The Journal of Adhesive Dentistry, 03/2005

Purpose: To evaluate the bond strength of adhesive resins to artificially carious dentin specimens which were previously exposed to an acid buffer solution for various periods. Materials and Methods: Flat dentin disks were obtained from superficial occlusal dentin of extracted human third molars and polished with wet silicon carbide paper. Dentin disks were immersed in acid buffer solution for different periods to create the demineralized dentin layer. The first group of demineralized specimens was used for the evaluation of demineralization depth under SEM and the second group was used for the bond strength measurement. Shear bond strengths mediated by three dentin adhesives (Clearfil SE Bond, OptiBond Solo Plus Total-Etch, and OptiBond Solo Plus Self-Etch) were examined. A 0.75-mm-diameter area of dentin was bonded according to the manufacturers' instructions before placing a 0.5-mm-high resin composite cylinder. The bonds were stressed in shear at a crosshead speed of 1 mm/min. All data were analyzed using ANOVA and LSD multiple comparison test. Results: Depth of demineralization increased with the prolongation of demineralizing time. After dentin specimens were demineralized for up to 24 h, bond strengths of the self-etching adhesives were significantly higher than those of the total-etch adhesive. However, for longer demineralization periods, no statistical differences in bond strengths were observed. SEM photographs showed that resins cannot thoroughly infiltrate through the whole depth of the demineralized dentin layer. Conclusion: Bond strengths to demineralized, artificially carious dentin were affected by the depth of demineralization and adhesive resins used. Keywords: demineralized dentin, dentin adhesive, microshear bond test

Purpose: To investigate the effect of postextraction substrate aging on the microtensile bond strength (µTBS) of an adhesive system (Excite). Materials and Methods: Sixty sound human third molars were extracted for orthodontic purposes and prepared after the following storage periods in distilled water at 37°C (n = 10): G1 - 1 h; G2 - 24 h; G3 - 7 days; G4 - 30 days; G5 - 1 year; G6 - 2 years. The occlusal surfaces were removed using diamond disks to expose middle dentin and a standardized smear layer was created by polishing with wet 600-grit sandpaper. The adhesive system was applied according to the manufacturer's instructions, and a resin composite block (5 mm in height, Tetric Ceram shade A2/Ivoclar Vivadent) was built in 1-mm increments, each one being light cured for 40 s (600 mW/cm2). After storage in distilled water at 37°C for 24 h, teeth were sectioned to obtain stick-shaped specimens with a cross-sectional area of approximately 0.7 ± 0.2 mm2. Specimens were submitted to µTBS test in a Kratos universal testing machine at a crosshead speed of 0.5 mm/min. Data were statistically analyzed using one-way ANOVA at a significance level of 5% (p 0.05) Results: The mean µTBS in MPa ± SD were: G1 = 47 ± 3.1; G2 = 42 ± 5.1; G3 = 41 ± 6.4; G4 = 43 ± 9.8; G5 = 40 ± 7.0; G6 = 52 ± 5.7. No statistically significant difference was found among experimental groups. Conclusion: Human teeth stored for long periods of time can be used to determine the in vitro µTBS of one-bottle adhesive systems. Keywords: microtensile bond strength, dentin aging, adhesive systems

Purpose: The aim of this in vitro study was to compare the dentin bond strength of directly and indirectly inserted composite restorations. Materials and Methods: Twenty extracted human mandibular molars were prepared to form a flat occlusal dentin surface using an Isomet saw under water. Five-mm-thick composite restorations (Filtek Z 250 and Clearfil AP-X) were placed on the dentin surfaces by direct or indirect techniques. The direct restorations were bonded with Single Bond and Clearfil SE Bond bonding agents. Indirect restorations were cemented with two composite luting cements (3M Opal Luting Cement and Panavia F). All restorative procedures were applied under simulated pulpal pressure (15 cm H2O). Each tooth was then vertically sectioned with an Isomet saw through the composite buildups and the dentin. Thus, for microtensile testing, 0.65 x 0.65 mm specimens were obtained from pulpal and remote dentin regions. The results were analyzed according to the regional dentinal surfaces (pulpal and remote dentin). For statistical analyses, two-way ANOVA and Duncan post-hoc tests were used (p 0.05). Results: Direct application of Clearfil AP-X showed that tensile bond strengths were higher than those obtained for directly and indirectly applied Filtek Z 250 and indirectly applied Clearfil AP-X. No significant difference in tensile bond strengths was demonstrated between pulpal and remote dentin (p > 0.05). Conclusion: It is concluded that the bond strengths of resin luting cements to dentin need further improvement. Keywords: microtensile bond strength, indirect inlay, direct posterior composite, pulpal pressure

