Glutaraldehyde-based desensitizer does not influence postoperative sensitivity and clinical performance of posterior restorations: A 24-month randomized clinical trial

OBJECTIVES

To evaluate the influence of a glutaraldehyde-based desensitizer (GL) on postoperative sensitivity (POS) in posterior bulk-fill resin composite restorations using an adhesive applied in the self-etch (SE) and etch-and-rinse (ER) strategies; and to assess the clinical performance of the restorations.

METHODS

Posterior resin composite restorations (n = 228) at least 3 mm deep were inserted in 57 subjects using a split-mouth design. The adhesive was applied with/without prior application of a GL. A resin composite was used for all restorations. Spontaneous POS (risk and intensity), as well as POS caused by stimulation with an air blast and assess the response to horizontal and vertical percussion was assessed using two scales in the baseline and after 7, 14, and 30 days. In addition, some parameters were evaluated using FDI criteria up to 24 months of clinical service.

RESULTS

No significant POS was observed (p > 0.05). A higher absolute risk and intensity of spontaneous POS was observed within 7 days (35.1%), without statistically significant differences among groups. At 24 months 5 restorations were considered clinically unsatisfactory, and 73 restorations showed minor discrepancies in adaptation, with no significant differences between groups (p > 0.05).

SIGNIFICANCE

A GL agent does not influence POS in posterior restorations with bulk-fill resin composite. It may be considered a dispensable clinical step in the restorative protocol.

Effect of Extra Hydrophobic Resin Layer on Bonding of Universal Adhesive Systems to Enamel

OBJECTIVE

The objective of this study was to compare the effect of solvent in universal adhesives (UA) and the application of an extra layer of hydrophobic bonding resin on enamel shear bond strengths (SBS).

METHODS AND MATERIALS

Crowns of 224 bovine mandibular incisors were embedded in acrylic resin, wet-polished up to 600-grit silicon carbide paper and assigned to 3 UAs with different solvents (n=32): ethanol-based UA (ADU, AdheSE Universal, Ivoclar Vivadent); isopropanol-based UA (PBU, Prime&Bond Universal, Dentsply Sirona); and acetone-based UA (OPT, OptiBond Universal, Kerr Co). The same UAs were also applied with an extra layer of a hydrophobic bonding resin (HLB, Heliobond, Ivoclar Vivadent): ADU + HLB; PBU + HLB; and OPT + HLB. HLB alone was used as control. Enamel was etched with 37.5% H3PO4 (Kerr Gel Etchant, Kerr Co) for 15 seconds, rinsed with water, and air dried. UAs were applied according to the respective manufacturer's instructions. After adhesive application, composite cylinders (Filtek Z250, 3M Oral Care) were built up and light-cured (40 seconds/increment, 40 J/cm2) keeping the light tip in contact with the mold. Specimens were stored in water for 24 hours (24H) or for 6 months (6M). A knife-edged metallic rod (Ø=2.8-mm semicircular notch) loaded the composite cylinders until fracture. Mode of failure was analyzed with optical microscopy (40×). Statistics included twoway analysis of variance (ANOVA; adhesive strategy and water storage) and Tukey honestly significant difference (HSD) post hoc test (α=95%).

RESULTS

Mean enamel SBS ranged from 3.6 (±2.2) MPa (HLB/6M) to 24.7 (±7.1) MPa (ADU + HLB/6M). ANOVA revealed significant differences for adhesive strategy (p≤0.001) but no significant differences for water storage (p>0.05). All UAs resulted in similar mean enamel SBS with or without an extra layer of HLB at 24H. After 6M, only ADU resulted in higher enamel SBS when an extra layer of HLB was applied. All UAs resulted in higher mean enamel SBS than HLB (control). Most failures were adhesive exception for PBU/HLB/6M, which had mostly mixed failures.

CONCLUSIONS

UAs resulted in statistically higher enamel SBS than the nonsolvated hydrophobic bonding resin (control), regardless of the solvent in their composition. Application of an extra layer of hydrophobic bonding resin over UAs did not improve mean enamel SBS for isopropanol- and acetone-based UAs but did improve mean enamel SBS for the ethanol-based UA after 6M. Resin composite bonding to enamel using a hydrophobic bonding resin alone is not recommended.

Evidence-based fact checking for selective procedures in restorative dentistry

OBJECTIVES

Similar to other dental specialties, there are many clinical procedures in restorative dentistry that may or may not be supported by good evidence. Thus, the effectiveness of these procedures is uncertain. The aim of this paper is to reduce this knowledge gap by critically inspecting selective procedures in restorative dentistry and exploring if these well-established or widely advocated treatment modalities are necessary for improving treatment outcomes based on the best available evidence.

MATERIALS AND METHODS

A MEDLINE search was conducted to identify research on selective procedures while focusing on clinical trials and systematic reviews. Due to their practical relevance in the decision-making process, cost-effectiveness analyses were also included.

RESULTS

Mixed results were identified regarding the included interventions. Some procedures had adequate evidence supporting them while others were mostly based on beliefs.

CONCLUSIONS

A critical review of the available literature indicates that some common restorative procedures lack adequate support from high-quality research evidence.

CLINICAL RELEVANCE

This paper attempts to highlight the need to critically examine the scientific validity of traditional knowledge and techniques through the context of current research evidence. This will not only help generate consensus between educators, clinicians, and researchers regarding restorative procedures but will also lead to improved patient care and outcomes.

Functional signatures of ex-vivo dental caries onset

Background

The etiology of dental caries remains poorly understood. With the advent of next-generation sequencing, a number of studies have focused on the microbial ecology of the disease. However, taxonomic associations with caries have not been consistent. Researchers have also pursued function-centric studies of the caries microbial communities aiming to identify consistently conserved functional pathways. A major question is whether changes in microbiome are a cause or a consequence of the disease. Thus, there is a critical need to define conserved functional signatures at the onset of dental caries.

Methods

Since it is unethical to induce carious lesions clinically, we developed an innovative longitudinal ex-vivo model integrated with the advanced non-invasive multiphoton second harmonic generation bioimaging to spot the very early signs of dental caries, combined with 16S rRNA short amplicon sequencing and liquid chromatography-mass spectrometry-based targeted metabolomics.

Findings

For the first time, we induced longitudinally monitored caries lesions validated with the scanning electron microscope. Consequently, we spotted the caries onset and, associated with it, distinguished five differentiating metabolites - Lactate, Pyruvate, Dihydroxyacetone phosphate, Glyceraldehyde 3-phosphate (upregulated) and Fumarate (downregulated). Those metabolites co-occurred with certain bacterial taxa; Streptococcus, Veillonella, Actinomyces, Porphyromonas, Fusobacterium, and Granulicatella, regardless of the abundance of other taxa.

Interpretation

These findings are crucial for understanding the etiology and dynamics of dental caries, and devising targeted interventions to prevent disease progression.

