The Journal of Adhesive Dentistry, 06/2015

Purpose: To evaluate shear bond strength and microleakage of a new self-etching/self-adhesive fissure sealant on prismless enamel compared with conventional fissure sealing. Materials and Methods: A total of 90 extracted third molars were assigned to 3 main groups: group 1: selfetching/ self-adhesive sealant, without acid etching; group 2: self-etching/self-adhesive sealant, with prior acid etching; group 3: conventional fissure sealing (control group). After specimen preparation, each group was divided into 3 subgroups according to storage time (1-day water storage, 3-month water storage, and 1-day water storage followed by 5000x thermocycling). The shear bond strength was determined with a universal testing machine, according to ISO standard 29022. Afterwards, the failure mode was analyzed. An additional 24 third molars were used for microleakage assessment. The fissure pattern was sealed in strict accordance with the manufacturers' instructions. After thermocycling, the dye penetration was examined. Data were analyzed using the Mann-Whitney U-Test at a significance level of 0.05. Results: The shear bond strength of the self-etching/self-adhesive fissure sealant without prior acid etching was significantly lower (4.3 MPa) than that of the self-etching/self-adhesive fissure sealant with prior acid etching (17.1 MPa) and the conventional fissure sealing (19.1 MPa). Microleakage was significantly lower in the control group (1.1%) and in the group with the self-etching/self-adhesive sealant with prior acid etching (0.8%) compared to the group that used the self-etching/self-adhesive material alone (49.4%). Conclusion: The self-etching/self-adhesive fissure sealant can be recommended for clinical use when enamel is etched with phosphoric acid. The self-etching/self-adhesive sealant without prior acid etching showed significantly inferior results. Keywords: pit-and-fissure sealant, shear bond strength, microleakage, self-etching sealant, self-adhesive sealant

Purpose: To evaluate the effects of different antioxidant treatments on the microtensile bond strength of an adhesive system to sodium hypochlorite (NaOCl)-treated dentin. Materials and Methods: Thirty extracted third molars were sectioned 3 mm below the occlusal surface and divided into six groups according to the antioxidant treatment received: control group: distilled water; NaOCl group: 5.25% NaOCl and distilled water; proanthocyanidin (PA) group: 5.25% NaOCl, 5% PA and distilled water; 1-week storage group: 5.25% NaOCl and storage for 1 week in distilled water; Accel group: 5.25% NaOCl, Accel, and distilled water; noni group: 5.25% NaOCl, noni fruit juice, and distilled water. NaOCl, PA, Accel, noni, and distilled water were administered for 30 s, 10 min, 30 s, 10 min, and 30 s, respectively. A self-etching adhesive system (Single Bond Universal Adhesive) was applied to each specimen and a resin composite (Filtek Z550) was built up to a height of 5 mm on the dentin surface. Each specimen was serially sectioned to obtain sticks with a cross-sectional area of 1 mm2, and their microtensile bond strength was determined. Statistical differences between groups were analyzed using one-way ANOVA and Tamhane's T2 test. Results: Microtensile bond strength in the NaOCl group was significantly lower than in all other groups. However, there were no significant differences in the bond strength between the groups treated with different antioxidants. Conclusions: NaOCl significantly reduced the microtensile bond strength of the adhesive system. The application of PA, Accel, and noni fruit juice to NaOCl-treated dentin significantly improved the microtensile bond strength. Keywords: NaOCl, antioxidant, adhesive, microtensile bond strength

