The Journal of Adhesive Dentistry, 03/2008

Purpose: To investigate the influence of different water concentrations in the solvents of self-etching primers on microtensile bond strength (µTBS) of an experimental adhesive system. Materials and Methods: Five experimental self-etching primers with 0, 5, 10, 20 and 40 (wt%) water as solvent were formulated. An experimental adhesive resin (AD-50) was also synthesized to create one experimental self-etching adhesive system. Clearfil SE Bond (CSEB) was used as the commercial reference. Sixty bovine incisors were randomly separated into 6 groups. Buccal enamel was removed to expose the superficial coronal dentin; this surface was polished wet to create a standardized smear layer. After rinsing, water was removed, leaving the surface visibly dried. The dentin surfaces were etched with primer and air dried, adhesive resin was applied and photoactivated, then the composite resin restoration was placed. After storage for 24 h, the specimens were sectioned with a cooled diamond saw at low speed. Microtensile bond strength was measured and data were analyzed with one-way ANOVA/Tukey's test (α = 0.05). Results: ANOVA showed that primer composition was a significant factor for bond strength. There was no significant difference in bond strengths between the primers with a water concentration of 40% (53.9 ± 12.7 MPa), 20% (51.1 ± 11.5 MPa, and 10% (47.5 ± 11.4 MPa), and CSEB (50.7 ± 9.8 MPa). The groups with 5% (38.6 ± 12.9 MPa) and 0% (31.5 ± 7.5 MPa) water presented similar bond strengths amongst themselves but were statistically significantly lower than that of the other groups. Conclusion: The water concentration in the primer solvent exercises a significant influence on the bond strength of this experimental self-etching adhesive system. Keywords: dental adhesive, microtensile bond strength, self-etching, dental materials

Purpose: This study examined the effects of cutting dentin with different burs at various speeds on the microtensile bond strength (µTBS) of two self-etching adhesive systems. Materials and Methods: Flat deep dentin surfaces from 50 extracted human third molars were divided into 5 groups (n = 10) according to bur type and speed of rotation: (I) high-speed diamond bur, (II) low-speed diamond bur, (III) highspeed tungsten carbide bur, (IV) low-speed tungsten carbide bur. Controls were abraded with 600-grit SiC paper. A two-step self-etching adhesive, Clearfil SE Bond (SE, Kuraray) and a one-step self-etching adhesive, Clearfil S3 Bond (S3, Kuraray) were applied to dentin surfaces and light cured. Composite buildups were performed using Filtek Z250 (3M ESPE). For µTBS evaluation, composite-dentin beams of 0.8 mm2 were stressed to failure at a crosshead speed of 1 mm/min. The µTBS data were analyzed using two-way ANOVA and Tukey's multiple comparison tests. Representative fractured beams from each group were prepared for fractographic analysis under SEM. Results: Two-way ANOVA showed that the effects of dentin surface preparations, adhesive systems, and their interaction were statistically significant (p 0.001). The µTBS was the highest when bonding SE to dentin surface prepared with 600-grit SiC abrasive paper (47.3 ± 7.4 MPa), followed by high-speed tungsten carbide burs (40.8 ± 6.1 MPa), and the lowest when bonding S3 to dentin surfaces prepared with a high-speed diamond bur (15.2 ± 6.2 MPa). SEM observation of the fractured surfaces revealed mixed and adhesive failures for SE groups, while in the S3 groups, adhesive failures predominated with numerous inclusion droplets. Conclusion: Higher bond strengths are achieved with SE bond when applied on dentin surfaces prepared with tungsten carbide burs. Proper bur and adhesive selection are essential to optimize dentin adhesion of self-etching adhesives. Keywords: surface preparation, microtensile bond strength, self-etching adhesive, dentin