A critical analysis of research methods and experimental models to study the load capacity and clinical behavior of the root filled teeth

The prognosis of root‐filled teeth depends not only on a successful root canal treatment but also on the restorative prognosis. This critical review discusses the advantages and limitations of various methodologies used to assess the load capacity or clinical survivability of root‐filled teeth and restorations. These methods include static loading, cyclic loading, finite element analysis and randomized clinical trials. In vitro research is valuable for preclinical screening of new dental materials or restorative modalities. It also can assist investigators or industry to decide whether further clinical trials are justified. It is important that these models present high precision and accuracy, be reproducible, and present adequate outcomes. Although in vitro models can reduce confounding by controlling important variables, the lack of clinical validation (accuracy) is a downside that has not been properly addressed. Most importantly, many in vitro studies did not explore the mechanisms of failure and their results are limited to rank different materials or treatment modalities according to the maximum load capacity. An extensive number of randomized clinical trials have also been published in the last years. These trials have provided valuable insight on the survivability of the root‐filled tooth answering numerous clinical questions. However, trials can also be affected by the selected outcome and by intrinsic and extrinsic biases. For example, selection bias, loss to follow‐up and confounding. In the clinical scenario, hypothesis‐based studies are preferred over observational and retrospective studies. It is recommended that hypothesis‐based studies minimize error and bias during the design phase.

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

OBJECTIVE

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

METHODS AND MATERIALS

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

RESULTS

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

CONCLUSIONS

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

Postoperative sensitivity in posterior resin composite restorations with prior application of a glutaraldehyde-based desensitizing solution: A randomized clinical trial

OBJECTIVES

To evaluate the effect of a glutaraldehyde-based desensitizer on the postoperative sensitivity (POS) in posterior resin composite restorations up to 12 months using a universal adhesive (Tetric N-Bond Universal) with selective enamel etching (SE) or an etch-and-rinse (ER) strategy.

METHODS

Class I and class II resin composite restorations (n = 220) at least 3 mm deep were inserted in 55 subjects. The universal adhesive was applied using the SE (self-etch strategy on dentin with selective enamel etching) or the ER strategy, with or without prior application of a glutaraldehyde-based desensitizer (Gluma Desensitizer - GL) to form groups SEGL and ERGL. A bulk-fill resin composite (Tetric NCeram Bulk Fill) was used for all restorations. Spontaneous POS was assessed 7 days after the restorative procedure using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). After 7, 14, and 30 days of completing each restoration, the subjects were reassessed to evaluate POS caused by stimulation with an air blast, horizontal and vertical percussion. In addition, marginal discoloration, marginal adaptation, fracture, and recurrence of caries were evaluated using the FDI (World Dental Federation) criteria after 7 days and at 12 months.

RESULTS

No significant spontaneous or stimuli-induced POS was observed when restorations with or without GL were compared (p>0.05). A higher risk of spontaneous POS was observed within 7 days (40.0%; 95% CI 28.1 to 53.1), without statistically significant differences among groups. None of the participants reported POS at 12 months, however five restorations were considered clinically unsatisfactory (p > 0.05).

CONCLUSIONS

The previous application of GL did not significantly reduce spontaneous or stimuli-induced POS in posterior resin composite restorations at any time, regardless of the adhesive strategy used.

CLINICAL SIGNIFICANCE

The use of a glutaraldehyde-based desensitizing agent did not generate lower incidence of postoperative sensitivity in resin composite posterior restorations.

Anterior Veneer Restorations - An Evidence-based Minimal-Intervention Perspective

PURPOSE

The goals of this review are (1) to describe the evidence behind the use of ceramics vs composite resin to restore teeth with anterior veneers using a minimally-invasive strategy; and (2) to discuss the choice of materials and techniques for anterior veneer restorations.

OVERVIEW

In recent years new adhesive restorative materials and techniques have been introduced in dentistry, including nanofilled composite resins for direct restorations, new ceramic materials that combine esthetics and strength, and polymer/ceramic materials for indirect restorations that are fabricated chairside using CAD/CAM technology, allowing the dentist to design, mill, and cement the restoration in one session. In spite of the novelty and new technology behind the introduction of new materials, the available evidence that backs some of these materials does not justify their use over similar materials or techniques that have been used by dentists for some years. Notwithstanding the success of laminate veneers and the popularity of new materials and digital techniques, the classical direct composite resin veneer is still very popular among clinicians and taught in dental schools and continuing education courses. Direct composite resin veneers are usually more affordable than indirect veneers, less invasive of the tooth structure, and easier to repair. Current composite resin materials can be finished to a tooth-like appearance, but they are susceptible to alterations of the surface gloss and potential discoloration of the composite resin. On the other hand, the preparation for indirect veneers is generally more invasive and the respective restorations are more difficult to repair. In addition, the esthetic outcome of bonded ceramic restorations still depends on the clinical behavior of the dentin adhesive and resin luting cement used to bond the restoration to the tooth structure.

CONCLUSIONS

The ultimate goals of any restorative treatment are to restore function and esthetics, prevent recurrent caries lesions and bacterial leakage into the pulp space, save tooth structure, and promote the well-being of our patients. The armamentarium of new dental materials for esthetic clinical procedures has increased exponentially in the last few years. The use of different materials and techniques for anterior veneer restorations must be based on sound evidence rather than on the marketing hype or testimonials.

Universal adhesives and dual-cured core buildup composite material: adhesive properties

Dual-cured buildup composites and simplified light-cured adhesive systems are mixed with a chemical activator to prevent the incompatibility between them.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Effect of Methacryloyloxydecyl Dihydrogen Phosphate–Containing Silane and Adhesive Used Alone or in Combination on the Bond Strength and Chemical Interaction With Zirconia Ceramics Under Thermal Aging

Clinical Relevance

Achieving durable bonding to zirconia is fundamental for the application of a methacryloyloxydecyl dihydrogen phosphate (MDP)–containing silane solution or an MDP-containing silane solution associated with an MDP-containing universal adhesive.

SUMMARY

Objectives: To evaluate the effect of a methacryloyloxydecyl dihydrogen phosphate (MDP)–containing silane coupling agent and universal adhesive, used alone or in combination, on the microshear bond strength (μSBS) to zirconia after 24 hours of water storage (24h) and after 10,000 thermocycles (TC), complemented with chemical analysis of the surface to establish the presence of MDP on the surface of the zirconia after bonding procedures.

Methods and Materials: Thirty computer-aided design/computed-aided manufacturing blocks of zirconia were cut into four sections (6×6×6 mm) and sintered. Zirconia sections (n=96) were assigned to 24 groups according to three factors: 1) silane (no silane, Monobond S [MBS], Monobond P [MB+]), 2) adhesive + resin cement (no adhesive + Enforce [ENF], no adhesive + RelyX Ultimate [REX], Prime&Bond Elect + Enforce [PBE/ENF], Scotchbond Universal + RelyX Ultimate [SBU/REX]), and 3) thermocycling (no thermocycling [24h], 10,000 thermocycles [TC]). Upon silane/adhesive application, cylinder-shaped matrices were filled with resin cement and light cured. Specimens were tested in μSBS (1.0 mm/min) after 24h or TC. The μSBS data were analyzed using twoway ANOVA and Tukey’s post hoc test (α=0.05). In addition, micro-Raman spectroscopy was used to analyze the zirconia surface for immediate chemical interaction analysis (n=24).

