a resin composite to form a square adhesion area of 9 mm2 (TetricEvo Ceram, Ivoclar Vivadent), and light cured for 20 s on each side (1200 mW/cm2, Bluephase 20i, Ivoclar Vivadent). All specimens were stored for 24 h in distilled water at 37°C. Half of the specimens from each environmental setting and pretreatment method (n = 15) were thermocycled (TC, 5000 cycles, 5/55°C, 30-s dwell time), and tensile bond strength (TBS) testing was performed for all groups using an x-bar rope-assisted set-up. Data were statistically analyzed using two-way ANOVA (a = 0.05) with Bonferroni adjustment.

RESULTS

Regardless of the environmental and storage conditions (24 h or TC), MEP showed a significantly higher mean TBS than GBL. A decrease in TBS was recorded in specimens under OC compared to RC and LC for both pretreatment methods independent of the storage condition. No significant difference in mean TBS was found between RC and LC within the MEP pretreatment group for the 24 h stored and thermocycled specimens. For all MEPs and GBLs, TC reduced the mean TBS in all environmental conditions. The NoPT groups showed no adhesion regardless of environmental or storage conditions.

CONCLUSIONS

Increased temperature and high humidity significantly reduced TBS. However, MEP was less sensitive to environmental influences than GBL, which makes it a promising candidate for intraoral ceramic repair. These findings suggest that clinical intraoral repair of lithium-disilicate glass-ceramics should be performed using a rubber-dam, primarily when using GBL.

[Effects of carboidiimide with different bonding techniques on the property of dentin bonding]

PURPOSE

To explore the effects of carbodiimide combined with different bonding techniques on the property of dentin bonding.

METHODS

64 third molars in vitro were randomly divided into 8 groups(n=8), including EWB and EWBa (no pretreatment+ethanol-wet bonding), E-EWB and E-EWBa (0.5 mol/L EDC+ethanol-wet bonding), E-WB and E-WBa (0.5 mol/L EDC+water-wet bonding), E-DB and E-Dba (0.5 mol/L EDC+dry bonding). Group EWB, E-EWB, E-WB and E-DB were immediate groups, while group EWBa, E-EWBa, E-WBa and E-DBa were aging groups. Six specimens in each group were randomly chosen to test shear bonding strength and then observe failure patterns. The remaining specimens were used to observe bonding interface under SEM. SPSS 20.0 software package was used for statistical analysis of the data.

RESULTS

There was no significant difference in shear bonding strength between group EWB and E-EWB, group E-EWB and E-WB(P＞0.05), while shear bounding strength in group E-EWB and E-WB were significantly greater than group E-DB(P＜0.05). The shear bonding strength of group E-EWBa was significantly greater than group EWBa (P＜0.05). The shear bonding strength of group E-EWBa, E-WBa and E-DBa was gradually decreased, and their differences were significant (P＜0.05). The factors of EDC, bonding techniques and aging played a significant role in shear bonding strength (P＜0.05). Interactions between EDC and aging was significant (P＜0.05), and that between bonding techniques and aging was also significant (P＜0.05). The main failure modes of the water-wet bonding and the ethanol-wet bonding were resin failure, adhesive interface failure and mixed failure. The main failure of dry bonding was adhesive interface failure. The thickest and densest hybrid layer were found in group E-EWB. Some tiny cracks were presented between the hybrid layer and adhesives layer in group EWBa and E-EWBa. Partially uneven cracks existed in the hybrid layer in group E-WBa, and that was more obvious in group E-DBa.

CONCLUSIONS

EDC pretreatment combined with ethanol-wet adhesive technique acquires the optimal shear bonding strength and the durability of dentin bonding.

Comparative Assessment of pH and Degree of Surface Roughness of Enamel When Etched with Five Commercially Available Etchants: An In Vitro Study

AIM

To evaluate the pH and degree of surface roughness caused by five commercially and readily available etchants on tooth enamel.

MATERIALS AND METHODS

Five different etchants were chosen. An electric pH meter was utilized to test the pH of the etchants employed. Fifteen maxillary bicuspids that had been extracted were cleansed and stored in thymol solution. The samples were sorted into five groups of three each. A noncontact profilometer was employed to assess the microsurface changes of the pre-etched enamel. The teeth were then etched for 30 seconds with respect to the group to which they belonged before being cleaned and dried. The surface roughness after etching was analyzed, measured and values were tabulated. Descriptive statistics and paired t-test were done.

RESULTS

The pH of the etchants and surface roughness of the enamel are varied across the five groups, though they have the same composition of 37% orthophosphoric acid. Etchant from Group C was found to be most acidic while the one manufactured by Group E was least acidic. Ivoclar, DPI, and DTECH showed a statistically significant value in surface roughness parameter post-etching (p <0.05). A statistical difference that was significant was observed with the Kruskal-Wallis test for surface roughness parameter (p <0.05).

CONCLUSION

All five etchants had varied pH and the amount of surface roughness was also varied though the composition was the same. Further elemental analysis of these etchants has to be done to validate the results obtained.

CLINICAL SIGNIFICANCE

Etchants of the same composition should ideally produce the same effect on the tooth enamel surface, but etchants from different manufacturers produce different levels of surface roughness which could be due to differences in the composition of the prepared etchant. The study was conducted to assist in making an educated selection about the most cost-effective but efficient etchant for clinical application.

[Comparative evaluation of the shear bond strength of a universal adhesive system in different etching modes and a total etch adhesive system]

OBJECTIVE

To determine a comparative evaluation between the shear bond strength (SBS) of total etch adhesive system and the SBS of universal adhesive system in various etching techniques.

MATERIAL AND METHODS

There were made 60 sections of teeth for the laboratory research. The studied samples had been divided into 4 groups (15 samples in each group). The control group of the study was the Adper SingleBond 2 total etch adhesive system. The SingleBondUniversal adhesive system had been used in three comparison groups: the first group was the total etch technique; the second group was selective etch technique; the third group was self-etching techinque. The Zwick Roell Z010 testing machine had been used for the study. The received results were fixed. The statistical data were processed. Comparison of researched groups were performed in pairs using the nonparametric Mann-Whitney U test.