Purpose: This study evaluated the etching effect of self-etching priming agents applied to intact and ground enamel. Materials and Methods: Thirty-two human molars were used. Each tooth was divided into two halves. The buccal or lingual mid-coronal surface of 32 half-teeth was ground with 600-grit silicon carbide paper. The other half-teeth were left intact (control). Teeth were treated with Clearfil SE Bond (SE), Prompt L-Pop (PLP) or Adper (AD). Those in the control group were etched with 35% phosphoric acid. The etching effect of such systems on enamel surfaces was assessed by three different approaches using scanning electron microscopy: 1) in situ or direct morphological examination of the etched enamel; 2) indirect morphological examination, that is, evaluation of the etching pattern left on resin reproductions; 3) adhesive interface examination. Results: SE exhibited the least aggressive dissolution of the intact and ground enamel, with many sites of the intact enamel remaining completely unetched. SE monomer infiltration into etched enamel was restricted to the superficial layer. PLP and AD produced equivalent etching patterns on intact and ground enamel, which resemble that produced by the phosphoric acid control group. PLP and AD monomer penetration extended along the porous subsurface enamel layer. Conclusion: SE produced mild morphological changes on intact and ground enamel surface, resulting in a very superficial resin infiltration particularly into intact enamel. No differences were evident among the etching and resin infiltration pattern produced by both all-in-one self-etching adhesives, PLP and AD, and the phosphoric acid system. Keywords: self-etching adhesives, enamel bonding, SEM evaluation

Purpose: To compare the marginal adaptation of adhesively luted ceramic inserts in standardized cylindrical cavities of bovine dentin and enamel with the marginal adaptation of adhesively luted ceramic inlays in extracted molars after mechanical loading, and to calculate the minimum sample size required to differentiate between material groups based on the findings of this investigation. Materials and Methods: Ceramic inserts of similar dimension were luted in standardized cylindrical cavities of bovine dentin and enamel (n = 6, Ø = 4 mm) with seven different adhesive/resin cement systems (Syntac/Variolink, Prime&Bond NT/Variolink, Excite DSC/Variolink, AdheSE/Variolink, Excite DSC/Multilink, Multilink Primer/Multilink, RelyX Unicem). The same materials were used to lute ceramic inlays (Empress II) in three-surface cavities of extracted human molars (n = 6 per group). All specimens were submitted to 2000 cycles of thermocycling. In addition, restored teeth were submitted to cyclic loading (640,000 cycles, 50 N) in a chewing simulator. Replicas after stressing were analyzed with SEM, and the percentage of continuous margin of the inserts and the inlays was calculated, differentiating the proximal part of the inlay into cervical dentin/enamel and axio-proximal enamel. The mean percentage values per material group of the insert and inlay groups were ranked using relative ranks. Sample size estimation was done for pooled standard deviations comparing between two and seven materials and assuming 20% or 10% of the mean of continuous margin to be statistically significant. Results: The Spearman correlation coefficient between the variables "insert dentin" and "inlay cervical dentin" was 0.71 (p = 0.07), between "insert enamel" and "inlay axio-proximal enamel" 0.07 (p = 0.9). The variability of the test results was large for both the insert and inlay variables, especially at the resin-dentin interface. No statistically significant difference between the materials could be found for the insert method when ANOVA and Bonferroni post-hoc tests were applied (p > 0.05), while the inlays luted with Prime&Bond NT/Variolink showed significantly less continuous margin at the cervical dentin than all other groups with the exception of RelyX Unicem. At least 16 (63) inlays and 14 (57) inserts had to be used per group for differences of 20% (10%) of the mean of continuous margin. Conclusion: To evaluate luting agents with regard to their ability to reduce marginal discrepancies, the inlay model is inadequate due to high sample numbers which make the test time-consuming and expensive; furthermore, its clinical relevance is uncertain. Alternatively, the insert method may be a suitable screening method for dentinal margins, although its clinical relevance is also unknown. Keywords: marginal adaptation, SEM, luting cements, ceramic inlay, ceramic insert, sample size