Results: For the 24h condition, PBE/ENF resulted in lower mean μSBS than both groups with silane without PBE (MBS and MB+ groups; p<0.001). SBU alone or MB+ alone and MB+ associated with SBU showed the highest mean μSBS (p<0.001). For the TC condition, all groups showed a significant decrease in mean μSBS compared with those of 24h (p<0.001), with the exception of MB+ associated to SBU (p>0.05). However, the application of MB+ alone or MB+ associated to SBU resulted in higher mean μSBS (p<0.001) after TC than the remaining TC groups. In terms of chemical interaction, only the SBU groups, alone or combined with both of the silane agents, were associated with the methacrylate groups after rinsing.

Conclusions: The results of the current study support the use of an MDP-containing silane solution or an MDP-containing silane solution associated with an MDP-containing universal adhesive for bonding to air-abraded zirconia, as a more stable bonding after thermocycling.

Current perspectives on dental adhesion: (1) Dentin adhesion - not there yet

The essential goal of any adhesive restoration is to achieve a tight and long-lasting adaptation of the restorative material to enamel and dentin. The key challenge for new dental adhesives is to be simultaneously effective on two dental substrates of conflicting nature. Some barriers must be overcome to accomplish this objective. While bonding to enamel by micromechanical interlocking of resin tags within the array of microporosities in acid-etched enamel can be reliably achieved and can effectively seal the restoration margins against leakage, bonding effectively and durably to organic and humid dentin is the most puzzling task in adhesive dentistry.

Much of the research and development of dental adhesives has focused on making the clinical procedure more user-friendly by reducing the number of bottles and/or steps. Although clinicians certainly prefer less complicated and more versatile adhesive materials, there is a trade-off between simplification of dental adhesives and clinical outcomes. Likewise, new materials are launched with claims of being novel and having special properties without much supporting evidence.

This review article discusses dental adhesion acknowledging pioneer work in the field, highlights the substrate as a major challenge to obtain durable adhesive restorations, as well as analyzes the three adhesion strategies and their shortcomings. It also reviews the potential of chemical/ionic dental adhesion, discusses the issue of extensively published laboratory research that does not translate to clinical relevance, and leaves a few thoughts in regard to recent research that may have implications for future adhesive materials.

Five-year clinical evaluation of a universal adhesive: A randomized double-blind trial

OBJECTIVE

To evaluate the five-year clinical performance of Scotchbond Universal Adhesive (SU; 3M Oral Care, St. Paul, MN, USA) in non-carious cervical lesions (NCCLs) using two evaluation criteria.

METHODS

Thirty-nine patients participated in this study. Two hundred restorations were assigned to four groups: SU-ERm: etch-and-rinse + moist dentin; SU-ERd: etch-and-rinse + dry dentin; SU-Set: selective enamel etching; and SU-SE: self-etch. A nanofilled composite resin was placed incrementally. The restorations were evaluated at baseline and after 5 years using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. The survival rates (retention/fractures) were calculated with the Kaplan-Meier and the log-rank test. For the secondary outcomes, Friedman repeated measures analysis of variance by rank was applied (α = 0.05).

RESULTS

After 5 years the recall rate was 86%. The retention/fracture rates were 93% for Erm and ERd, 88.4% for SEet and 81.4% for SE. A significant difference was observed for SE vs. ERd and SE vs. ERm (p = 0.01). Also, marginal discoloration and adaptation showed significant differences with ERm and ERd resulting in fewer marginal discrepancies than SE (p < 0.05).

SIGNIFICANCE

After 5 years, the clinical behavior of the universal adhesive in the etch-and-rinse strategy was better when compared to the self-etch strategy. The use of selective enamel etching is highly recommended for the self-etch strategy. The FDI and USPHS evaluation criteria showed similar results after 5 years.

Resin infiltration of enamel white spot lesions: An ultramorphological analysis

OBJECTIVE

There is not a clear understanding of the ultramorphology of enamel white spot lesions (WSLs). The purpose of this study is to characterize resin infiltration of enamel WSLs using electron microscopy.

MATERIALS AND METHODS

Enamel sections with sound enamel and WSLs were sectioned from extracted teeth and assigned to three groups: (a) left untreated; (b) etched with 15% hydrochloric acid (Icon-Etch); (c) restored with the resin infiltration sequence (Icon-Etch, Icon-Dry, and Icon-Infiltrant). Restored specimens were demineralized to obtain replicas. Observations were carried out under a field-emission scanning electron microscope.

RESULTS

Icon-Etch resulted in an array of pits and funneled holes on the WSL. Replicas of WSLs depicted 0.5-6.0-μm-thick shaggy resin tags up to a depth of 465 μm. Enamel crystallites were enveloped with resin at the bottom of the WSL forming a hybrid layer.

CONCLUSIONS

The resin infiltrant filled the spaces between the crystallites and resulted in an enamel hybrid layer.

CLINICAL SIGNIFICANCE

In addition to masking enamel WSLs, resin infiltration is able envelop residual enamel crystallites forming an enamel hybrid layer. This hybridization makes resin-embedded enamel more resistant to acid attack than sound enamel.

Digital versus conventional impressions for full-coverage restorations: A systematic review and meta-analysis

BACKGROUND

The primary objective of this systematic review was to investigate the survival of full-coverage restorations fabricated by using digital impressions (DIs) versus that of those fabricated by using conventional impressions. The authors also compared secondary outcomes of marginal and internal fit and occlusal and interproximal contacts.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic literature search in multiple databases to identify clinical trials with no restrictions by publication type, date, or language. The authors assessed study-level risk of bias and outcome-level strength of evidence. The authors performed a meta-analysis by using a random-effects model.

RESULTS

Ten studies met the inclusion criteria. The authors identified no studies in which the investigators compared the impression techniques with respect to survival of full-coverage restorations. Mean differences for marginal gap and internal gap were -9.0 micrometers (95% confidence interval, -18.9 to 0.9) and -15.6 μm (95% confidence interval, -42.6 to 11.4), respectively. Studies assessing internal gap were substantially heterogeneous (I² = 72%; P = .003).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Research is lacking to draw robust conclusions about the relative benefits of DIs in terms of restoration survival. Low-quality evidence for marginal fit and internal fit suggested similar performance for both techniques. Evidence quality for interproximal contact and occlusal contact was very low and insufficient to draw any conclusions regarding how the impression techniques compared. Given the uncertainty of the evidence, results should be interpreted with caution. With increasing popularity and adoption of digital scanners by dentists, pragmatic practice-based trials involving standardized, patient-centered outcomes may improve confidence in the comparative effectiveness of DIs.

Effect of a hydrophobic bonding resin on the 36-month performance of a universal adhesive-a randomized clinical trial

OBJECTIVES

To evaluate if the addition of a layer of a hydrophobic bonding resin to the recommended application sequence of a universal adhesive improves the respective clinical behavior in non-carious cervical lesions (NCCLs) after 36 months.