RESULTS

In the control group the average value of the shear bond strength (SBS) was 15.01±5.2 MPa, in the first comparison group - 15.6±4.8 MPa, in the second comparison group - 19.7±6.04 MPa, in the third comparison group - 17.9±5.85 MPa. The groups with SingleBondUniversal adhesive system in selective etch technique (19.74 MPa) and self-etching (17.9 MPa) technique had the highest average values of the shear bond strength. The universal adhesive system with total etch technique and the total etch adhesive system had statistically similar data (p≥0.05). The control group with Adper SingleBond 2 total etch adhesive system had the lowest shear bond strength (15.01 MPa).

CONCLUSIONS

The universal adhesive system had high average values of SBS in all etching techniques. During the comparative evaluation there were established correspondence between average values of SBS of universal adhesive system and SBS of total etch adhesive system. The universal adhesive system in selective etch technique had the highest shear bond strength (SBS) with enamel and dentin.

Using self-etch adhesive agents with pit and fissure sealants. In vitro analysis of shear bond strength, adhesive remnant index and enamel etching patterns

Purpose

The aim of this study was to evaluate in vitro, the shear bond strength (SBS) and adhesive remnant index (ARI) of pit and fissure sealants (PFS) after enamel conditioning with different new-generation self-etching (SE) agents; additionally, enamel etching patterns were assessed.

Methods

Healthy unerupted third molars surgically removed for therapeutic reasons (n = 25p/g), were randomly assigned to six groups. Conventional etching (CE) or SE was applied prior to pit and fissure sealants bonding. Enamel conditioned surfaces were evaluated by SEM at × 500, × 1000, and × 2000 magnification to determine etching patterns. Subsequently, 25 PFS blocks (3 × 2 × 1.5 mm) p/g were bonded to enamel surface.

Samples were stored in water at 37 °C for 24 h, previous to SBS and ARI test. One-way ANOVA and Tamhane statistic tests were used for SBS; while Mann–Whitney U and Kruskal–Wallis were employed for ARI (p ≤ 0.05).

Results

For SBS test, CE_PFS_3M and SE1_PFS_Shofu groups showed the lowest values (8.74 ± 4.02 and 8.75 ± 3.90, respectively). The highest scores were observed in SE_PFS_Kuraray group (13.46 ± 5.83). Significant differences in SBS and ARI assessments were found. All experimental groups showed type 1 etching pattern.

Conclusion

The etching pattern was less pronounced in self-etching groups, which showed an equal or superior in vitro performance compared to conventional etching agents. The clinical use of self-etching agents could be recommended before pit and fissure sealants application in new dental protocols. The best in vitro performance was observed when both applied materials, self-etching agent and pit and fissure sealant have 10-methacryloyloxydecyl dihydrogen phosphate in their chemical composition.

Evaluation of MDP and NaF in Two-step Self-etch Adhesives on Enamel Microshear Bond Strength and Morphology of the Adhesive-Enamel Interface

PURPOSE

To evaluate the roles of MDP and NaF in the bonding resin of a two-step self-etch adhesive (2-SEA) on enamel bonding performance.

MATERIALS AND METHODS

The experimental 2-SEAs were composed of an MDP-containing self-etching primer and four different bonding resins which were MDP- and NaF-free (00), MDP-containing and NaF-free (M0), MDP-free and NaF-containing (0F), and MDP- and NaF-containing (MF) adhesives. Microshear bond strength (µSBS) to enamel and ultimate tensile strength (UTS) of the adhesive resin were determined. The morphological characteristics of the adhesive-enamel interface after acid-base challenge were observed using SEM to evaluate the acid-base resistant zone (ABRZ).

RESULTS

No decrease in μSBS was observed even after thermocycling (TC) in 00, 0F and MF. However, the μSBS of M0 significantly decreased after TC. The UTS of M0 significantly decreased after 1- and 180-day storage in water. SEM observations indicated that ABRZ was present in all groups. However, formation of erosion beneath the ABRZ was observed in M0 and 00, whereas formation of a slope without erosion was observed at the bottom of the ABRZ in MF.

CONCLUSION

In the experimental 2-SEAs, the addition of MDP alone to the adhesive resin did not contribute to an improvement in enamel bonding durability and interfacial morphology, whereas the addition of NaF in the adhesive resin demonstrated an enhancement of the bonding durability and improvement of acid resistance at the bonded interface.

Effects of Selective Phosphoric Acid Etching on Enamel Using "No-wait" Self-etching Adhesives

PURPOSE

To evaluate the effect of selective phosphoric acid etching on enamel using "no-wait" self-etching adhesives.

MATERIALS AND METHODS

Clearfil Universal Bond Quick (UBQ, Kuraray Noritake) or G-Premio BOND (GPB, GC) was applied to ground human enamel surfaces. The adhesives were used in 3 modes: no-waiting self-etching mode (UBQ-0 or GPB-0), 10-s self-etching mode (UBQ-10 or GPB-10), and the selective-etch mode with phosphoric acid etching (UBQ-PA or GPB-PA). After an acid-base challenge, the morphological attributes of the interface were examined using scanning electron microscopy (SEM) to characterize the acid-base resistant zone (ABRZ). Microshear bond strength (µSBS) testing to enamel and ultimate tensile strength (UTS) of the adhesive resin were carried out.

RESULTS

ABRZ formation was confirmed in all groups. UBQ-PA and GPB-PA created thicker ABRZ with no funnel-shaped erosion beneath the adhesive-enamel interface. µSBS of UBQ-PA was significantly higher than UBQ-0 and UBQ-10 (p < 0.05). However, there were no statistically signficant differences in µSBS among GPB-0, GPB-10, and GPB-PA. For the UTS, UBQ was significantly higher than GPB.

CONCLUSION

Selective phosphoric acid etching created a stable adhesive-enamel interface. The no-waiting self-etching concept adhesive led to a thinner ABRZ. The results of µSBS suggest that phosphoric acid etching effects on enamel are material dependent.