Purpose: To determine the marginal leakage of Class V restorations bonded with etch-and-rinse and self-etching adhesives applied after different dentin pretreatments over a maximum storage time of 24 months. Materials and Methods: Standardized mixed Class V cavities (5 mm x 3 mm and 2 mm deep) were cut on the buccal and lingual surfaces of 180 human molars. Two self-etching adhesive systems, Adper Prompt L-Pop (3M ESPE) and Clearfil SE Bond (Kuraray), and one etch-and-rinse bonding agent (One Step, Bisco) were applied as follows: 1. according to manufacturers' instructions; 2. after 37% H3PO4 etching for 15 s; 3. after 37% H3PO4 etching for 15 s and 5% NaOCl aq application for 2 min. Teeth were stored for 24 h, 6, 12, and 24 months in saline solution at 37°C before being stained in 0.5% solution of basic fuchsine. Dye penetration was scored on a 0 to 3 ordinal scale and analyzed with the Kruskal-Wallis H test (p 0.05), Mann-Whitney U-test (p 0.01), and Wilcoxon paired test (p 0.05). Results: Significant differences exist after using the tested adhesives at dentin and enamel margins. Adhesive type and substrate pretreatment had a significant effect on the long-term sealing of Class V restorations, and aging increased leakage overtime. The extent of leakage at the enamel margins was lower than that at dentin margins. One Step recorded the best results after 24 months. Conclusion: Optimal adhesion of restorative materials to enamel and dentin is hampered by a reduction in marginal seal over time. Alternative dentinal treatments (etching or collagen removal) might increase bonding efficacy, depending on the adhesive system used. Keywords: resin-infiltrated dentin, marginal integrity, microleakage, Class V restoration, bond longevity, substrate modification

Purpose: The bond strength and bond durability of two high-viscosity dual-curing resin luting agents with different surface treatments of ceramic were investigated. Materials and Methods: GN-I machinable ceramic surfaces were treated with 37% phosphoric acid for 30 s (PA), 5% hydrofluoric acid for 5 s (HF-5), 10 s (HF-10), or 30 s (HF-30), or blasting with 50-µm Al2O3 for 10 s (AB). The roughness of the ceramic surface was measured. Treated ceramic surfaces were bonded with three resin bonding systems (RBS): Ceramic Primer/LinkmaxHV (CP/LMHV), Monobond S/VariolinkIIHV (MBS/VLIIHV), or MBS/Heliobond/VLIIHV (MBS/HB/VLIIHV). A microshear test was used to measure the bond strength after 24 h (TC 0) and subsequent thermocycling (TC 10,000 at 4°C and 60°C). ANOVA was performed for statistical analysis, with significance set at p 0.05. Results: For three RBSs, bond strength at TC 0 was not affected, regardless of ceramic surface treatment (p > 0.05). All combined groups of ceramic surface treatment and resin bonding system decreased after 10,000 thermal cycles, especially groups treated with alumina blasting and bonded with each of three RBSs (p 0.05). MBS/HB/VLIIHV with each surface treatment did not improve the bond strength and durability compared with MBS/VLIIHV. Conclusion: CP/LMHV and MBS/VLIIHV obtained sufficient bond strength and bond durability to GN-I machinable ceramic by only cleaning with PA; the application of HB may not be necessary. Keywords: resin luting agent, machinable ceramic, surface treatment, silane coupling agent, microshear bond strength

Purpose: To investigate the effect of different adhesives on the shear bond strength between a feldspathic machinable ceramic and a luting resin. Materials and Methods: Seven groups of 20 ceramic specimens each were machined from Vita Mark II blocs. Their surfaces were uniformly treated with 1000-grit paper. Group 1 (control) was hydrofluoric-acid etched for 60 s, group 2 abraded with CoJet, and group 3 PyrosilPen-treated and silanized. Groups 4 and 5 were hydrofluoric-acid etched for 60 s and silanized with two experimental silanes. Variolink II was used as the luting resin for groups 1 to 5. Group 6 and 7 were phosphoric-acid etched for 15 s. Then group 6 was treated with Nexus and group 7 with the Panavia F 2.0 system. All specimens were stored dry for 24 h at 37°C. Shear bond strength was measured prior to and after 5000 thermocycles (TC) between 5°C and 55°C in water. ANOVA was performed with p = 0.05. Results: Shear bond strength values 24 h / TC in MPa (SD) were as follows: group 1: 11 (3.0) / 12 (5.3), group 2: 22 (3.9) / 25 (7.3), group 3: 26 (9.0) / 30 (8.0), group 4: 12 (5.9) / 8 (2.0), group 5: 8 (2.4) / 7 (3.4), group 6: 16 (6.1) / 3 (1.6) and group 7: 16 (8.6) / 16 (4.3). Cojet (24 h, p = 0.0007 / TC, p = 0.0001) and PyrosilPen (24 h, p = 0.0001 / TC, p = 0.0001) showed significantly higher bond strength than the control but did not differ significantly from each other. No significant differences between the control and groups 4, 5, 6, and 7 were found. PyrosilPen (p = 0.0001) significantly performed best prior to and after TC. Bond strength of experimental silane A (p = 0.0499) and Nexus (p = 0.0002) significantly decreased after TC. Conclusion: Silicoating technology and tribochemistry are fast, trouble-free, and effective surface treatment methods for achieving very good bond strength between feldspathic ceramics and luting resins. Etching with H2F2 can thus be avoided. Keywords: ceramic, silane, silicating, luting resin, shear bond strength