MATERIALS AND METHODS

Scotchbond Universal Adhesive (SBU, 3M Oral Care) was applied in NCCLs of 39 subjects using four adhesion strategies: (1) three-step ER (etch-and-rinse), (2) two-step ER, (3) two-step SE (self-etch), and (4) one-step SE. An extra layer of a hydrophobic bonding resin was applied for strategies three-step ER and two-step SE. The same composite resin (Filtek Supreme XTE, 3M Oral Care) was used for all strategies. Restorations were evaluated at baseline and 18 and 36 months using the modified United States Public Health Service (USPHS) criteria. Kruskal-Wallis, Mann-Whitney U, Friedman, and Wilcoxon non-parametric tests were computed.

RESULTS

The cumulative failure rate was 8.6%. The 36-month retention rates were 100% for both 3-ER and 2-ER, 76.0% for 2-SE, and 86.2% for 1-SE. A lower retention rate was observed for two-step SE at 36 months compared with both three-ER (p < 0.01) and two-ER (p < 0.01). Identical retention rates were measured for the two SE groups. When retention rate was compared at baseline versus 36 months for each adhesion strategy, a significant decrease was observed for 2-SE. The restorations performed with 3-ER, 2-SE, and 1-SE had a significant deterioration in marginal discoloration at the 18-month recall.

CONCLUSIONS

The 36-month clinical performance of Scotchbond Universal Adhesive improved for both etch-and-rinse strategies.

CLINICAL RELEVANCE

Phosphoric acid etching is still recommended to provide retention to composite restorations in NCCLs.

Effect of MDP-containing Silane and Adhesive Used Alone or in Combination on the Long-term Bond Strength and Chemical Interaction with Lithium Disilicate Ceramics

PURPOSE

To evaluate the effect of a silane and an adhesive containing MDP, used alone or combined in the same solution, on the microshear bond strength (μSBS) to lithium disilicate ceramics immediately and after 1-year water storage, and compare the bond strength results with the Raman spectra of the treated lithium disilicate surfaces.

MATERIALS AND METHODS

A total of 30 CAD/CAM blocks of lithium disilicate (LD; IPS e.max CAD) were cut into four square sections (6 x 6 x 6 mm; n = 60 per group) and processed as recommended by the manufacturer. The LD specimens were divided into 12 groups according to the following independent variables: silane coupling agent (no silane; silane without 10-MDP [MBS, Monobond S]; silane with 10-MDP [MB+, Monobond Plus]) and adhesive + luting composite (no adhesive + Enforce; no adhesive + RelyX Ultimate; Prime & Bond Elect [PBE], a silane- and MDP-free universal adhesive + Enforce; Scotchbond Universal Adhesive [SBU], a silane- and MDP-containing universal adhesive + RelyX Ultimate). After each treatment, cylindrical, transparent matrices were filled with a luting composite and light cured. Specimens were stored in water (37°C for 24 h or 1 year) and submitted to the microshear bond strength (μSBS) test. The failure pattern and μSBS were statistically evaluated (α = 0.05). In addition, specimens were examined for chemical interaction using Raman spectroscopy.

RESULTS

The use of the adhesive PBE alone showed higher mean μSBS compared with both groups with silane (MSB or MB+) without PBE (p < 0.001) at 24 h. The use of the SBU adhesive or MBS silane alone, as well as MB+ associated with SBU, showed higher mean μSBS (p < 0.001) at 24 h. After 1-year water storage, all groups showed a significant decrease in mean μSBS. However, the application of PBE or SBU associated with MB+ silane showed higher 1-year mean μSBS (p < 0.001). In terms of chemical interaction, when silane (MSB or MB+) was applied, only a slight decrease of Si-O peaks occurred. Otherwise, when PBE or SBU adhesives were applied, methacrylate peaks were only observed in the SBU groups.

CONCLUSION

The best results in terms of bond strength after water storage were obtained when an MDP-containing silane was associated with a universal adhesive. The use of a simplified bonding protocol that includes either a silane or a universal adhesive is not recommended.

Long-term In Vitro Adhesion of Polyalkenoate-based Adhesives to Dentin

PURPOSE

To study the influence of a polyalkenoate copolymer (VCP) on the immediate (24 h) and 6-month dentin bonding stability of VCP-based adhesives, using microtensile bond strength (μTBS), nanoleakage (NL), and ultramorphological analyses (FE-SEM).

MATERIALS AND METHODS

Eighty-four caries-free molars were randomly assigned to seven adhesives: Clearfil SE Bond (CSE, Kuraray Noritake); Adper Single Bond Plus (SB, 3M ESPE); SB without VCP (SBnoVCP, 3M ESPE); Scotchbond Universal Adhesive applied as a etch-and-rinse adhesive (SBU_ER); SBU without VCP applied as an etch-and-rinse adhesive (SBUnoVCP_ER); SBU applied as a self-etch adhesive (SBU_SE, 3M ESPE); SBU without VCP applied as a self-etch adhesive (SBUnoVCP_SE, 3M ESPE). Half of the beams were tested after 24 h, and the other half was aged in water for 6 months prior to testing. For each tooth/evaluation time, two beams were randomly selected for NL analysis. Statistical analyses of µTBS results were performed using two-way ANOVA, Tukey's post-hoc tests, and Student's t-test for paired data (α = 0.05). Nanoleakage was statistically analyzed using the Kruskal-Wallis and Mann-Whitney tests, with Wilcoxon's test for paired data. For FE-SEM, four caries-free molars were assigned to each of the seven groups. Dentin disks were restored and cross sectioned into halves. One half was observed at 24 h, and the other at 6 months.

RESULTS

The highest 6-month mean μTBS was obtained with SBU_SE/SBUnoVCP_SE and SBUnoVCP_ER. SBUnoVCP_SE resulted in greater silver deposition at 6 months. FE-SEM observations showed that CSE and SBU_SE specimens resulted in a submicron hybrid layer without signs of degradation at 6 months.

CONCLUSIONS

VCP may contribute to the long-term bonding stability of VCP-based adhesives.

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

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

Two-year clinical evaluation of proanthocyanidins added to a two-step etch-and-rinse adhesive

OBJECTIVE

To compare the clinical behavior of Proanthocyanidins (PA)-free and PA-containing two-step etch-and-rinse adhesive used underneath resin composite restorations in non-carious cervical lesions (NCCLs) over a 6- (6 M) and 24-month (24 M) period.

METHODS

135 restorations were randomly placed in 45 subjects. The NCCLs were conditioned (37% phosphoric acid for 15 s) and distributed into 3 groups: Control (EX0) - ExciTE F (Ivoclar Vivadent) adhesive applied following the manufacturer's recommendations; EX2 and EX5 - 2 wt% and 5 wt% of PA were added to ExciTE F, respectively, and applied as in EX0. Resin composite was placed incrementally and light-cured. The restorations were evaluated at baseline, 6 M and 24 M, using FDI and USPHS criteria. Statistical analyses were performed using Friedman and Wilcoxon tests (α = 0.05).

