The Journal of Adhesive Dentistry, 04/2005

Purpose: This study tested an in vitro model of dentin hypermineralization, aiming to simulate naturally hypermineralized dentin for bond strength studies. The effect on bond strength of a double-etching treatment on the artificially hypermineralized substrate was also evaluated. Materials and Methods: Extracted human third molars were selected and 2 groups were formed: a group of 3 teeth, called N (normal dentin) and a group of 6 teeth, called H (hypermineralized dentin). Occlusal surfaces were ground flat to expose midcoronal dentin. Group H was subjected to artificial hypermineralization and subdivided into 2 subgroups: Ht and Hd. The exposed dentinal surfaces of group N and subgroup Ht were etched with 37% phosphoric acid for 15 s prior to bonding with Single Bond adhesive. Dentin of the subgroup Hd was etched twice (double etching) prior to bonding with Single Bond. A 4-mm-high Z100 composite buildup was created on each tooth and, after 24 h water storage, bond strengths were evaluated by the microtensile method. The data between group N and subgroup Ht and between subgroups Ht and Hd were compared using the Student's t test (α = 0.05). Results: No significant difference was observed between bond strengths of group N and subgroup Ht (p = 0.108). Subgroup Hd was statistically different from Ht (p 0.0001). Conclusions: Bond strengths of Single Bond to artificially hypermineralized dentin did not differ statistically from those to normal dentin substrate. The double etching approach significantly reduced bond strengths of artificially hypermineralized dentin. Keywords: hypermineralized dentin, bond strength, double etching

Purpose: To determine the effect of chemomechanical caries removal on the bonding quality of contemporary single-component adhesives to dentin. Materials and Methods: N-monochloro-DL-2-aminobutyrate solution (NMAB) and Carisolv gel were used to chemomechanically remove dentin caries in 60 extracted human molars. Caries removal with rotating instruments served as the control. Two single-component adhesive systems, Syntac Single Component and Excite, were applied to bond the hybrid composite Tetric Ceram to the treated dentin surfaces. The prepared samples were sectioned for microtensile bond strength testing and SEM examination of the bonding interfaces. The debonding patterns of the fractured samples were also assessed. Results: No statistically significant differences were found between the bond strengths of either adhesive to the conventionally and the NMAB-treated dentin (p > 0.05). However, the Carisolv-treated dentin yielded significantly higher (p > 0.05) bond strength values with both adhesives compared to those on dentin prepared with rotating instruments. No statistical difference could be discerned between the 2 adhesive systems (p > 0.05), nor was the interaction between the 2 variables under investigation (method of caries removal and the type of adhesive) statistically significant (p = 0.7712). SEM images indicated unspecific effects of the tested variables on both the thickness of the hybrid layer and the length of the resin tags. Conclusion: Under the conditions of this study, using the Carisolv chemomechanical caries removal system to prepare dentin surfaces enhanced the dentin/adhesive bond strength. In addition, the chemical nature of the adhesive systems seems to have no effect on the values of bond strength. Keywords: dentin, caries removal, adhesives, chemomechanical method, microtensile bond strength

Purpose: The purpose of this study was to evaluate the effect of age of dentin and enamel on the microtensile bond strengths of a glass-ionomer based, all-in-one, single-step, self-etching adhesive system (Reactmer Bond, RB) and an antibacterial, two-step self-etching primer system (ABF Bond, ABF). Materials and Methods: Extracted molars from 3 age groups (20 to 25, 35 to 40, and 50 to 55 years) were used. Enamel was removed from the occlusal surfaces of the teeth, and the entire flat surfaces were covered with composite resin (4 mm in height) following application of bonding agents. The bonded specimens were thinly sectioned parallel to the long axis of the tooth into 0.87 ± 0.03 mm2 rectangular sections, resulting in 6 to 7 enamel specimens and 10 to 15 dentin specimens per tooth. The specimens were subjected to the microtensile test at a crosshead speed of 1 mm/min. The data were analyzed by Univariate ANOVA, Tukey HSD, and regression analysis. Results: The bond strength of ABF to both enamel and dentin was higher than the bond strength of RB. Bond strengths of ABF to dentin were significantly higher than the bond strengths to enamel (p 0.05). The 35- to 40-year age group of ABF showed the highest bond strength of all. In RB dentin groups, 34% of specimens showed cohesive failure in composite resin material. Conclusion: Bond strength values to enamel were not affected by age of teeth in either bonding system. Dentinal bond strength using ABF changed according to age of the teeth. Age did not affect bond strength values of RB to dental hard tissues. However, the high number of cohesive failures in Reactmer paste indicated low tensile strength of the material. Keywords: dentin structure, age, bond strength, dentin bonding systems