Deproteinization of primary enamel with sodium hypochlorite before phosphoric acid etching

The aim of this study was to evaluate the deproteinization of primary enamel by analyzing etching pattern types, with and without the application of 5% NaOCl before acid etching with 37% H3PO4. Fifteen extracted human primary molars were randomly selected for the present in vitro study; 1mm x 1mm blocks were prepared and divided into two groups (n = 21). These groups were treated as follows: Group A- Acid Etching with 37% H3PO4 gel for 15 s; Group B- 5% NaOCl for 60 s + Acid Etching with 37% H3POfor 15 s. The specimens were prepared for scanning electron microscopy analysis. The images were evaluated for quality types I and II etching of the enamel surface using ImageJ software. Datasets were checked for normality by Kolgomorv-Smirnov test and the nonparametric unpaired Mann-Whitney test was applied. The mean surface area of type I and II etching pattern values was 1922.314 µm2for Group A and 3840.473 µm2Group B. We conclude that deproteinization with 5% NaOCl prior to acid etching can be used to increase the area of adhesion and the quality of the etching pattern.

Bond strength of resin cement to ceramic with simplified primers and pretreatment solutions

Manufacturers have recently introduced surface primers and pretreatment solutions that reportedly simplify the bonding process of resin cements to ceramics through various combinations of etchant and coupling agents. This study evaluated the shear bond strength (SBS) of a resin cement to a lithium disilicate glass-ceramic material pretreated with various new surface treatment solutions and compared the results to those of a control group prepared with the traditional application of hydrofluoric acid (HF) and silane. Resin cement was bonded to pretreated glass-ceramic surfaces, and specimens were tested for SBS after 24 hours of storage in water. Traditional surface treatment of lithium disilicate glass ceramic with HF and silane resulted in a significantly greater mean SBS than did simplified primer solutions. There were no statistically significant differences among the simplified pretreatment groups. In the control group, the majority of failures were due to mixed adhesive-cohesive fracture, while in the simplified treatment groups the failure mode was usually adhesive, suggesting a weaker interface.

Clinical Effectiveness of Different Polishing Systems and Self-Etch Adhesives in Class V Composite Resin Restorations: Two-Year Randomized Controlled Clinical Trial

The aim of this randomized controlled clinical trial was to compare the clinical effectiveness of different polishing systems and self-etch adhesives in class V composite resin restorations. A total of 164 noncarious cervical lesions (NCCLs) from 35 patients were randomly allocated to one of four experimental groups, each of which used a combination of polishing systems and adhesives. The two polishing systems used were Sof-Lex XT (Sof), a multistep abrasive disc, and Enhance/Pogo (EP), a simplified abrasive-impregnated rubber instrument. The adhesive systems were Clearfil SE bond (CS), a two-step self-etch adhesive, and Xeno V (XE), a one-step self-etch adhesive. All NCCLs were restored with light-cured microhybrid resin composites (Z250). Restorations were evaluated at baseline and at 6, 12, 18, and 24 months by two blinded independent examiners using modified FDI criteria. The Fisher exact test and generalized estimating equation analysis considering repeated measurements were performed to compare the outcomes between the polishing systems and adhesives. Three restorations were dislodged: two in CS/Sof and one in CS/EP. None of the restorations required any repair or retreatment except those showing retention loss. Sof was superior to EP with regard to surface luster, staining, and marginal adaptation (p<0.05). CS and XE did not show differences in any criteria (p>0.05). Sof is clinically superior to EP for polishing performance in class V composite resin restoration. XE demonstrates clinically equivalent bonding performance to CS.

Laboratory Study of Micro-shear Bond Strength of Two Resin Cements to Leucite Ceramics using Different Ceramic Primers

AIM

To evaluate the effect of Monobond Etch & Prime on the micro-shear bond strength (MSBS) of resin cements to leucite surface and to compare the MSBS of two different resin cements to conditioned leucite surfaces with different primer systems.

MATERIALS AND METHODS

Twenty-one leucite ceramic disks (10 mm diameter, 2 mm thickness) were divided into three groups (n = 7). Group I: 9.6% hydrofluoric (HF) acid and Monobond S (Ivoclar Vivadent, Liechtenstein), then conventional resin cement was applied. Group II: Monobond Etch & Prime (Ivoclar Vivadent, Liechtenstein), then conventional resin cement was applied. Group III: 9.6% HF acid and with Monobond N (Ivoclar Vivadent, Liechtenstein), then adhesive resin cement was applied. The assigned resin cement was applied in each disk through five plastic tubes with an inner diameter of 1.6 and 1.9 mm height, and then light cured. Micro-shear bond strength was determined by pulling out the resin cement using universal testing machine (Instron^®, USA).

RESULTS

One-way analysis of variance (ANOVA) and Student's t-test were used to determine statistical difference (a = 0.05) between each two groups. The results showed that group III had the highest MSBS values (7.32 ± 2.47) followed by group II (6.24 ± 2.16), whereas group I had the lowest MSBS values (5.7 ± 2.7). Nevertheless, there was no statistically significant difference between the results of all the groups.

CONCLUSION

Monobond Etch & Prime has shown comparable results to the most popular combination of HF acid and silane. The combination of HF acid and Monobond N and self-adhesive resin cement has shown the best MSBS results, though not statistically significant.

CLINICAL SIGNIFICANCE

The clinicians can use simplified ceramic primer technique (Monobond Etch & Prime) which has comparable MSBS to the most popular combination of HF acid and silane.

Application of Calcium Silicate Materials After Acid Etching May Preserve Resin-Dentin Bonds

INTRODUCTION

The aim of the present study was to evaluate the effect of the application of calcium silicate materials (CSMs), after acid etching, on the longevity of the hybrid layer and marginal adaptation of composite restorations.

METHODS AND MATERIALS

Eighty human permanent molars received an intrapulpal pressure of 15 cm H₂O. Sixty teeth received a mesial proximal slot preparation with the gingival margin extending 1 mm below the cemento-enamel junction. The samples were divided into two groups. Group 1 received restorations using two types of etch-and-rinse adhesives: ethanol based (Single Bond, 3M ESPE, St Paul, MN, USA) and acetone based (Prime & Bond NT, Dentsply, DeTrey GmbH, Germany). In group 2 samples, a commercially available CSM (ProRoot MTA) was allowed to set before grinding and placing into a distilled water solution. This solution was applied on the cavity floor after acid etching. The surface was washed after 30 seconds followed by application of adhesives and restorations as in group 1. The samples were stored in phosphate-buffered saline for six months, maintaining the intrapulpal pressure. An epoxy replica was made, and the marginal adaptation was evaluated using scanning electron microscopy. The percentage of continuous margin (CM) was recorded for each group. Another 20 samples were used for hybrid layer evaluation. The crowns were ground to expose dentin. Intrapulpal pressure was applied. The samples were divided into two groups and restored similar to samples restored for marginal adaptation evaluation. The samples were longitudinally cut in 1-mm slices. The slices were stored under 15 cm of phosphate-buffered saline to simulate the pulpal pressure. After six months, the adhesive interface was evaluated using a scanning electron microscope. Statistical analysis was done with two-way analysis of variance with Holm-Sidak's correction for multiple comparisons.

