The Journal of Adhesive Dentistry, 02/2016

Purpose: To evaluate the potential cytotoxic effects of four one-step self-etching dental adhesives [Adper Easy One (AEO), iBond (IB), Clearfil S³ Bond (CSB), and G-Bond (GB)] on cultured human periodontal ligament fibroblasts. Materials and Methods: Cured adhesives were immersed in complete DMEM or deionized water and maintained at 37°C for 24 h, followed by sterilization. The deionized water-based extract was used for Fourier transform infrared spectroscopy analysis. The DMEM-based extract was diluted into various concentrations for cytotoxicity tests. The viability, integrity, and apoptosis of cultured human periodontal ligament fibroblasts upon treatment with the extracts were determined using the CCK-8 assay, microscopy, and flow cytometry. Results: All of the four adhesives induced cell viability loss, cell morphology alteration, and cell death. GB showed the greatest cytotoxicity by inducing cell apoptosis and necrosis, while IB had the weakest cytotoxic effect on the cultured cells. Conclusion: All tested dental adhesives have significant adverse effects on cell viability. Therefore, precautions should be taken to protect the periodontal tissues when dental adhesives are applied in the clinic. Keywords: one-step self-etching adhesive, cytotoxicity, human periodontal ligament fibroblasts

Purpose: To assess the effects of different curing stages of 4-META/MMA-TBB resin on osteoblasts and gingival keratinocytes. Materials and Methods: The MC3T3-E1 murine pre-osteoblastic cell line and GE-1 murine gingival epithelial cell line were cultured with mixtures of Super-Bond C&B at different curing stages, and the cell viability was assessed. The alkaline phosphatase (ALP) activity of the MC3T3-E1 cells was also assessed. Results: The majority of the MC3T3-E1 cells died and showed no ALP activity when cultured with 4-META/MMA-TBB resin during the initial curing phase (1 min of curing). A later curing phase of the 4-META/MMA-TBB resin (7 min of curing) showed cytotoxicity at day 1, but the toxic effect was temporary and the proliferative capacity and ALP activity in the cells were similar to control cells at day 7. Completely cured 4-META/MMA-TBB resin (after 1 or 12 h of curing) did not affect the cell viability or ALP activity of the MC3T3-E1 cells. In contrast, 4-META/MMA-TBB resin showed no effect on the GE-1 cells at any stage of curing. Conclusion: Although 4-META/MMA-TBB resin during the initial curing phase shows toxic effects on MC3T3-E1 cells, that cytotoxicity is minimal at later curing phases. In contrast, neither the uncured nor cured resins affected the GE-1 cells. Keywords: 4-META/MMA-TBB resin, osteoblast, gingival keratinocyte, curing time, periradicular surgery, tissue adhesive

Purpose: To evaluate the effect of bulk filling Class I posterior cavities on bonding to cavity-bottom dentin. Materials and Methods: Two flowable "base" bulk-fill composites (Filtek Bulk Fill Flowable, SDR), one paste-like "full-body" bulk-fill composite (Tetric EvoCeram Bulk Fill) and one conventional paste-like composite (Filtek Z100) were bonded (G-ænial Bond) to either a flat surface (3.5 x 3.5 x 4 mm; C-factor: 0.18) or a Class I cavity (3.5 x 3.5 x 4 mm; C-factor: 5.8). After 1-week water storage, the restorations were sectioned to obtain 4 rectangular microspecimens that were subjected to microtensile bond strength (μTBS) testing. Results: No significant differences in μTBS were recorded between all composites when bonded onto a flat surface (p > 0.05). When bonded into a Class I cavity, the μTBS of all composites except SDR significantly decreased (p 0.001). Conclusion: Both the configuration factor and the type of bulk-fill composite were found to have a great impact on bonding to cavity-bottom dentin. Keywords: adhesion, μTBS, shrinkage, configuration

Purpose: To investigate the influence of silane reaction time on the repair strength of an aged nanofilled composite and to characterize the bonding mechanism. Materials and Methods: Nanofilled composite disks (n = 110, Filtek Supreme XT) were aged for 90 days in water. After tribochemical treatment (CoJet-Sand), the specimens were assigned to 5 groups (n = 22), primed with silane (Espe-Sil), and left to react for 1, 2, 3, 4, and 5 min. A thin layer of adhesive (Visio-Bond) was applied and a new composite with the same dimension was placed and cured. Non-aged specimens immediately layered and cured using the incremental technique served as controls. After aging (30 days in water plus 5000 thermal cycles), the interface was subjected to a shearing force until failure. Failure mode was evaluated under a stereomicroscope and scanning electron microscopy (SEM). Additional aged and treated surfaces were evaluated for morphology as well as elemental and molecular composition using SEM/EDX and ATR-FTIR. Results: The mean shear bond strength (SBS) of the repaired specimens was 53.9 ± 8.6 MPa, with no significant difference among the various reaction times, but significantly lower compared to the control (88.1 ± 12.5 MPa). Tribochemical treatment created an irregular surface morphology with particles imbedded in the aged surface. Interfacial SEM/EDX analysis showed a 5-μm non-uniform high atomic number zone rich in Al and Si. Conclusion: Tribochemical treatments for repairing composite using a short silane reaction period (1 min) are equally effective as the prolonged reaction periods (2 to 5 min), yielding interfacial shear strength of ~60% of unrepaired material. Keywords: resin composite, repair, tribochemical, silane, reaction time, surface, interfacial characterization