Purpose: To evaluate the immediate microtensile bond strengths achieved with representative adhesive systems from each of the four current bonding approaches. Materials and Methods: Resin composite was bonded incrementally to flat, midcoronal dentin from 33 human molars, using the adhesives (Adper Scotchbond MP; Adper Scotchbond 1; Optibond Solo Plus; Clearfil SE Bond; AdheSE; Tyrian SPE + One Step Plus; Optibond Solo Plus self-etching; One-Up Bond F; iBond; Adper Prompt L-Pop; Xeno III) according to the respective manufacturer's instructions. The bonded specimens were immediately sectioned into sticks and underwent microtensile bond testing either immediately or after 24 h. Data were analyzed with two-way ANOVA and LSD tests. Results: No significant differences were found between immediate and 24-h bond strengths (p > 0.05). However, significant differences were observed among adhesives (p = 0.001). The all-in-one adhesive iBond showed statistically lower values when compared to all the other adhesives. Adper Prompt L-Pop, Xeno III, Tyrian SPE + One Step Plus and One-Up Bond F, all self-etching adhesives, were significantly weaker than AdheSE, Optibond Solo Plus, Adper Scotchbond 1, Optibond Solo Plus self-etching, Clearfil SE Bond, and Adper Scotchbond MP, which did not differ statistically from each other. Conclusion: Microtensile bond strengths of representative adhesive systems from the four categories of bonding agents were not equivalent, with the lowest values recorded for the one-step self-etching adhesives. There were no differences in the bond strengths when measured immediately and after 24 h. Keywords: microtensile bond strength, dentin, adhesive system, test period

Purpose: To evaluate the effect of different insertion techniques and adhesive systems on microleakage of Class V composite resin restorations. Materials and Methods: Forty-eight human molars were randomly assigned to four groups (n = 12). Standardized mixed Class V cavities (enamel and dentin margins) were prepared at the CEJ. A total-etch (Adper Scotchbond MultiPurpose) and a self-etching (iBond) adhesive system were evaluated using either an incremental or single-step (bulk) insertion technique. The preparations were restored with Esthet·X micromatrix hybrid composite. The teeth were thermocycled 1000 cycles, immersed in 1% methylene blue dye for 24 h, and invested in acrylic resin. The specimen blocks were then sectioned longitudinally, with dye penetration (microleakage) examined with a 20X binocular microscope. Enamel and dentin margins were scored separately for microleakage using an ordinal ranking system. Results were analyzed using non-parametric tests at a p 0.05 level of significance. Results: Significance was exhibited between the groups (adhesive material/insertion technique) at the coronal and apical margins. At the coronal margin, the total-etch adhesive/incremental insertion group exhibited significantly less leakage than the other groups, while at the apical margin, the total-etch adhesive/incremental insertion group showed significantly less leakage than the self-etching adhesive/bulk insertion group. Significantly less leakage was found at the coronal margins compared to the apical margins of the material/technique groups. Conclusion: The use of a total-etch adhesive system and incremental insertion of composite significantly reduced microleakage at the coronal and apical margins of Class V composite restorations. Keywords: adhesives, composite resin, microleakage, Class V restoration