RESULTS

Application of CSMs improved the marginal adaptation values in both adhesive groups. In group 1, there were areas of incomplete penetration of resins along with evidence of partial degradation of resin tags. Samples receiving CSM application after acid etching demonstrated long and regular resin tags with very few signs of degradation.

CONCLUSIONS

Application of CSMs after acid etching can be a potential avenue in preserving the resin-dentin bonds.

Water-associated attributes in the contemporary dentin bonding milieu

OBJECTIVES

The water-associated attributes of resin-dentin interfaces created by contemporary adhesives are important determinants of bond integrity and stability. In the present work, these attributes were estimated from the perspectives of causality, to examine the behavior of the first and most-recently launched versions of universal adhesives when applied in either the etch-and-rinse mode or the self-etch mode.

METHODS

The immediate cause of interfacial permeability and the time-dependent cause of water sorption were investigated in conjunction with the intermediate effect of interface degradation and the more long-term effect of loss of mechanical strength, before and after thermomechanical cycling. The results were compared with control etch-and-rinse and self-etch adhesives.

RESULTS

Although the introduction of this new class of universal adhesives has brought forth significant changes to the dental adhesion arena, including more application options, reduced bonding armamentarium and increased user friendliness, the water-associated attributes that are critical for making resin-dentin bonds more durable to environmental challenges and less susceptible to degradation have remained unchanged at large, when compared with benchmarks established by former classes of adhesives.

CONCLUSION

It appears that the current trend of adhesive development has brought forth significant changes but lacks the vigor that demarcates progress and technological sublimity.

CLINICAL SIGNIFICANCE

The advent of the user friendly universal adhesives has brought forth significant changes to the dental adhesion arena. However, the elements that are critical for making resin-dentin bonds more durable to environmental challenges and less susceptible to degradation have remained unchanged at large.

Self-etching Primers vs Acid Conditioning: Impact on Bond Strength Between Ceramics and Resin Cement

This study tested whether a self-etching surface agent and the conventional hydrofluoric acid (HF) would provide the same bonding capacity between resin cement and feldspathic (Fd) and lithium disilicate (Ld) ceramics. Ceramic blocks were cut with a low-speed diamond saw with water cooling (Isomet 1000, Buehler, Lake Bluff, IL, USA) into 20 blocks of 5 × 7 × 4 mm, which were ground flat in a polishing machine (EcoMet/AutoMet 250, Buehler) under water cooling. The blocks were randomly divided into eight groups (n=5), according to ceramic type (Ld or Fd), surface conditioning (HF + Monobond Plus or Etch and Prime), and aging by thermocycling (TC or absence-baseline). After 24 hours in 37°C distilled water, blocks were embedded into acrylic resin and 1-mm² cross-section beams composed of ceramic/cement/composite were obtained. The microtensile test was performed in a universal testing machine (DL-1000, EMIC, São José dos Campos, Brazil; 0.5 mm.min^-1, 50 kgf load cell). Bond strength (MPa) was calculated by dividing the load at failure (in N) by the bonded area (mm²). The fractured specimens were examined under stereomicroscopy, and one representative sample of each group was randomly selected before the cementation and was further used for analysis using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). The self-etching agent showed the highest bond strength for Fd (24.66±4.5) and Ld (24.73±6.9) ceramics and a decrease in surface wettability. SEM and EDS showed the presence of similar components in the tested materials with different topographies for both. Therefore, the self-etching primer was able to deliver even higher bonding than HF+silane to a resin cement.

Fatigue Failure Load of Restored Premolars: Effect of Etching the Intaglio Surface of Ceramic Inlays With Hydrofluoric Acid at Different Concentrations

The aim of this study was to evaluate the effect of etching, with different hydrofluoric acid concentrations at the intaglio surface of feldspathic ceramic inlays, on the fatigue failure load of restored premolars. A total of 60 upper premolars were embedded in plastic cylinders with acrylic resin (up to 3 mm below the cement-enamel junction) and prepared using a device specially designed for that purpose. Teeth were randomly assigned to three groups (n=20): HF1, HF5, and HF10 (etching with hydrofluoric acid for 60 seconds at concentrations of 1%, 5%, and 10%, respectively). Preparations were scanned and restorations were milled by a computer-aided design / computer-aided manufacturing system. The inner surfaces of the inlays were etched and received an application of a silane coupling agent; the dentin and enamel were treated appropriately for the luting system (RelyX ARC, 3M-ESPE). The restorations were cemented and the fatigue failure load (in N) was determined using the staircase method (10 Hz; 10⁵ cycles in each step). The initial load (585.5 N) was applied on the slopes of the cusps (labial and palatal/lingual, simultaneously) through a cylinder attached to the test machine (Instron ElectroPuls E3000). The tested samples were analyzed under a stereomicroscope for failure analysis. Fatigue data were analyzed by one-way analysis of variance. There was no statistical difference among the fatigue failure loads (in N): HF1 (448.5±79.1), HF5 (360.7±55.4), and HF10 (409.5±121.1). Regarding the fracture mode, there was a predominance of interfacial fracture (50%), followed by cusp fracture (34.6%). It may be concluded that the etching with hydrofluoric acid at the tested concentrations (1%, 5%, and 10%) does not influence the fatigue failure load of feldspathic ceramic inlays cemented on premolars.