Purpose: To evaluate whether the application of an enamel etchant (Etch-37 BAC) and a desensitizer (PrepEze desensitizer) which contain the antibacterial agent benzalkonium chloride (BAC) affects the bond strength of the orthodontic resin Transbond XT. Materials and Methods: Eighty-five extracted premolars were used. They were divided into four groups: 1. Transbond XT, 2. Etch-37 BAC/Transbond XT, 3. PrepEze/Transbond XT, 4. Etch-37 BAC/PrepEze/Transbond XT. Shear bond strength was measured using a universal testing machine with a crosshead speed of 1 mm/min. The adhesive remnant on the tooth after debonding was quantified using image analysis equipment. Results: No significant differences were found in shear bond strength when Transbond XT was bonded with the conventional etchant or with Etch-37 BAC (p > 0.008). PrepEze decreased the shear bond strength and the amount of adhesive remnant on the tooth after debonding significantly (p 0.008). The amount of adhesive remnant on the tooth surface diminished significantly when the enamel was etched with Etch-37 BAC (p 0.008). Conclusions: The bond strength values obtained with the application of Etch-37 BAC are similar to those obtained with a conventional etchant. However, the application of PrepEze significantly decreased the bond strength of Transbond XT. Keywords: antibacterial bonding systems, shear bond strength, bracket bonding

Purpose: The aim of this in vivo study was to clarify how blistering formation occurs along intraradicular dentin bonded interfaces. Materials and Methods: Patients were selected and post space was prepared in vivo in endodontically treated teeth. Post space was etched, dried with ethanol, and bonded with one of the following adhesive systems: All Bond 2, XP-Bond, Clearfil SE Bond, Xeno III. The four adhesives were considered as representative of each bonding system class. An additional group was prepared with phosphoric acid treatment + application of Pre-Bond unfilled resin of All Bond 2, without the use of the primer agent. Etching was avoided for self-etching materials. Replicas of the post space were taken (1) after post space preparation; (2) after etching, rinsing, and drying; (3) after ethanol drying, and (4) after adhesive application. Replicas were analyzed with SEM and blisters were counted by independent observers. Statistical analysis was performed with Kruskal-Wallis ANOVA and Dunn's multiple comparison tests at p = 0.05. Results: No blister formation occurred on replicas taken prior to adhesive application, while blister formation was evident in all replicas of bonded interfaces, irrespective of the adhesive system. No statistical difference in the number of droplets was found between All Bond 2, XP-Bond, and Clearfil SE Bond. Xeno III exhibited the highest number of blisters. Specimens bonded with Pre-Bond unfilled resin of All Bond 2 without primer application showed no blister formation. Conclusion: This study revealed that blister formation occurs only if the priming agent of the adhesive system was applied, thus supporting the hypothesis that blistering occurs due to adhesive phase separation or insufficient solvent evaporation. Keywords: adhesive permeability, simplified adhesives, root canal, droplet formation