Purpose: To compare and evaluate shear bond strength of self-etching adhesives bonded to cavities prepared by diamond bur or Er,Cr:YSGG laser and the effect of prior acid etching on shear bond strength. Materials and Methods: Ninety-six caries-free human premolars were selected and divided into 2 groups depending on mode of cavity preparation (48 teeth each). Cavities were prepared with Er,Cr:YSGG laser in group 1 and diamond burs in an air-turbine handpiece in group 2. Groups 1 and 2 were further subdivided into three subgroups of 8 teeth each, which were bonded with sixth- or seventh-generation adhesives with or without prior acid etching, followed by restoration of all samples with APX Flow. These samples were subjected to shear bond strength testing. In addition, the surface morphology of 24 samples each from groups 1 and 2 was evaluated using SEM. Data were analyzed using the Shapiro-Wilk test, one- and two-way ANOVA, the t-test, and the least significant difference test, which showed that the data were normally distributed (p > 0.05). Results: The shear bond strength of adhesives in cavities prepared by Er,Cr:YSGG laser was significantly higher than in diamond bur-prepared cavities (p < 0.05). SEM analysis showed a smear-layer-free anfractuous surface on laser-ablated teeth, in contrast to conventional bur-prepared teeth. Conclusions: The Er,Cr:YSGG laser-ablated surface proved to be more receptive for adhesion than those prepared by diamond bur irrespective of the bonding agent used. Seventh-generation adhesives yielded higher shear bond strength than did sixth-generation adhesives. Prior acid etching decreased the shear bond strength of self-etching adhesives. Keywords: adhesives, Clearfil SE Bond, Er, Cr:YSGG laser, SEM, shear bond strength, Clearfil S3 Bond

Purpose: To evaluate the radiopacity, bond strength, and micromorphology of experimental filled dental adhesives. Materials and Methods: Five experimental filled dental adhesives with different concentrations of radiopaque barium-borosilicate glass (wt%) [0 (R0), 30 (R30), 40 (R40), 50 (R50), and 60 (R60)] and the commercial adhesive Adper Single Bond 2 were used in this study. Specimens were prepared by dispensing the uncured resin into a mold (5.0 mm x 1.0 mm). Digital radiographs (n = 5) of both 1-mm-thick adhesive specimens and tooth were taken with a CCD sensor. The gray levels of enamel, dentin, and adhesive systems were measured by histogram analysis and compared. Adhesives were applied to flat dentin surfaces of third molars (n = 7). Resin composite buildups were constructed and sectioned to obtain resin-dentin bonded sticks to test immediately or after 6 months of water storage. Three specimens for each tooth were qualitatively analyzed using scanning electron microscopy. Data on bond strength and radiopacity were evaluated by two-way and one-way ANOVA, respectively, and Tukey's test (α = 0.05). Results: All experimental filled dental adhesives showed radiopacity similar to enamel (p > 0.05) and most yielded significant reductions of bond strength over time. However, the R30 produced a radiopaque material without jeopardizing the bonding of the material to the dentin substrate. Conclusions: The addition of 30% barium-borosilicate oxide produced radiopaque adhesives without jeopardizing the bonding to the dental substrate. Keywords: radiopacity, filler particles, dentin bonding agents, dental bonding, adhesive

Purpose: To evaluate the effect of different surface treatments on luting CAD/CAM composite resin workpieces. Materials and Methods: One-hundred eight (108) composite CAD/CAM block sections (Lava Ultimate) 3 mm in thickness were polished up to 4000 grit and then randomly assigned to 6 experimental groups according to the applied surface treatment (no treatment, sodium bicarbonate [NaHCO3], glycine, alumina [Al2O3], CoJet, and SilJet). After standardized sandblasting procedures, 2 block sections from each group were randomly chosen for the qualitative SEM evaluation of the sandblasted surfaces. The remaining 96 CAD/CAM block sections were luted in pairs using a bonding agent (Single Bond) and a restorative composite resin (Filtek Ultimate). Specimens were aged for 2 weeks in 37°C water with 3000 thermal cycles (5°C/55°C), the microtensile test was performed (n = 30), and the values were statistically analyzed with ANOVA and Tukey's HSD post-hoc test (p = 0.05). Results: The qualitative SEM evaluation of the sandblasted surfaces showed that sodium bicarbonate and glycine had almost no conditioning effect on the CAD/CAM composite resin. In contrast, aluminum oxide, CoJet, and SilJet had a profound conditioning effect on the CAD/CAM composite resin. No treatment, sodium bicarbonate, and glycine specimens were debonded after thermal stressing (0 MPa), while aluminum oxide, CoJet, and SilJet showed high microtensile values (Al2O3: 104.45 ± 18.76 MPa; CoJet: 105.55 ± 11.88 MPa; SilJet: 105.02 ± 20.84 MPa), which were not statistically significantly different from each other. Conclusion: Aluminum oxide-based sandblasting powders are the best choice for the surface treatment of CAD/ CAM workpieces. Keywords: composite CAD/CAM blocks, surface treatment, adhesion testing, microtensile bond strength