Purpose: To test the effect of surface conditioning protocols on the reparability of CAD/CAM zirconia-reinforced lithium silicate ceramic compared to lithium-disilicate glass ceramic. Materials and Methods: Zirconia-reinforced lithium silicate ceramic (Vita Suprinity) and lithium disilicate glass-ceramic blocks (IPS e.max CAD) were categorized into four groups based on the surface conditioning protocol used. Group C: no treatment (control); group HF: 5% hydrofluoric acid etching for 60 s, silane (Monobond-S) application for 60 s, air drying; group HF-H: 5% HF acid etching for 60 s, application of silane for 60 s, air drying, application of Heliobond, light curing for 20 s; group CO: sandblasting with CoJet sand followed by silanization. Composite resin (Tetric EvoCeram) was built up into 4 x 6 x 3 mm blocks using teflon molds. All specimens were subjected to thermocycling (5000x, 5°C to 55°C). The microtensile bond strength test was employed at a crosshead speed of 1 mm/min. SEM was employed for evaluation of all the debonded microbars, the failure type was categorized as either adhesive (failure at adhesive layer), cohesive (failure at ceramic or composite resin), or mixed (failure between adhesive layer and substrate). Two-way ANOVA and the Tukey's HSD post-hoc test were applied to test for significant differences in bond strength values in relation to different materials and surface pretreatment (p 0.05). Results: The highest microtensile repair bond strength for Vita Suprinity was reported in group CO (33.1 ± 2.4 MPa) and the lowest in group HF (27.4 ± 4.4 MPa). Regarding IPS e.max CAD, group CO showed the highest (30.5 ± 4.9 MPa) and HF the lowest microtensile bond strength (22.4 ± 5.7 MPa). Groups HF, HF-H, and CO showed statistically significant differences in terms of all ceramic types used (p 0.05). The control group showed exclusively adhesive failures, while in HF, HF-H, and CO groups, mixed failures were predominant. Conclusions: Repair bond strength to zirconia-reinforced lithium silicate ceramics and lithium-disilicate glass ceramic could be improved when ceramic surfaces are sandblasted with CoJet sand followed by silanization. Keywords: intraoral repair, adhesion, ceramic

Purpose: To evaluate the fracture strength and the failure mode of endodontically treated teeth restored with composite resin overlays with and without glass-fiber reinforcement. Materials and Methods: A total of 32 extracted molars were divided into four equal groups. In the NFR-NFRC (no foundation restoration, no fiber-reinforced composite) and NFR-FRC (no foundation restoration, fiber-reinforced composite) groups, only a 5-mm-thick composite resin layer sealed the pulp chamber floors, whereas in the FR-NFRC (foundation restoration, no fiber-reinforced composite) and FR-FRC (foundation restoration, fiber-reinforced composite) groups, a 3.0-mm foundation restoration was used. NFR-NFRC and FR-NFRC groups were restored with composite resin overlays, whereas NFR-FRC and FR-FRC groups were restored with fiber-reinforced composite resin overlays. All specimens were subjected to mechanical loading in a computer-controlled masticator and then the fracture resistance was evaluated. Differences in means were compared using two-way ANOVA and Tukey's test. The level of significance was set at ɑ = 0.05. Results: All specimens successfully completed the fatigue test. The least fracture-resistant group was NFR-FRC, exceeded by FR-NFRC, NFR-NFRC, and FR-FRC, in that order, with FR-FRC being the most fracture-resistant group. Statistically significant differences were detected between the pairs NFR-NFRC/FR-FRC (p = 0.001), NFR-FRC/FR-FRC (p = 0.001), and FR-NFRC/FR-FRC (p = 0.001). Eight vertical root fractures occurred in group FR-NFRC, six in group NFR-NFRC, four in group NFR-FRC, and none occurred in group FR-FRC. Conclusions: Within the limitations of this in vitro study, the incorporation of glass fibers and the presence of a foundation restoration were found to increase the fracture resistance and can favorably influence the fracture mode. Keywords: molars, resin-bonded onlays, root fractures