RESULTS

The retention rates were 98% (95% confidence interval 88-99%) for EX0, 92% (80-97%) for EX2; and 85% (72-93%) for EX5 at 6 M. A significant difference was found only for EX5 at 6 M when compared with the respective baseline findings (p = 0.03) and when compared with EX0 and EX2 (p = 0.001) at 6 M. After 24 M, the retention rates were 98% (88-99%) for EX0, 73% (59-84%) for EX2, and 71% (56-82%) for EX5. Only EX0 did not result in significant difference in retention rate at 24 M when compared with baseline but showed a significant higher retention rate when compared with those of EX2 and EX5 (p = 0.001).

CONCLUSION

Adding proanthocyanidins to the adhesive solution jeopardized the retention of composite resins restorations in non-carious cervical lesions after 24 months.

CLINICAL RELEVANCE

In spite of being user-friendlier than when used separately, the incorporation of proanthocyanidins into the adhesive solution impairs the longevity of composite restorations.

Does a Self-etching Ceramic Primer Improve Bonding to Lithium Disilicate Ceramics? Bond Strengths and FESEM Analyses

OBJECTIVE:

To compare the effect of hydrofluoric acid (HF) vs self-etching ceramic primer on resin cement microshear bond strength (μSBS) and ultramorphology of lithium disilicate (LD) ceramic.

METHODS AND MATERIALS:

LD (IPS e.max CAD, Ivoclar Vivadent) blocks (14×4×2 mm³) were polished to 1200 grit and assigned to nine groups (n=5): CON: control, no LD surface treatment; IVO: 5.0% HF (IPS Ceramic Etching Gel, Ivoclar Vivadent); VIT: 5.0% HF (Vita Ceramics Etch, VITA Zahnfabrik); FGM: 5.0% HF (Condac Porcelana, FGM); ULT: 9.0% HF (Porcelain Etch, Ultradent); PRM: 9.6% HF (Premier Porcelain Etch Gel, Premier); BIS: 9.5% HF (Porcelain Etchant, Bisco Inc); DEN: 10.0% HF (Condicionador de Porcelanas, Dentsply Brazil); and MEP: self-etching ceramic primer (Monobond Etch & Prime, Ivoclar Vivadent). For all HF groups and control, an MDP-containing silane solution (MB⁺, Monobond Plus, Ivoclar Vivadent) was applied on rinsing the HF gel and air drying. Three transparent matrices for each specimen were filled with light-cured resin cement (Variolink Veneer, Ivoclar Vivadent). After storage in water for 48 hours at 37°C, specimens were tested in shear mode to measure μSBS. Mode of failure was analyzed at 50×. Statistical analysis included one-way analysis of variance and the Duncan post hoc test (α=0.05). Thirty-six additional LD specimens were assigned to the same experimental groups (n=4) and observed under a field-emission scanning electron microscope (FESEM) at magnifications ranging from 10,000× to 100,000×.

RESULTS:

IVO resulted in statistically higher mean μSBS than all the other groups. MEP resulted in statistically lower μSBS than all HF groups. The failure mode for MEP was predominantly adhesive. The most frequent failure mode for the HF groups was mixed. CON resulted in 100% pretesting failures. For FESEM, no retentive pattern was observed for CON specimens. MEP resulted in the least pronounced etching pattern, few areas around crystals exhibited a slight increase in retention pattern compared to the control group. All HF gels created microporosities on the LD surface with distinct etching patterns. VIT and DEN resulted in an LD ultramorphology that suggested overetching.

CONCLUSIONS:

HF etching followed by a silane solution resulted in higher bond strengths than a self-etching ceramic primer. Some HF gels may cause overetching of the LD intaglio surface.

Adesivos Universais de Condicionamento Total e Restaurações Indiretas em Resina com Polimerização Dual: Propriedades Adesivas

Avaliou-se a resistência ao microcisalhamento (RUM) e a nanoinfiltração (NI) de adesivos universais aplicados como sistemas convencionais em restaurações indiretas com ou sem ativador de autopolimerização (AA) usando diferentes protocolos de polimerização. Utilizou-se dentina oclusal de 55 molares humanos. Os espécimes foram alocados aleatoriamente para: All-Bond Universal / Core Flo DC [ABU] Clearfil Universal Bond / Clearfil DC Core Plus [CFU] Prime & Bond Elect / FluoroCore 2+ [PBE] e One Coat 7 Universal / ParaCore [OCU]. O Clearfil SE Bond / Clearfil DC Core Plus [CSE] foi utilizado como controle. Para CFU, PBE e OCU, foram utilizados protocolos de fotopolimerização [FP], polimerização dual [DP] e autopolimerização [AP]. Testes ANOVA e Tukey foram utilizados (a 0,05). RUM: Modo FP - ABU resultou em RUM menor do que todos os outros adesivos FP. Modo DP - CSE mostrou resultado maior do que CBU e OCU, porém semelhante ao PBE. Modo AP - PBE resultou em RUM menores que os modos PBE / DP e FP.  Para CBU e OCU, não houve diferença nos modos FP,  DP e AP.  NI: ABU resultou em    NI menor que o modo PBE / FP, mas semelhante ao modo CBU / FP e OCU / FP. O modo CSE / DP resultou em NI maior em comparação com todos os adesivos universais DP. O modo CFU / AP resultou em NI maior que CFU / FP e modo DP. PBE / FP e DP resultaram em NI maior que o modo PBE / AP. O modo OCU / DP resultou em NI maior do que OCU / FP e modo AP. Para os adesivos universais, AA e os diferentes protocolos de polimerização influenciaram o RUM e NI todavia, esta influência foi adesivo- dependente.Palavras-chave: Microcisalhamento. Nanoinfiltração. Restaurações Indiretas.

Randomized clinical trials of dental bleaching - Compliance with the CONSORT Statement: a systematic review

We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at "low" risk; 62.1% were classified as "unclear"; and 30.3% as "high" risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.

Masking of Enamel Fluorosis Discolorations and Tooth Misalignment With a Combination of At-Home Whitening, Resin Infiltration, and Direct Composite Restorations

This clinical report illustrates a conservative technique to mask enamel discolorations in maxillary anterior teeth caused by hypomineralization associated with enamel fluorosis and subsequent direct resin composite to improve the anterior esthetics. The treatment consisted of at-home whitening with 10% carbamide peroxide gel with potassium nitrate and sodium fluoride in a custom-fitted tray to mask the brown-stained areas, followed by resin infiltration to mask the white spot areas. An existing resin composite restoration in the maxillary right central incisor was subsequently replaced after completion of the whitening and resin infiltration procedures, whereas the two misaligned and rotated maxillary lateral incisors were built up with direct resin composite restorations to provide the illusion of adequate arch alignment, as the patient was unable to use orthodontic therapy.

Does Tack Curing Luting Cements Affect the Final Cure?