Evaluation of osseous integration of titanium orthopedic screws with novel SLA treatment in porcine model

The success of many endosseous implants in orthopaedic and dental applications depends on the surface characteristics, as they affect osseous integration. Previous investigations indicated that a novel large-grit sand-blasted and acid-etched (SLA) titanium (denoted as SLAffinity-Ti) implant had better bone integration than that of a comparably shaped implant with a plasma-sprayed titanium surface. The purpose of the present investigation was to create a SLAffinity surface on pedicle screws and trauma screws and to compare it with the surfaces of a sand-blasted-only implant and commercial implants in terms of bone integration. The cortical bone and spine of twelve minipigs were implanted with 3 and 4 implants, respectively, and the bone integration was evaluated using micro-computed tomography (micro-CT), mechanical tests (pull-out strength and stripping torque), and histological analysis (toluidine blue and hematoxylin and eosin staining) one and three months after implantation. The micro-CT images showed that the gap between the bone and implant was consistently higher in the sand-blasted-only and commercial groups compared to that in the SLAffinity group 1 and 3 months after implantation. Moreover, the bone volume of implant inserted into bone and the percentage of implant inside bone tissue were greater in the SLAffinity screws 1 and 3 months after implantation, as compared to the sand-blasted and commercial screws. In the mechanical tests, the removal torque and pull-out strength (p < 0.05) were higher in the SLAffinity group at 1 and 3 months. The histological results were consistent with mechanical testing, showing that the SLAffinity group had the most mineralized matrix, the most bone formation around the screws, and the most bone cells in bone tissue. These findings indicate that a SLAffinity surface can effectively enhance the holding strength and integration of pedicle screws and cortical screws, promoting early healing and improving outcomes, compared to sand-blasted-only and commercial implants.

Confocal microscope analysis of depth of etch between self-limiting and traditional etchant systems

OBJECTIVE

To see whether there is an advantage to using a self-limiting phosphoric acid etchant versus a traditional 34% phosphoric acid etchant for bonding by measuring the depth of etch at multiple time intervals.

MATERIALS AND METHODS

A total of 25 bovine teeth were mounted and etched on the facial surface with two different etchants: standard 34% phosphoric acid and a self-limiting 35% phosphoric acid etchant at varied time intervals of 15, 30, 60, 90, and 120 seconds. Teeth were scanned using a three-dimensional laser confocal scanning microscope prior to etching and scanned again after etching to determine the depth of enamel etched compared to the baseline enamel surface prior to etching.

RESULTS

The 34% phosphoric acid etchant etched significantly deeper than the self-limiting etch. Etch times exceeding 30 seconds also etched significantly deeper for both types of etchant.

CONCLUSION

The etch depth of the self-limiting etchant was consistently less than the standard etchant. Both types of etchant etched deeper after 30 seconds, but the depth of etch at 120 seconds was not different than at 60 seconds, indicating that both etchants are somewhat self-limiting in depth. Therefore, there is no advantage to using the self-limiting etchant.

Effect of surface treatments on the bond strength of self-etching adhesive agents to dentin

The aim of this study was to investigate the influence of different surface treatments on the shear bond strength (SBS) of self-etching adhesive systems to dentin. Ninety freshly extracted noncarious human molars were sectioned mesiodistally and embedded in chemically cured resin with the buccal or lingual surfaces facing upward. Superficial dentin was exposed, and specimens were randomly assigned to 3 groups, according to the self-etching adhesive system utilized: Clearfil SE Bond (2-step), Scotchbond Universal (1-step), and Clearfil S³ Bond Plus (1-step). These groups were assigned to 5 subgroups (n = 12), according to the following treatments: G1, distilled water (control); G2, 35% phosphoric acid gel; G3, ultrasonic vibration; G4, sandblasting; G5, pumice slurry. For the 1-step self-etching adhesives, no significant differences in SBS values were observed between the different surface treatment groups and their control subgroup (P > 0.05). For the 2-step adhesive, mean values were significantly higher in the ultrasonic vibration and pumice-treated groups than in the control subgroup (P < 0.05). Overall, the use of vibration resulted in superior mean SBS values to dentin for all adhesives tested, although the values were not always significantly higher.

Does Post-etching Cleaning Influence Bond Strength of Lithium Disilicate Laminate Veneers?

This paper aims to present a clinical case of laminate veneers in lithium disilicate (LD) reinforced ceramic, complemented with scanning electron microscopy and energy dispersive x-ray spectroscopy analysis of this ceramic's surfaces submitted to some of the different post-etching cleaning protocols proposed by literature. Many dentists are applying all-ceramic restorations, especially veneers, with the most applied material being LD, due to its good mechanical properties, esthetics, and ability to adhere to tooth substrate. The cementation process is critical to clinical success of indirect restorations. Combination of hydrofluoric acid and silane application on the inner surface of ceramic has been the most recommended method to increase bond strength between ceramic and tooth substrate. As a result of surface corrosion, residual subproducts are formed and precipitate on the ceramic surface, affecting the bonding process to the resin cement. Elimination of residue is recommended in the literature and can be done via 3 common techniques: thorough washing with air/water spray for 30 seconds, 37% phosphoric acid for 60 seconds, or ultrasonic bath for 4 to 10 minutes. Little information on LD ceramics post-etching cleaning methods is available in the literature. For this ceramic, the thorough washing with air/water spray for 30 seconds appeared to remove most of the residue without damaging the material. Being also the most practical and easiest of the reviewed procedures, it was, therefore, the protocol of choice for the clinical cases presented in this paper with success after 18 months.

Evaluating Various Preparation Protocols on the Shear Bond Strength of Repaired Composite

INTRODUCTION

The aim of this study is to evaluate the effect of different combinations of various surface treatments on the shear bond strength (SBS) of repaired composite resin.

MATERIALS AND METHODS

A total of 122 composite samples were prepared from Filtek Z350 XT. Samples were light cured and stored for 6 weeks. Surface treatment of old composite was done in five groups: Group I: bur roughening + phosphoric acid etching, group II: bur roughening + hydrofluoric acid etching + silane coupling agent, group II: air abrasion + phosphoric acid etching, group IV: air abrasion + phosphoric acid etching + silane coupling agent, group V: air abrasion + hydrofluoric acid etching + silane coupling agent. Bonding agent was applied to all surface-treated old composites and light cured. The fresh composite resin was bonded to treated surfaces and cured and stored in water at 37°C for 6 weeks. Shear bond strength was measured by a universal testing machine.

RESULTS

Shear bond strength values of all groups were not statistically significant except for group V, which showed statistically significant higher SBS than group III.

CONCLUSION

Techniques with readily available materials at the clinic can attain similar SBS to more elaborate technique involving potentially hazardous materials.