Purpose: To evaluate the effects of three different radiation doses on the bond strengths of two different adhesive systems to enamel and dentin. Materials and Methods: Eighty human third molars were randomly divided into four groups (n = 20) according to the radiation dose (control/no radiation, 20 Gy, 40 Gy, and 70 Gy). The teeth were sagittally sectioned into three slices: one mesial and one distal section containing enamel and one middle section containing dentin. The sections were then placed in the enamel and dentin groups, which were further divided into two subgroups (n = 10) according to the adhesive used. Three restorations were performed in each tooth (one per section) using Adper Single Bond 2 (3M ESPE) or Universal Single Bond (3M ESPE) adhesive system and Filtek Z350 XT (3M ESPE) resin composite and subjected to the microshear bond test. Data were analyzed using a two-way ANOVA followed by Tukey's test. Failure modes were examined under a stereoscopic loupe. Results: Radiotherapy did not affect the bond strengths of the adhesives to either enamel or dentin. In dentin, the Universal Single Bond adhesive system showed higher bond strength values when compared with the Adper Single Bond adhesive system. More adhesive failures were observed in the enamel for all radiation doses and adhesives. Conclusion: Radiotherapy did not influence the bond strength to enamel or dentin, irrespective of the adhesive or radiation dose used. Keywords: radiotherapy, microshear bond strength, adhesive systems, head and neck cancer

Purpose: To investigate the resistance to dislodgment produced by Biodentine (Septodont) and White-MTA (Angelus) after immersion in phosphate-buffered saline (PBS) for different durations. Materials and Methods: Dentin disks 1 ± 0.1 mm thick were obtained from the middle third of the roots of 6 human maxillary canines. On the coronal surface of each dentin disk, four 0.8-mm-diameter holes were drilled. Then the slices were halved using a low-speed saw diamond disk, and the two holes in each half were filled with one of the two tested materials. Each filled half was immersed in PBS solution (pH 7.2) either for 7 days (short term) or 60 days (long term) at 37°C. The push-out test was performed after both time periods. A general linear model (GLM) for repeated measures ANOVA was used to verify the effect of the material and duration of contact with PBS on the push-out strength. The material was considered as the within-subject contrast and the contact duration as the between-subjects effect (p 0.05). Results: Repeated measures GLM indicated a significant impact of material and time on the push-out strength of the samples (p = 0.000 and p = 0.033, respectively). Biodentine significantly improved the push-out strength compared to MTA at both times (p = 0.000). The lack of significance in the interaction between material and time indicates that PBS immersion positively influenced the push-out values of both tested materials. Conclusion: Long-term PBS immersion positively influenced the resistance to dislodgement from dentin of all cements tested. The Biodentine cement provided greater resistance to push-out force than did the MTA. Keywords: Biodentine, MTA, push-out test

Purpose: To assess the light irradiance (LI) delivered by two light-curing units and to measure the degree of conversion (DC) of three composite cements and one flowable composite when cured through zirconia or ceramic-veneered zirconia plates with different thicknesses. Materials and Methods: Three dual-curing composite cements (Clearfil Esthetic Cement, Panavia F2.0, G-CEM LinkAce) and one light-curing flowable composite (G-aenial Universal Flo) were investigated. Nine different kinds of zirconia plates were prepared from three zirconia grades (YSZ: Aadva and KATANA; Ce-TZP/Al2O3: NANOZR) in three different thicknesses (0.5- and 1.5-mm-thick zirconia, and 0.5-mm-thick zirconia veneered with a 1.0-mm-thick veneering ceramic). Portions of the mixed composite cements and the flowable composite were placed on a light spectrometer to measure LI while being light cured through the zirconia plates for 40 s using two light-curing units (n = 5). After light curing, micro-Raman spectra of the composite films were acquired to determine DC at 5 and 10 min, 1 and 24 h, and at 1 week. Results: The zirconia grade and the thickness of the zirconia/veneered zirconia plates significantly decreased LI. Increased LI did not increase DC. Only the Ce-TZP/Al2O3 (NANOZR) zirconia was too opaque to allow sufficient light transmission and resulted in significantly lower DC. Conclusion: Although zirconia-based restorations attenuate the LI of light-curing units, the composite cements and the flowable composite could be light cured through the YSZ zirconia. LI is too low through Ce-TZP/Al2O3 zirconia, necessitating the use of self-/dual-curing composite cements. Keywords: zirconia, degree of conversion, micro-Raman, light spectrometer, light-curing unit, composite cement