PURPOSE

Short initial light curing or "tack curing" is used to create a semi-gel state in luting cements for easier excess material cleanup. The effect of tack curing on the final cure of luting cements was measured in terms of hardness.

MATERIALS AND METHODS

Three cement types were tested: two dual-curing composite cements (RelyX Unicem 2; Maxcem Elite); three light-curing veneer cements (Choice 2; Variolink Esthetic LC; RelyX Veneer); and two self-curing resin-modified glass-ionomer (RMGI) luting cements (RelyX Luting Plus; Nexus RMGI). Cements were placed in 1.5 × 2 × 8 mm plaster slots covered with orange glass during curing and were cured from one end. Tack curing was performed for 2 to 5 s using an LED curing light, followed 2 min later by 10-40 s final light curing or self-curing, as per manufacturer instructions (n = 10). Control groups received only final light curing or self-curing. After 24 h storage (37°C, 100% humidity), Vickers hardness was measured in 0.5-mm depth increments. Results were analyzed using two-way ANOVA and pairwise comparisons (α = 0.05).

RESULTS

The hardness of dual-curing and light-curing cements significantly decreased with increasing depth (p = 0.0001). Tack curing of dual-curing and light-curing cements tended to increase hardness at all depths, except near the surface for light-curing veneer cements. Self-curing cements showed no hardness reduction with depth and no effect from tack curing.

CONCLUSION

Although a slight surface hardness reduction may occur in light-curing veneer cements, the overall effect on three luting cement types was insignificant or resulted in only a slight increase in depth-of-cure.

Chemical Adhesion of Polyalkenoate-based Adhesives to Hydroxyapatite

PURPOSE

To evaluate the chemical interaction between synthetic hydroxyapatite (HAp) and polyalkenoic acid copolymer- based (also known as Vitrebond copolymer [VCP]) adhesives.

MATERIALS AND METHODS

Six dentin adhesive formulations were used: 1) Adper Single Bond Plus (SB); 2) SB formulation without VCP (SBnoVCP); 3) Adper Easy Bond (EB); 4) EB formulation without VCP (EBnoVCP); 5) Scotchbond Universal adhesive (SBU); 6) SBU formulation without VCP (SBUnoVCP). Each adhesive was mixed with HAp, polymerized, and analyzed using FTIR and 13C/31P NMR spectroscopy.

RESULTS

The FTIR spectra of SB+HAp indicated that the carbonyl group changed absorption wavenumber compared to that of SBnoVCP+HAp. 13C NMR analysis showed that the presence of methacrylated phosphoric esters in the EB and SBU formulations led to similar carbonyl resonance with or without VCP. 31P NMR revealed a resonance shift at 0.5 ppm for SB+HAp, EB+HAp and SBU+HAp spectra. In comparison with EB+HAp and SBU+HAp, a slight fade-out of the same resonance shift for EBnoVCP+HAp and SBUnoVCP+HAp was observed without completely disappearing, respectively, meaning that VCP might induce a modification of phosphorus moieties in addition to the ionic interaction between phosphate ester groups and HAp.

CONCLUSION

Our data suggests that a chemical interaction occurred between VCP-containing adhesives and synthetic HAp.

Laboratory Performance of Universal Adhesive Systems for Luting CAD/CAM Restorative Materials

PURPOSE

To evaluate the microshear bond strength (μSBS) of several universal adhesive systems applied on five different indirect restorative materials.

MATERIALS AND METHODS

Five CAD/CAM materials were selected: 1) indirect resin composite (LAV); 2) feldspathic glass ceramic (VTR); 3) leucite-reinforced glass-ceramic (EMP); 4) lithium disilicate ceramic (EMX); 5) yttrium-stabilized zirconium dioxide (CZI). For each material, 15 blocks were cut into 4 rectangular sections (6 × 6 × 6 mm) (n = 60 per group), and processed as recommended by the respective manufacturer. For each indirect material, the following adhesive systems were applied according to the respective manufacturer's instructions: 1) AdheSE Universal [ADU]; 2) All-Bond Universal (ABU); 3) Ambar Universal (AMB); 4) Clearfil Universal (CFU); 5) Futurabond U (FBU); 6) One Coat 7 Universal (OCU); 7) Peak Universal Bond (PUB); 8) Prime&Bond Elect (PBE); 9) Scotchbond Universal Adhesive (SBU); 10) Xeno Select (XEN, negative control). After the application of the adhesive system, cylinder-shaped transparent matrices were filled with a dual-curing resin cement (NX3) and light cured. Specimens were stored in water (37°C for 24 h) and tested in shear mode at 1.0 mm/min (mSBS). The failure pattern and μSBS were statistically evaluated (a = 0.05).

RESULTS

LAV, VTR, and EMP showed a greater number of cohesive fractures than EMX and CZI (p < 0.0001). PUB was the only adhesive for which the mean μSBS reached the highest ranking of statistical significance for all five substrates. When each adhesive was compared across the five substrates, 8 out of 10 (ADU, ABU, AMB, CFU, OCU, PUB, PBE, and SBU) reached the statistically highest mean μSBS when applied on CZI.

CONCLUSION

The specific chemical composition of universal adhesives was not the decisive factor in the bond strength values measured for different CAD/CAM indirect materials. There was a wide variability in mean μSBS when different universal adhesives were applied to the several CAD/CAM indirect materials. Most universal adhesives bonded well to air-abraded zirconia.

Quantitative Sensory Testing of the Effect of Desensitizing Treatment After Dental Bleaching

The aim of this study was to quantify tooth sensitivity during bleaching and after a desensitizing treatment. Sensitivity was measured with a new device, TSA-II, which uses thermal stimuli for Quantitative Sensory Testing (QST). Ten patients underwent bleaching treatment using Whiteness HP Maxx (FGM Produtos Odontológicos Ltda) containing 35% hydrogen peroxide. After the bleaching session, the teeth were cleaned with air/water spray and the product Desensibilize KF 2% (FGM Produtos Odontológicos Ltda) was applied to the upper left teeth. Saline solution at room temperature was applied in the upper right teeth. QST was performed before bleaching, immediately after bleaching, and immediately after desensitizing treatment. In order to standardize tooth analysis, a 100% ethylene copolymer and vinyl acetate tray with circular perforations was used during measurements. Analysis of variance and the Student's t-test were used (a=0.05). Mean temperatures (SD) of cold sensation threshold for the upper right quadrant were: BB-13.898 (4.81), AB- 19.241 (3.68), AD-20.646 (3.72) and for the upper left quadrant they were: BB-14.102 (3.22), AB-19.646 (4.82), AD- 13.835 (3.63). Dental bleaching with highly concentrated peroxides changed dental cold sensation thresholds, but the topical desensitizer changed the immediate cold sensation thresholds produced by the cold stimulus.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Microshear Bond Strength of Resin Cements to Lithium Disilicate Substrates as a Function of Surface Preparation

OBJECTIVES

To investigate the effect of hydrofluoric acid (HF) etching, silane solution, and adhesive system application on the microshear bond strength (μSBS) of lithium disilicate glass-ceramic (LD) to three resin cements.