Purpose: The aim of this study was to evaluate the effect of provisional cements on the adhesion of resin bonded indirect restorations and determine the best method for avoiding adverse effects. Materials and Methods: Forty-five bovine incisors were selected, and the enamel removed with a 600-grit SiC abrasive disk to expose superficial dentin. Provisional restorations of acrylic resin were cemented with three different provisional cements: calcium hydroxide cement, Dycal (HC); cement containing zinc oxide-eugenol, Provy (ZOE); zinc oxide eugenol-free cement, TempBond NE (ZNE). The specimens were stored at 100% humidity, 37°C. Then provisional restorations were removed with: (1) hand scaler for 10 s; (2) pumice-water slurry for 10 s; (3) aluminum oxide sandblasting for 10 s. The indirect restorations were subsequently cemented with Single Bond and Rely-X ARC. The teeth were sectioned, 4 slices per tooth (n = 16), and each slice trimmed with a diamond bur to obtain an adhesion area of 1 mm2. The microtensile bond strength test was performed with a universal testing machine (Instron-4411) at a crosshead speed of 0.5 mm/min. The results were analyzed with ANOVA, followed by Tukey's test (p 0.05). Results: ANOVA showed significant differences in the interaction between provisional cement and dentin cleaning method; in general, aluminum oxide sandblasting provided the highest values of bond strength and calcium hydroxide the lowest. Conclusion: The type of provisional cement and its method of removal can affect the adhesion of resin-bonded indirect restorations. Keywords: provisional cements, dentin cleaning method

Purpose: 1) To determine the surface energy characteristics of three variously treated post materials and two resin cements, and 2) to investigate if previously measured bond strengths between cements and treated posts could be related to the surface energy characteristics of the posts and cements. Materials and Methods: The post materials were those of ParaPost XH, ParaPost Fiber White, and Cerapost, and the resin cements were ParaPost Cement and Panavia F. The post materials were surface treated by grinding, sandblasting, CoJet, or with Alloy Primer. Droplets of four reference liquids were placed on the surfaces and the contact angles measured. On this basis the dispersive, acid, and base components of the surface free energy of the materials were calculated. Then the thermodynamic work of adhesion between resin cements and treated post surfaces was calculated, as well as its dispersive and polar components. Results: It was found that the surface energy characteristics varied significantly between the investigated surfaces. The previously measured bond strengths correlated statistically significantly (p 0.02) to the dispersive component of the work of adhesion between posts and cements (r = 0.53), to the dispersive component of the surface free energy of the posts (r = 0.54), and to the contact angle determined with ethylene glycol as reference liquid (r = - 0.52), but not to other surface energy characteristics. Conclusion: In spite of the significant correlations, the "explained" part of the variation in bond strength did not surpass 30%. This means that factors other than surface energy characteristics of adherend and adhesive play a role in determining the strength of the bond. Keywords: adhesion, contact angle, CoJet, titanium, resin composite, zirconia

Purpose: To verify with SEM the cement layer thickness and uniformity of resin-relined translucent fiber posts (anatomic posts) and standard translucent fiber posts. Materials and Methods: On 20 extracted maxillary anterior teeth, the roots were endodontically treated and prepared for the insertion of a fiber post. Translucent fiber posts (DT) were luted with a dual-curing resin cement (Duo-Link) in 10 specimens (group 1) after the canal walls had been treated with the One-Step bonding system. In the other 10 specimens (group 2), experimental anatomic posts (Anatomic Post'n Core) were tested. To these posts, a layer of light-curing resin is added to allow for a pre-cementation relining of the post, aimed at improving its fit into the endodontic space. For luting, the same adhesive-resin cement combination of group 1 was used. All the roots were sectioned and prepared for SEM observations. At the 1-mm, 4.5-mm, and 8-mm level of each root, cement thickness was measured, and the presence of gaps or voids within the luting material or at its interfaces was evaluated. A statistical analysis was performed to test the significance of differences in the cement layer thickness around the two types of post and at different levels of the same type of post. Results: In the presence of anatomic posts, the cement layer was significantly thinner and more uniform at the coronal and middle level of the root. In both groups, voids and bubbles were detected within the luting material, within the abutment material, and between fiber post and cement. Gaps were also visible between post and relining material. Conclusions: The resin cement thickness was significantly lower in the anatomic post group than in the control group (standardized posts), except at the apical third of the canal, where there was no statistically significant difference. A good adaptation of anatomic posts was evident in all of the specimens. Keywords: fiber posts, dental bonding, endodontically treated teeth