Purpose: To evaluate the effect of different curing modes of dual-curing luting systems and root regions on the pushout strength of fiber posts to intraradicular dentin. Materials and Methods: Forty-two extracted premolars with a single root canal were sectioned at the cementoenamel junction and the roots were endodontically treated. The roots were divided into two groups according to two dual-curing luting systems: (1) XP BOND-Dual Cure/Calibra resin cement; (2) XP BOND-Dual Cure/FluoroCore 2. For each luting system, three different curing modes were applied to the dentin adhesive and resin cement: "Self-cure and Self-cure (SC&SC)", "Self-cure and Dual-cure (SC&DC)", and "Dual-cure and Dual-cure (DC&DC)". Translucent Easy fiber posts (Dentsply Maillefer) were luted in the roots. A thin-slice push-out test was performed, and the data of push-out strength were analyzed using three-way ANOVA with luting system, curing mode, and root region (apical, middle and coronal) as factors. Tukey's test was used for post-hoc comparisons. Results: The push-out strength of XP BOND-Dual Cure/Calibra was significantly lower when Calibra resin cement was self-cured than when it was dual-cured (SC&SC: 6.04 ± 2.65 MPa; SC&DC: 10.69 ± 3.01 MPa; DC&DC: 10.72 ± 3.63 MPa; p 0.05). The curing modes did not affect the push-out strength of XP BOND-Dual Cure/FluoroCore 2 (SC&SC: 7.90 ± 3.94 MPa; SC&DC: 8.32 ± 2.73 MPa; DC&DC: 9.27 ± 4.12 MPa; p > 0.05). The coronal push-out strength was significantly higher than the apical push-out strength (p 0.05). Conclusion: Retention of fiber posts in root canals was affected by the curing modes of dual-curing luting system and root regions. Keywords: curing modes, push-out strength, fiber post, root region

Purpose: To evaluate the cytotoxicity of three desensitizers, one nonrinse, and one etch-and-rinse adhesive system applied on dentin specimens of different thickness. Materials and Methods: The test materials (A: Admira Protect, B: Gluma Desensitizer, C: Seal&Protect, D: Clearfil Protect Bond, E: Optibond FL) and a positive control (35% H2O2) were applied on 1.0-, 1.5-, and 2.5-mm-thick bovine dentin specimens (each subgroup n = 5) in a dentin barrier test device. The experiments were performed with perfusion (2 ml/h) of the pulpal part of the chamber. The eluates were obtained before (baseline) and 15, 30, 45, 60, and 120 min after application of the adhesives and pipetted onto L-929 fibroblasts. Cytotoxicity of the materials was determined in relation to the baseline value using the MTT assay (succinic dehydrogenase activity). Statistical analysis was performed using ANOVA and Student's t-test. Results: With regard to 1.0-mm dentin specimens, application of Clearfil Protect Bond (D) decreased enzyme activity significantly, while test materials A to C and E were not cytotoxic. However, cytotoxicity of D was limited to up to 15 min and decreased thereafter. Application of the test materials A to E on 1.5- and 2.5-mm dentin samples exhibited no significant cytotoxic effects within 120 min. Generally, ANOVA found significant interactions between the test materials and dentin thickness. However, only for Admira Protect was a significant increase of enzyme activity with increasing dentin thickness observed. Conclusion: Desensitizing agents might exhibit cytotoxic potential when applied on dentin less than 1.0 mm thick. The tested desensitizers and the adhesive systems caused similar effects, in which cytotoxicty might be influenced by the duration of perfusion and dentin thickness. Keywords: desensitizer, cytotoxicity, dentin, perfusion, cell culture

Purpose: The aim of this study was to assess the 6-year performance of the ART (atraumatic restorative treatment) approach in Class III restorations in permanent teeth. Materials and Methods: A total of 127 ART Class III restorations, using Ketac-Molar (3M ESPE) ionomer cement, was performed in 58 adult patients by one experienced operator in 1998. After a 6 years, 34 patients and 65 restorations were evaluated according to ART criteria. Two calibrated examiners carried out the evaluation. Data were analyzed by exact 95% Confidence Interval and Survival Analysis using the Jackknife method for standard error determination. Results: Among assessed restorations, 73.8% (95% CI = 61.5% to 86.2%) were in good condition and classified as successful, with a 67.6% (95% CI = 54.4% to 80.7%) cumulative survival rate. Failed restorations included 13.9% completely or partially missing restorations, 9.2% restorations that had been replaced by other treatment, 1.5% restorations with a large defect at the margin, and 1.5% restorations that presented high wear on the surface. No caries was observed even in those teeth in which restorations were absent. Conclusion: The 6-year success rate of the ART approach in anterior permanent teeth (Class III) was considered high. Keywords: glass-ionomer cements, ART, dental caries