MATERIALS AND METHODS

Circular bonding areas were delimited on the lithium disilicate surfaces using a perforated adhesive tape. Specimens were assigned to 18 subgroups (n=12) according to surface treatment: NT = no treatment; HF = 4.8% HF for 20 seconds; silane solution: (1) no silane; (2) Monobond Plus, a silane/10-methacryloyloxydecyl dihydrogen phosphate solution for 60 seconds; (3) Monobond Plus+ExciTE F DSC, a dual-cure adhesive; and resin cement: (1) Variolink II, a bisphenol A diglycidyl ether dimethacrylate (bis-GMA)-based, hand-mixed, dual-cure resin cement; (2) Multilink Automix, a bis-GMA-based, auto-mixed, dual-cure resin cement; (3) RelyX Unicem 2, a self-adhesive, auto-mixed, dual-cure resin cement. Tygon tubes (Ø=0.8 mm) were used as cylinder matrices for resin cement application. After 24 hours of water storage, the specimens were submitted to the μSBS test. Mode of failure was evaluated under an optical microscope and classified as adhesive, mixed, cohesive in resin cement, or cohesive in ceramic. Data were statistically analyzed with three-way analysis of variance and Dunnett test (p<0.05).

RESULTS

When means were pooled for the factor surface treatment, HF resulted in a significantly higher μSBS than did NT (p<0.0001). Regarding the use of a silane solution, the mean μSBS values obtained with Monobond Plus and Monobond Plus+ExciTE F DSC were not significantly different but were higher than those obtained with no silane (p<0.001). Considering the factor resin cement, Variolink II resulted in a significantly higher mean μSBS than did RelyX Unicem 2 (p<0.03). The mean μSBS for Multilink Automix was not significantly different from those of Variolink II and RelyX Unicem 2. According to Dunnett post hoc test (p<0.05), there was no significant difference in μSBS between the different resin cements for HF-etched and silanized (with or without adhesive application) LD surfaces.

CONCLUSION

LD may benefit from pretreatment of the inner surface with HF and silanization, regardless of the resin cement used.

Randomized clinical trial of four adhesion strategies in posterior restorations-18-month results

PURPOSE

To evaluate the 18-month clinical performance of four adhesive strategies in posterior composite restorations placed in private practice.

MATERIALS AND METHODS

Upon approval by an institutional review board, 144 restorations were inserted in 45 subjects (average age = 32.6) to treat caries lesions or to replace existing restorations in vital molars and premolars. The adhesives OptiBond FL (three-step etch-and-rinse), OptiBond SOLO Plus (two-step etch-and-rinse), OptiBond XTR (two-step self-etch), and OptiBond All-in One (one-step self-etch) were applied as per manufacturer's (Kerr Co.) instructions followed by a nanofilled resin composite (Filtek Z350XT, 3M ESPE) under rubber dam isolation. Restorations were evaluated at baseline and at 18 months using United States Public Health Service (USPHS)-modified criteria and high-resolution digital photographs. Statistical analyses included the McNemar and the Mann-Whitney non-parametric tests (p < 0.05).

RESULTS

A total of 137 restorations were evaluated after 18 months. The number of alfa ratings did not change significantly from baseline to 18 months for any of the adhesion strategies. When the 18-month evaluation criteria were pooled by pairs of adhesives, none of the adhesives resulted in a significantly different number of alfa ratings for any of the criteria compared with the other adhesives.

CONCLUSION

Bonding strategy did not influence the clinical performance of posterior composite restorations under the clinical conditions used in this study.

CLINICAL SIGNIFICANCE

When used in ideal clinical conditions, the composition of current dentin adhesives may be more clinically relevant than their adhesion strategy.

Randomized clinical trial of four adhesion strategies in cervical lesions: 12-month results

The aim of this study was to evaluate the 6- and 12-month clinical performance of four adhesion strategies from the same manufacturer (Kerr) in non-carious cervical lesions (NCCLs) using two evaluation criteria. Thirty-five patients, with at least four NCCLs each, participated in this study. After samplesize calculation, 180 restorations were assigned to one of the following groups: OFL (Optibond FL), OSP (Optibond Solo Plus), XTR (Optibond XTR), and AIO (Optibond All-In-One). The composite resin Filtek Supreme Ultra (3M ESPE) was placed incrementally. The restorations were evaluated at baseline, after 6 months, and after 12 months, using both the FDI and the USPHS-modified criteria. Statistical analyses were performed with Friedman repeated measures, ANOVA by rank, and the McNemar test for significance in each pair (α=0.05). Six restorations (2 for OFL, 1 for OSP, 2 for XTR, and 1 for AIO) were lost at 12 months (P>0.05 for both evaluation criteria). Marginal staining was observed in seven restorations using the FDI criteria (P>0.05) and three restorations using the USPHSmodified criteria (P>0.05). Eight restorations (2 for OSP, 3 for XTR, and 3 for AIO) were classified as Bravo for marginal adaptation using the USPHSmodified criteria (P>0.05). However, 62 restorations (14 for OFL, 12 for OSP, 15 for XTR, and 21 for AIO) were classified as Bravo using the FDI criteria (P>0.05). The four adhesion strategies showed similar clinical retention at 6 and 12 months. The FDI evaluation criteria tend to be more sensitive than the USPHS-modified criteria.

Prefabricated composite resin veneers--a clinical review

OBJECTIVE

This clinical technique article is focused on the use of prefabricated veneers to enhance the esthetic appearance of the anterior dentition in patients who needed an alternative esthetic solution more affordable than traditional porcelain veneers.

CLINICAL CONSIDERATIONS

Because prefabricated composite veneer systems have been recently introduced, they are not widely used. The Componeer system (Coltene, Altstätten, Switzerland) contains thin pre-polymerized hybrid composite shells, several shades of a direct hybrid composite resin, an etch-and-rinse adhesive system, and restorative accessories including finishing points and disks. The prefabricated restorations can be customized in the mouth for color and shape. The technique described in this article can be used to restore function and esthetics in one office visit.

CONCLUSIONS

The prefabricated composite veneer technique has some of the advantages of direct composite restorations, as only one session is required without the need to take impressions to send to the dental laboratory. This new treatment option may open new opportunities for dental professionals and their patients. However, it is paramount to carry out controlled clinical studies with this restorative technique prior to recommending it without restrictions in general practice.

CLINICAL SIGNIFICANCE

The clinical technique described in this paper has the potential for being used routinely to lengthen anterior teeth, to correct malpositioned teeth, to mask discolorations, and to close diastemas. The technique can also be used to restore extensive caries lesions and tooth fractures, and to refurbish large old anterior restorations, especially when other treatment options are out of reach for the patient for financial reasons.

Prefabricated veneers - bond strengths and ultramorphological analyses

PURPOSE

To measure the microshear bond strengths (μSBS) of composite resin to the intaglio surface of prefabricated indirect veneers and analyze the FE-SEM ultramorphology of the pretreated intaglio surfaces as well as the fracture modes.