Purpose: The purpose of this study was to evaluate the pulpal response of a fluoride-releasing one-step adhesive in nonexposed monkey teeth. Materials and Methods: Cervical Class V cavities were prepared in monkey teeth. The cavities were divided into three groups of different restorative materials. A one-step adhesive (SI-IB551, Shofu) was applied to the teeth, and the cavities were filled with a resin composite (Beautifil, Shofu). In the other two groups, a two-step adhesive (Imperva FluoroBond, Shofu) together with either a resin composite (Beautifil) or a glass-ionomer cement (Fuji II, GC) was placed in the cavities. The teeth were then extracted after 3, 30, and 90 days, fixed in 10% buffered formalin solution, and prepared according to routine histological techniques. Five-micrometer sections were stained with hematoxylin and eosin, or Brown & Brenn gram stain for bacterial observation. Four histological features, odontoblastic change, inflammatory cell infiltrate, reparative dentin formation, and the bacterial staining, were evaluated and compared. The results were compared statistically with significance defined as p 0.05 (Kruskall-Wallis test). Results: Disarrangement of the odontoblasts and slight inflammatory cell infiltrations were the main initial reactions, while deposition of reparative dentin was the major long-term reaction in all groups. No statistically significant differences in the four histological features were seen among the restorative materials placed in the cavities (p > 0.05). No serious pulpal inflammatory reactions, such as necrosis or abscess formation, were observed in any of the experimental groups. Conclusion: The one-step adhesive showed acceptable biological compatibility with the monkey pulp, whereas the pulpal response to the system was minimally different from that of the glass-ionomer cement or the two-step self-etching adhesive. Keywords: one-step adhesive, fluoride, pulpal response

Purpose: The objective of this study was to evaluate the pulpal response to a newly-developed MMA resin cement (MultiBond, Tokuyama) when used for adhesively luting composite resin inlays. Materials and Methods: Cervical cavities were prepared in monkey teeth. The teeth were randomly divided into 3 groups. In the experimental group, a self-etching primer and a resin cement were applied to the cavities, and then hybrid composite inlays (Estenia, Kuraray) were inserted using freshly mixed resin cement. In the other groups, a zinc oxide/eugenol cement (Eugedain, Showa Yakuhin Kakou) or a glass-ionomer cement (Fuji II, GC) was used to fill the cavity. The teeth were then extracted after 3, 30, and 90 days, fixed in 10% buffered formalin solution, and prepared using routine histological techniques. Five-µm-thick sections were stained with hematoxylin and eosin, or Brown & Brenn gram stain for bacterial observation. Histopathological reactions in the pulp tissue and bacterial penetration along the cavity walls were assessed using a standardized score. Results: No serious inflammatory reactions in the pulp, such as necrosis or abscess formation, were observed in any of the experimental periods, except for 1 case after 30 days, in which a pulpal exposure was suspected. Disarrangement of the odontoblast layer and deposition of reparative dentin were the major reactions observed in this specimen. No bacterial penetration along the cavity walls was detected. The monkey pulpal response and in vivo sealing ability of the MMA resin cement in combination with the self-etching primer was considered as good as that of the glass-ionomer cement. Conclusion: The new MMA resin cement showed acceptable biological compatibility to the monkey pulp when used to adhesively lute composite resin inlays. Keywords: MMA-based resin cement, indirect restoration, adhesive luting, pulpal response

Purpose: To evaluate the influence of substrate moisture on the clinical behavior of two dentin adhesives after 18 months. The null hypothesis tested was that drying dentin with air upon rinsing off the acid would not influence the clinical performance of two dentin adhesives as compared to leaving the preparation visibly moist. Materials and Methods: Thirty-five patients were enrolled in this study. One hundred twenty-eight restorations divided into 4 groups were inserted and evaluated at baseline: (1) NT/Moist - Prime & Bond NT, an acetone-based adhesive, applied on moist dentin; (2) NT/Dried - Prime & Bond NT applied on dentin dried with air for 3 to 4 s; (3) SB/Moist - Single Bond, an ethanol- and water-based adhesive, applied on moist dentin; (4) SB/Dried - Single Bond applied on dentin dried with air for 3 to 4 s. A microfilled composite resin was used for all restorations. Patients were recalled at 6 and 18 months. Results: At 18 months after initial placement, 110 restorations (86% recall rate) were re-evaluated. Retention rates at 18 months were 92% for NT/Moist, 93% for NT/Dried, 100% for SB/Moist, and 89% for SB/Dried. No statistically significant differences were found among groups for retention rate. Both NT/Moist and SB/Moist resulted in a significant decrease in sensitivity to air from baseline to 18 months. When data were pooled for the variable "substrate moisture", SB resulted in an overall retention rate of 95%, while NT resulted in a retention rate of 92% (statistically similar). The marginal adaptation with SB was significantly worse at 18 months than at baseline. Conclusion: The moisture level of the dentin substrate in noncarious cervical lesions does not influence retention of composite restorations, but moist conditions caused less sensitivity to air. When applied as per manufacturers' instructions (moist dentin), both adhesives resulted in Class V retention rates exceeding the ADA 18-month full acceptance guidelines. Keywords: dental bonding, clinical trial, composite restorations