Two-Year Clinical Evaluation of a Nanofilled Etch-and-Rinse and a Self-Etch Adhesive System Containing MDPB and Fluoride in Non-carious Cervical Lesions

OBJECTIVES

The aim of this clinical study was to evaluate the performance of restorations for non-carious cervical lesions performed with a two-step etch-and-rinse or with a two-step self-etch adhesive.

MATERIALS AND METHODS

The teeth to be restored (15 patients, N = 90 restorations) were randomly assigned into 3 groups (n = 30), according to the adhesive system: group 1 (G1): Peak LC Bond; group 2 (G2): Clearfil Protect Bond; and group 3 (G3): prior selective acid etching of the enamel margins before bonding with Clearfil Protect Bond. The NCCLs were restored with Amelogen Plus composite resin. Two calibrated examiners evaluated the restorations using modified US Public Health Service criteria. The data of retention, marginal integrity, and marginal discoloration were analyzed using the Kruskal-Wallis and Wilcoxon tests.

RESULTS

There were no significant differences in clinical performance among the groups for the variables: retention, marginal integrity, and marginal discoloration after 1 year and 2 years. The alpha rates after 2 years were: 93.3% for G1 and 96.7% for G2 and G3 for retention; 93.3%, 100%, and 90% for G1, G2, and G3 for marginal discoloration; 86.7%, 96.7%, and 90% for G1, G2, and G3 for marginal integrity, respectively.

CONCLUSIONS

The adhesives presented similar clinical performance at the end of 2 years. Also, the prior etching with phosphoric acid did not significantly improve the clinical performance of self-etch adhesive.

Microleakage and shear bond strength of a new sealant containing prereacted glass ionomer particles

A new fluoride-releasing sealant system is claimed to allow easier and faster placement while providing high bond strengths without the need for phosphoric acid etching. A study was designed to compare the microleakage and shear bond strength of a self-etching, Giomer-based sealant system with those of a traditional resin sealant. Group 1 received traditional sealant applied after use of a 35% phosphoric acid etchant; group 2 received Giomer sealant after use of a self-etching primer; and group 3 received Giomer sealant after the addition of an initial phosphoric acid etching step and placement of the primer. The sealants were placed in the occlusal pits and fissures of extracted human third molars, thermocycled, placed in dye, and sectioned. The extent of microleakage (dye penetration) was expressed as a percentage of the cross-sectional length of the sealed interface. The sealants were also bonded to the facial enamel of bovine incisors. Specimens were thermocycled and tested in shear mode in a universal testing machine. The new self-etching sealant demonstrated significantly greater microleakage (P < 0.017) and lower bond strength (P < 0.05) than both the traditional sealant system and the new system when placed with phosphoric acid etchant. Phosphoric acid etching significantly improved the shear bond strength and reduced the microleakage of the new sealant.

[Influence of surface treatment with sodium hypochlorite solution on dentin bond strength]

OBJECTIVE

To evaluate the influence of sodium hypochlorite (NaOCl) solution used during root canal therapy on dentin bond strength.

METHODS

In the study, 15 freshly extracted human third molars with complete dental crowns, caries and filling-free were selected. The occlusal enamel was removed perpendicular to the long axis of the tooth to expose middle flat surfaces of sound dentin. The occlusal dentin surfaces were then polished using 600-grit silicon papers for 1 min and rinsed with deionized water for 1 min. The teeth were randomly divided into three groups according to the treatment received: group A (negative control group), the samples were immersed in deionized water for 20 min; group B, the dentin surfaces were immersed in 2.50% NaOCl solution for 20 min, with the solution being renewed every 5 min; group C, the dentin surfaces were immersed in 5.25% NaOCl solution for 20 min, with the solution being renewed every 5 min. All the treated dentin surfaces were bonded using a self-etching adhesive system (SE bond) with a 5 mm in height resin composite (AP-X). After storage in deionized water at 37 °C for 24 h, the adhesive samples were sectioned longitudinally to produce 1.0 mm×1.0 mm stick specimens(n=45) for micro-tensile bond strength testing (MPa). Failure modes (adhesive failure, cohesive failure or mixed failure) at the dentin-resin interface were observed using a stereomicroscope. The micro-tensile bond strength data among the three groups were analyzed by a one-way ANOVA, then the Post-hoc test(LSD) was employed for pairwise comparison. The distribution of failure modes among the groups were analyzed by chi-square test.

RESULTS

Significant decreased bond strength values were found for the 2.50% NaOCl-treated group (26.04±5.74) MPa and 5.25% NaOCl-treated group (24.46±3.77) MPa when compared with the strength of negative control group (48.71±7.77) MPa,P=0.000. Compared with the negative control group, themicro-tensile bond strength of the 2.50% NaOCl-treated group and 5.25% NaOCl-treated grouphad dropped by 46.5% and 50.2%. However, there was no significant difference of bond strength between the 2 NaOCl-treated groups (P=0.214). The distribution of failure modes showed significant difference in all the three groups (2=56.324, P=0.000). The mixed failure (68.9%) was the most mode of fracture in the negative control group, followed by adhesive failure(24.4%), and the cohesive failure was least(6.7%). The proportion of adhesive failure mode was higher in NaOCl-treated groups than in negative control group (P=0.000). There was no significant difference of the distribution of failure modes between the 2.50% NaOCl-treated group and 5.25% NaOCl-treated group(P=0.197), and there was no cohesive failure mode detected in the two groups.

CONCLUSION

The micro-tensile bond strength of dentin to composite resin was lower after exposure to NaOCl solution.

Morphological Evaluation of the Adhesive/Enamel interfaces of Two-step Self-etching Adhesives and Multimode One-bottle Self-etching Adhesives

PURPOSE

To evaluate the acid-base resistant zone (ABRZ) at the adhesive/enamel interface of self-etching adhesives with or without prior phosphoric acid etching.

MATERIALS AND METHODS

Four adhesives were used in 8 groups: Clearfil SE Bond (SEB), Optibond XTR (XTR), Scotchbond Universal Adhesive (SBU), and Clearfil BOND SE ONE (ONE) without prior phosphoric-acid etching, and each adhesive with phosphoric acid etching for 10 s (P-SEB, P-XTR, P-SBU and P-ONE, respectively). After application of self-etching adhesives on ground enamel surfaces of human teeth, a flowable composite was placed. For observation of the acid-base resistant zone (ABRZ), the bonded interface was exposed to demineralizing solution (pH 4.5) for 4.5 h, followed by 5% NaOCl with ultrasonication for 20 min. After the acid-base challenge, morphological attributes of the interface were observed using SEM.