MATERIALS AND METHODS

Three veneer systems (veneer and respective luting material) were used in this study: two prefabricated veneer types, Cerinate One-hour (CER, DenMat) and Componeer (CMP, Coltene), and a laboratory- made veneer, IPS e.max Press (IPS, Ivoclar Vivadent) used as the control. For each group, 10 veneers were used. After delimitation of the bonding area with a double-faced adhesive tape, 0.8-mm-diameter cylinders of composite luting material were bonded to the pretreated intaglio surface. After polymerization, the specimens were fractured in shear mode using the wire-loop method in a universal testing machine. The pretreated intaglio surface of two extra veneers and four fractured specimens per group were morphologically characterized using FE-SEM.

RESULTS

CER resulted in statistically lower mean μSBS (7.1 ± 1.2 MPa) than the other two veneer systems, CMP (15.2 ± 2.5 MPa) and IPS (14.7 ± 1.7 MPa) at p < 0.0001. As seen with the FE-SEM, the intaglio surface of CMP did not display microretentive features, while multiple microretentions were observed in both CER and IPS after HF etching.

CONCLUSION

Within the limitations of this in vitro study, the CMP and IPS veneer systems resulted in greater bond strengths than those of the CER veneer system.

A New Universal Simplified Adhesive: 18-Month Clinical Evaluation

Purpose

To evaluate the 18-month clinical performance of a multimode adhesive (Scotchbond Universal Adhesive, SU, 3M ESPE, St Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria.

Materials and Methods

Thirty-nine patients participated in this study. Two-hundred restorations were assigned to four groups: ERm, etch-and-rinse + moist dentin; ERd, etch-and-rinse + dry dentin; Set, selective enamel etching; and SE, self-etch. The composite resin, Filtek Supreme Ultra (3M ESPE), was placed incrementally. The restorations were evaluated at baseline, and at 18 months, using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed using Friedman repeated-measures analysis of variance by rank and McNemar test for significance in each pair (α=0.05).

Results

Five restorations (SE: 3; Set: 1; and ERm: 1) were lost after 18 months (p&gt;0.05 for either criteria). Marginal staining occurred in four and 10% of the restorations evaluated (p&gt;0.05), respectively, for USPHS and FDI criteria. Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38%, 40%, 36%, and 44% for groups ERm, ERd, Set, and SE, respectively, when the FDI criteria were applied (p&gt;0.05). However, when semiquantitative scores (or SQUACE) for marginal adaptation were used, SE resulted in a significantly greater number of restorations, with more than 30% of the total length of the interface showing marginal discrepancy (28%) in comparison with the other groups (8%, 6%, and 8%, respectively, for ERm, ERd, and Set).

Conclusions

The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy. The only differences between strategies were found for the parameter marginal adaptation, for which the FDI criteria were more sensitive than the USPHS criteria.

Immediate adhesive properties to dentin and enamel of a universal adhesive associated with a hydrophobic resin coat

OBJECTIVES

To evaluate the effect of acid etching and application of a hydrophobic resin coat on the enamel/dentin bond strengths and degree of conversion (DC) within the hybrid layer of a universal adhesive system (G-Bond Plus [GB]).

METHODS

A total of 60 extracted third molars were divided into four groups for bond-strength testing, according to the adhesive strategy: GB applied as a one-step self-etch adhesive (1-stepSE); GB applied as in 1-stepSE followed by one coat of the hydrophobic resin Heliobond (2-stepSE); GB applied as a two-step etch-and-rinse adhesive (2-stepER); GB applied as in 2-stepER followed by one coat of the hydrophobic resin Heliobond (3-stepER). There were 40 teeth used for enamel microshear bond strength (μSBS) and DC; and 20 teeth used for dentin microtensile bond strength (μTBS) and DC. After restorations were constructed, specimens were stored in water (37°C/24 h) and then tested at 0.5 mm/min (μTBS) or 1.0 mm/min (μSBS). Enamel-resin and dentin-resin interfaces from each group were evaluated for DC using micro-Raman spectroscopy. Data were analyzed with two-way analysis of variance for each substrate and the Tukey test (α=0.05).

RESULTS

For enamel, the use of a hydrophobic resin coat resulted in statistically significant higher mean enamel μSBS only for the ER strategy (3-stepER vs 2-stepER, p<0.0002). DC was significantly improved for the SE strategy (p<0.00002). For dentin, the use of a hydrophobic resin coat resulted in significantly higher dentin mean μTBS only for the SE strategy (2-stepSE vs 1-stepSE, p<0.0007). DC was significantly improved in groups 2-stepSE and 3-stepER when compared with 1-stepSE and 2-stepER, respectively (p<0.0009).

CONCLUSIONS

The use of a hydrophobic resin coat may be beneficial for the selective enamel etching technique, because it improves bond strengths to enamel when applied with the ER strategy and to dentin when used with the SE adhesion strategy. The application of a hydrophobic resin coat may improve DC in resin-dentin interfaces formed with either the SE or the ER strategy. On enamel, DC may benefit from the application of a hydrophobic resin coat over 1-stepSE adhesives.

Two-Year Clinical Performance of a Low-Shrinkage Composite in Posterior Restorations

Objectives

The aim of this study was to compare the two-year clinical performance of three restorative systems in posterior restorations, which included a low-shrinkage composite and both etch-and-rinse and self-etch adhesive strategies.

Materials and Methods

After signing an informed consent, 25 patients received three Class I (occlusal) or Class II restorations performed with one of three restorative systems: Filtek Silorane Restorative System, Adper Scotchbond 1 XT (a two-step etch-and-rinse adhesive) with Filtek Z250, and Adper Scotchbond SE (a two-step self-etch adhesive) with Filtek Z250. All materials were applied following the manufacturer's instructions. Two blind observers evaluated the restorations at three different moments (baseline; and after one and two years) according to the US Public Health Service modified criteria. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the behavior of the restorative systems, while Friedman and Wilcoxon tests were applied to analyze the intra-system data (p&lt;0.05).

Results

The three restorative systems showed a statistically similar clinical performance at two years. Intra-system comparisons between baseline and two years showed declining marginal adaptation scores in the restorations placed with all systems. In addition, marginal staining and surface roughness scores were lower after two years for the restorations placed with Adper Scotchbond SE + Filtek Z250.

Conclusions

Although the clinical performance of Filtek Silorane was considered acceptable after two years, no advantage of the silorane-based resin over the methacrylate-based composite was found. Teeth restored with Adper Scotchbond SE showed a tendency for marginal staining, which may compromise the final color of the restorations.

Critical appraisal: post-op sensitivity with direct composite restorations

Sales of self-etch adhesive systems have grown considerably over the last 10 to 12 years. One of the most important factors contributing to this growth is the perception that self-etch adhesives cause less postoperative sensitivity than etch-and-rinse adhesives. Certainly, there is much anecdotal evidence supporting this perception. But what does the science say? This Critical Appraisal presents evidence from several clinical trials of postoperative sensitivity in posterior composite restorations.