Purpose: Despite the different light sources and polymerization techniques developed to eliminate it, microleakage of resin composite still remains a problem. This in vitro study was designed to compare the effects of exponential mode soft-start polymerization with those of standard and high-intensity continuous light polymerization on microleakage in Class II resin composite restorations. Materials and Methods: Standardized Class II cavities (4 mm wide, 4 mm long, 5 to 6 mm high, 2 mm deep) were prepared in 50 extracted human molars. Specimens were divided into 5 groups (n = 10) and restored using the same hybrid resin composite (Z250), but separately polymerized by one of five different methods: group 1: continuous halogen light polymerization for 40 s; group 2: continuous high-intensity halogen light polymerization for 10 s; group 3: exponential mode soft-start halogen light polymerization for a total of 40 s; group 4: continuous LED light polymerization for 40 s; Group 5: exponential mode soft-start LED light polymerization for a total of 40 s. All specimens were thermocycled for 1000 cycles at 5°C to 55°C and then placed in 0.5% basic fuchsin dye for 24 h. Specimens were then rinsed, embedded in resin and sectioned longitudinally. Dye penetration at occlusal and cervical margins was rated using a scale of 0 to 4. Data was analyzed using Kruskal-Wallis and Mann-Whitney U-tests. Results: Significantly lower marginal leakage was recorded with exponential mode soft-start polymerization when compared to continuous light polymerization. No significant differences in microleakage were observed between LED and halogen light polymerization. Conclusion: Within the limits of this in vitro study, the use of the soft-start exponential mode of LED and/or halogen light units in the polymerization of hybrid composite was found to produce significantly lower microleakage at both occlusal and cervical margins when compared to continuous light polymerization methods. Keywords: composite resin, soft-start polymerization, halogen, LED

Purpose: To compare the antibacterial activities of two dentin bonding systems (DBS), Clearfil Protect Bond and Xeno III, by agar well, paper and dentin disks, and a cavity tooth model. Materials and Methods: For the well technique, the test materials were filled in the agar wells inoculated with Streptococcus mutans (ATCC 25175). The paper disks were embedded in adhesives and placed on the seeded agar plates for the second technique. The adhesives were applied on the dentin disks and placed in holes in the plates for the third technique. After 48 h, the zones of inhibition were measured. In the cavity tooth model test, 3 cavities were prepared in the flat occlusal dentin of extracted human molars. The teeth were left in S. mutans for 72 h to allow bacterial invasion. The DBS were applied in the same manner as in clinical application on each of the two infected cavities and the third was left unapplied for control. The teeth were kept in saline for 72 h. Standard amounts of dentin chips were obtained from the cavity walls and the number of bacteria recovered was counted. Results: The results were analyzed by factorial ANOVA and Dunnett C test. Clearfil Protect Bond primer exhibited the greatest inhibition zones followed by Consepsis and unpolymerized Xeno III in all the techniques tested (p = 0.05). Clearfil Protect Bond resulted in significantly less bacterial recovery than Xeno III by the tooth cavity method (p = 0.05). Conclusion: Clearfil Protect Bond was found to be the most antibacterial material with all the techniques used. Furthermore, Clearfil Protect Bond was able to inactivate the bacteria in the cavity more effectively than Xeno III. Keywords: antibacterial activity, adhesive system, MDPB

Purpose: Recently, highly flowable resin fillers have been proposed for filling root canals using a single-cone approach. The purpose of this study was to test the hypothesis that polymerization shrinkage, which is inherent to this type of filler, can break the close initial contact between the main core and the surrounding dentin even if root dentin infiltration has occurred. Materials and Methods: Twenty roots of anterior teeth were prepared chemomechanically and divided into 4 groups of 5 samples each. Groups 1 and 2: hydrophilic resin filler injected and spread, roots sectioned after setting; group 3: hydrophilic resin filler injected and spread, dental substrate dissolved after setting; group 4: hydrophobic resin sealer lentulo-spiraled and spread, roots sectioned after setting (as control). In groups 1, 2, and 3 the material was used following manufacturer's instructions. The section surfaces of groups 1 and 4, and the resin components of group 3 were processed for conventional FE-SEM. The section surfaces of group 2 were observed successively under environmental and high-vacuum conditions. Results: Microscopic examination of the resin-dentin interfaces of groups 1 and 2 showed the existence of resin-dentin interdiffusion zones (RDIZ); however, the close initial contact between the main core and the surrounding dentin was often lost. In group 3, resin tag morphology was well characterized. Identical morphological features were observed in the resin-dentin interfaces in group 4. Conclusion: Since the existence of resin tags did not exclude the existence of a gap between the main core and the adjacent RDIZ, our results confirmed the proposed hypothesis. Keywords: adaptation, filling, infiltration, root dentin, seal