RESULTS

ABRZ formation was confirmed in all groups. The funnel-shaped erosion beneath the interface was present in SBU and ONE, where nearly 10 to 15 μm of enamel was dissolved. With phosphoric acid etching, the ABRZs were obviously thicker compared with no phosphoric acid etching.

CONCLUSION

Enamel beneath the bonding interface was more susceptible to acid dissolution in SBU and ONE. In the case of the one-bottle self-etching adhesives and universal adhesives that intrinsically have higher pH values, enamel etching should be recommended to improve the interfacial quality.

Effect of Scrubbing Technique with Mild Self-etching Adhesives on Dentin Bond Strengths and Nanoleakage Expression

PURPOSE

To evaluate the effect of a scrubbing technique with one-step self-etching adhesives on bond strengths and nanoleakage expression at the resin/dentin interface.

MATERIALS AND METHODS

Flat human dentin surfaces bonded with one of two mild self-etching adhesives, SE One (SE) or Scotchbond Universal (SU) applied either with scrubbing or without scrubbing technique, were prepared (n = 5). The microtensile bond strengths (μTBS), SE micrographs of morphological changes on treated dentin surfaces, and expression of nanoleakage along the bonded dentin interfaces as shown with TEM were evaluated. μTBS data were analyzed using two-way ANOVA and the post-hoc t-test at the significance level of 0.05.

RESULTS

The scrubbing technique had a significant positive effect on the μTBS of SU (p < 0.05), while it produced no significant difference for SE (p > 0.05). Morphological evaluation of the treated dentin surfaces demonstrated that SU with scrubbing showed the highest etching ability, followed by scrubbing SE > nonscrubbing SE > nonscrubbing SU. In the nonscrubbing groups, nanoleakage formation using SU exhibited a reticular pattern throughout the hybridized complex, whereas with SE, water-tree nanoleakage was only found in the adhesive layer at dentinal tubule orifices. The scrubbing groups of both adhesives did not exhibit any nanoleakage expression.

CONCLUSION

Using a scrubbing technique when applying mild self-etching adhesives could improve resin monomer infiltration into dentin, chase water on adhesive surfaces, and facilitate smear layer removal.

Bonding Effectiveness of Luting Composites to Different CAD/CAM Materials

PURPOSE

To evaluate the influence of different surface treatments of six novel CAD/CAM materials on the bonding effectiveness of two luting composites.

MATERIALS AND METHODS

Six different CAD/CAM materials were tested: four ceramics - Vita Mark II; IPS Empress CAD and IPS e.max CAD; Celtra Duo - one hybrid ceramic, Vita Enamic, and one composite CAD/CAM block, Lava Ultimate. A total of 60 blocks (10 per material) received various mechanical surface treatments: 1. 600-grit SiC paper; 2. sandblasting with 30-μm Al2O3; 3. tribochemical silica coating (CoJet). Subsequent chemical surface treatments involved either no further treatment (control), HF acid etching (HF), silanization (S, or HF acid etching followed by silanization (HF+S). Two specimens with the same surface treatment were bonded together using two dual-curing luting composites: Clearfil Esthetic Cement (self-etching) or Panavia SA Cement (self-adhesive). After 1 week of water storage, the microtensile bond strength of the sectioned microspecimens was measured and the failure mode was evaluated.

RESULTS

The bonding performance of the six CAD/CAM materials was significantly influenced by surface treatment (linear mixed models, p < 0.05). The luting cement had a significant influence on bond strength for Celtra Duo and Lava Ultimate (linear mixed models, p < 0.05). Mechanical surface treatment significantly influenced the bond strength for Celtra Duo (p = 0.0117), IPS e.max CAD (p = 0.0115), and Lava Ultimate (p < 0.0001). Different chemical surface treatments resulted in the highest bond strengths for the six CAD/CAM materials: Vita Mark II and IPS Empress CAD: S, HF+S; Celtra Duo: HF, HF+S; IPS e.max CAD: HF+S; Vita Enamic: HF+S, S. For Lava Ultimate, the highest bond strengths were obtained with HF, S, HF+S. Failure analysis showed a relation between bond strength and failure type: more mixed failures were observed with higher bond strengths. Mainly adhesive failures were noticed if no further surface treatment was done. The percentage of adhesive failures was higher for CAD/CAM materials with higher flexural strength (Celtra Duo, IPS e.max CAD, and Lava Ultimate).

CONCLUSION

The bond strength of luting composites to novel CAD/CAM materials is influenced by surface treatment. For each luting composite, an adhesive cementation protocol can be specified in order to obtain the highest bond to the individual CAD/CAM materials.

Accelerated Fatigue Resistance of Thick CAD/CAM Composite Resin Overlays Bonded with Light- and Dual-polymerizing Luting Resins

PURPOSE

To evaluate the accelerated fatigue resistance of thick CAD/CAM composite resin overlays luted with three different bonding methods.

MATERIALS AND METHODS

Forty-five sound human second mandibular molars were organized and distributed into three experimental groups. All teeth were restored with a 5-mm-thick CAD/CAM composite resin overlay. Group A: immediate dentin sealing (IDS) with Optibond FL and luted with light-polymerizing composite (Herculite XRV). Group B: IDS with Optibond FL and luted with dual-polymerizing composite (Nexus 3). Group C: direct luting with Optibond FL and dual-polymerizing composite (Nexus 3). Masticatory forces at a frequency of 5 Hz were simulated using closed-loop servo-hydraulics and forces starting with a load of 200 N for 5000 cycles, followed by steps of 400, 600, 800, 1000, 1200 and 1400 N for a maximum of 30,000 cycles. Each step was applied through a flat steel cylinder at a 45-degree angle under submerged conditions.