Purpose: To evaluate the pullout strength of a glass fiber-reinforced composite post (glass FRC) cemented with three different adhesive systems and one resin cement. The null hypothesis was that pullout strengths yielded by the adhesive systems are similar. Materials and Methods: Thirty bovine teeth were selected. The size of the specimens was standardized at 16 mm by sectioning off the coronal portion and part of the root. The specimens were divided into three groups, according to the adhesive system, which were applied following the manufacturers' instructions: G1, ScotchBond Multi-Purpose Plus; G2, Single Bond; G3, Tyrian SPE/One-Step Plus. The glass FRCs (Reforpost) were etched with 37% H3PO4 for 1 min and silanized (Porcelain Primer). Thereafter, they were cemented with the dual resin cement EnForce. The specimens were stored for 24 h, attached to an adapted device, and submitted to the pullout test in a universal testing machine (1 mm/min). The data were submitted to the one-way ANOVA and Tukey's test (α = 0.05). Results: G1 (30.2 ± 5.8 Kgf) displayed the highest pullout strength (p 0.001) when compared to G2 (18.6 ± 5.8 Kgf) and G3 (14.3 ± 5.8 Kgf), which were statistically similar. Analysis of the specimens revealed that all failures occurred between the adhesive system and the root dentin (pullout of the post cement), regardless of group. Conclusion: The multiple-bottle, total-etch adhesive system provided higher pullout strength of the glass FRC when compared to the single-bottle, total-etch, and single-step self-etching adhesive systems. The null hypothesis was rejected (p 0.001). Keywords: pullout strength, adhesive systems, fiber post, bovine teeth

Purpose: Polyethylene fiber-reinforced composite inlay fixed partial dentures (FPDs) have been under development for some time. There is a lack of data on the clinical performance of such prostheses. This prospective clinical study evaluated the clinical performance of polyethylene fiber-reinforced composite FPDs over two years. Materials and Methods: Twenty-eight polyethylene fiber-reinforced composite inlay FPDs were fabricated for 19 patients. The treatment plan included removal of the existing restorations, placement of an ultrahigh molecular weight polyethylene (UHMWP) fiber ribbon, and final restoration with a light-curing hybrid resin. The 28 polyethylene fiber-reinforced composite inlay FPDs were examined clinically after 2 years. Results: All 28 FPDs were intact at the 2-year examination. There were no signs of fracture, debonding, or discoloration. Conclusion: Based on the results of this descriptive study, the polyethylene fiber-reinforced composite inlay FPDs were considered clinically successful at the 2-year examination. Keywords: ribbon, fiber-reinforced composite, inlay FPDs, polyethylene fiber, inlay retained FPDs

Purpose: To evaluate the four-year performance of a highly filled resin composite in Class II and Class I cavities. Materials and Methods: Each of 63 participants received at least one pair of restorations of the same size: one resin composite (Tetric Ceram) and one calcium aluminate cement. Seventy-one pairs were placed. The restorations were evaluated clinically according to slightly modified USPHS criteria at baseline, after 6 months, 1, 2, 3, and 4 years. At 3 years, the calcium aluminate cement material showed an inacceptable clinical cumulative failure frequency of 57% and its evaluation was discontinued. Results: Postoperative sensitivity was reported for 5 restorations (2 resin composite, 3 calcium aluminate cement). At 4 years, a cumulative failure frequency of 7.5% was observed for the resin composite material. Reasons for failure were partial material fracture (2), cusp fracture (2) and endodontic treatment (1). Conclusion: An annual failure rate of 1.9% for the resin composite material provided a good clinical performance during the 4-year period, which fulfills the ADA criteria for posterior resin composite materials. Keywords: dental restorations, cement, ceramic, clinical, composite resin