RESULTS

The fatigue test generated one failure in group A, three failures in group B, and no failures in group C. The survival table analysis for the fatigue test did not demonstrate any significant difference between the groups (p = 0.154). The specimens that survived the fatigue test were set up for the load-to-failure test with a limit of 4600 N. The survival table analysis for the load-to-failure test demonstrates an average failure load of 3495.20 N with survival of four specimens in group A, an average failure load of 4103.60 N with survival of six specimens in group B, and an average failure load of 4075.33 N with survival of nine specimens in group C. Pairwise comparisons revealed no significant differences (p < 0.016 after Bonferroni correction).

CONCLUSION

Within the limitations of this in vitro study, it can be concluded that although the dual-polymerizing luting material seems to provide better results under extreme conditions, light-polymerizing luting composites in combination with IDS are not contraindicated with thick restorations.

Microshear Bond Strength of Tri-Calcium Silicate-based Cements to Different Restorative Materials

PURPOSE

To evaluate the microshear bond strength of tri-calcium silicate-based materials to different restorative materials.

MATERIALS AND METHODS

Thirty-five disks of TheraCal LC and Biodentine were fabricated using teflon molds according to manufacturers' instructions. Then the specimens were randomly divided into 7 groups according to the materials applied: Fuji IX, Fuji II, Equia Fil, Vertise Flow, Filtek Bulk Fill Posterior Restorative, Filtek Z250 with Prime&Bond NT and with Clearfil SE Bond. All restorative materials were placed onto the disks using tygon tubes. Following a storage period, the specimens underwent microshear bond strength testing in a universal testing machine, and fracture modes were analyzed. Data were analyzed using one-way ANOVA and Tukey's post-hoc test.

RESULTS

For all restorative materials, TheraCal LC showed significantly higher μSBS values compared to Biodentine. GIC based materials showed the lowest μSBS for TheraCal and Biodentine. For Biodentine, Filtek Z250 applied with Prime&Bond NT and Filtek Bulk Fill Posterior Restorative applied with Scotchbond Universal Adhesive exhibited the highest μSBS, while Filtek Z250 applied with Clearfil SE Bond revealed the highest bond strength to TheraCal LC.

CONCLUSION

For all restorative materials tested in this study, TheraCal LC showed higher μSBS compared to Biodentine. For both TheraCal LC and Biodentine, the placement of GIC-based materials prior to composite resin restorations might decrease the bond strength. Composite resins applied with self-etching adhesives increased the bond strength of TheraCal LC; however, for Biodentine, application of etch-and-rinse adhesives may improve the adhesion of composite resins.

Quantitative Evaluation of MDP-Ca Salt and DCPD after Application of an MDP-based One-step Self-etching Adhesive on Enamel and Dentin

PURPOSE

To investigate the effects of an experimental 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-based one-step self-etching adhesive (EX adhesive) applied to enamel and dentin on the production of calcium salt of MDP (MDP-Ca salt) and dicalcium phosphate dehydrate (DCPD) at various periods.

MATERIALS AND METHODS

The EX adhesive was prepared. Bovine enamel and dentin reactants were prepared by varying the application period of the EX adhesive: 0.5, 1, 5, 30, 60 and 1440 min. Enamel and dentin reactants were analyzed using x-ray diffraction and solid-state phosphorus-31 nuclear magnetic resonance (31P NMR). Curvefitting analyses of corresponding 31P NMR spectra were performed.

RESULTS

Enamel and dentin developed several types of MDP-Ca salts and DCPDs with amorphous and crystalline phases throughout the application period. The predominant molecular species of MDP-Ca salt was determined as the monocalcium salt of the MDP monomer. Dentin showed a faster production rate and greater produced amounts of MDP-Ca salt than did enamel, since enamel showed a knee-point in the production rate of the MDP-Ca salt at the application period of 5 min. In contrast, enamel developed greater amounts of DCPD than did dentin and two types of DCPDs with different crystalline phases at application periods > 30 min. The amounts of MDP-Ca salt developed during the 30-s application of the EX adhesive on enamel and dentin were 7.3 times and 21.2 times greater than DCPD, respectively.

CONCLUSION

The MDP-based one-step adhesive yielded several types of MDP-Ca salts and DCPD with an amorphous phase during the 30-s application period on enamel and dentin.

Osseointegration of chemically modified sandblasted and acid-etched titanium implant surface in diabetic rats: a histological and scanning electron microscopy study

INTRODUCTION

The aim of this study is to assess the osseointegration of different dental implants surfaces in diabetic rats.

MATERIALS AND METHODS

In this study, were used 56 male Wistar rats, average weight of 300-350 g. Diabetes was induced by a single intraperitoneal injection of Streptozotocin. The glucose levels and weight of rats were periodically evaluated. After the diabetes mellitus is confirmed, the sandblasted, large-grit, acid-etched (SLA) and SLActive endosseous dental implants (TAG dental implants, TAG Medical, Israel), made of titanium alloy, Ti-6Al-4V, 1 mm diameter and 3 mm in length were inserted in the distal metaphysis of the left femur.

RESULTS

Diabetic rats have naturally lower number of bone cells and bone-implant contact (BIC%) than healthy rats when using the SLA implant, but when using SLActive implant, diabetic and healthy rats have the same numbers.

CONCLUSIONS

The use of the SLActive surface resulted in positive effects in healthy and especially in diabetic animals, which demonstrate that could improve the osseointegration progress in humans with diabetes.

Development of a Self-etch Adhesive for Resin-modified Glass Ionomers

The favorable self-adhesiveness of resin-modified glass ionomers (RMGIs) might be even further improved if the time-consuming and technically sensitive etch-and-rinse pre-treatment step with polyalkenoic acids could be avoided. We undertook this study to assess the effectiveness of an experimental self-etch adhesive for RMGIs that does not need to be rinsed off. Ultrastructural analysis and micro-tensile bond strength testing to enamel and dentin of a RMGI restorative material and a RMGI adhesive were performed after 4 different surface pre-treatments: no conditioning; 25% polyalkenoic acid; an experimental self-etch adhesive; and 37.5% phosphoric acid followed by the experimental self-etch adhesive. The use of an experimental self-etch adhesive increased the bond strength of RMGIs, especially after an additional conditioning step. Interfacial analysis showed the formation of a thin hydroxyapatite-containing hybrid layer. The self-etch technique enhances the user-friendliness of RMGIs and lowers their technique-sensitivity, while maintaining desirable characteristics of the conventional etch-and-rinse approach with polyalkenoic acids.