Purpose: To quantify hydrogen peroxide (H2O2) penetration into restored bovine teeth subjected to whitening treatment. Materials and Methods: Seventy-five enamel/dentin disks were divided into 5 groups (n = 15): intact disks (G1); cavity preparation only (G2); conventional adhesive system and composite resin (G3); resin-modified glass-ionomer cement (G4); and self-etching adhesive only (G5). After 24 h, the disks were placed into artificial pulp chambers containing an acetate buffer solution, and the first whitening session was performed using a 35% H2O2 (hydrogen peroxide) product. The disks were submitted to 10,000 thermal cycles and then stored for 1 year in deionized water. After this period, a second whitening session was performed. After each whitening procedure, the buffer solutions were analyzed for optical density in a spectrophotometer to assess the amount of H2O2 that had diffused. ANOVA and Tukey's test were used to compare the different groups and a Student's t-test was used to compare the different times (p ≤ 0.05). Results: Prior to aging, group 2 had the highest penetration of H2O2; the other groups showed similar, lower penetration. After thermocycling and aging, all groups showed a significant increase in H2O2 penetration. The greatest penetration of H2O2 into the pulp chamber was found in groups 2 and 5. Conclusion: Aged restorations allowed greater H2O2 permeation through the tooth structure. Keywords: hydrogen peroxide, dental bleaching, adhesive, restoration

Purpose: To evaluate the microtensile bond strength (μTBS) and marginal sealing ability of a self-adhering flowable composite between dentin and composite interfaces, as well as the microleakage of Class V restorations. Materials and Methods: The occlusal thirds of 40 third molars were removed and randomly divided into 4 groups according to the applied adhesive: Adper Easy One (AEO, 3M ESPE), Clearfil SE Bond (CSEB, Kuraray), Prime & Bond NT (PBNT, Dentsply) and a self-adhering flowable composite (Dyad Flow, DF, Kerr). Filtek Flowable (3M ESPE) resin composite crowns were then built up in the first three groups; in group DF, composite crowns were built up without the application of an adhesive. Thirty stick-shaped microspecimens were prepared per group, 10 of which were used for morphological observation of bonded interfaces by scanning electron microscopy (SEM) after decalcification. The remaining microspecimens underwent microtensile bond strength testing and the failure mode was analyzed. Microleakage evaluation was performed on 10 premolars per group in which standardized box-shaped Class V cavities were prepared. After 500 thermocycles, the premolars were immersed in 1% methylene blue for 24 h, and three slices from each tooth were observed under a stereomicroscope and scored. Statistical analysis was performed using one-way ANOVA, Student-Newman-Keuls and chi-square tests. Results: The PBNT group presented the highest μTBS values, followed by the CSEB and AEO groups, which did not differ significantly from each other. The DF group showed the lowest μTBS values. No significant differences in microleakage were observed among these four groups. Conclusion: Although individual usage of the self-adhering flowable composite showed the lowest bond strength, the same marginal sealing ability was observed as that of combining self-etching and etch-and-rinse adhesives with flowable composite. Keywords: microtensile bond strength, microleakage, self-adhering, flowable composite, adhesive

Purpose: To compare the bonding performance of three new self-adhesive resin cements to human dentin after storage under two different conditions. Materials and Methods: Buccal, lingual, mesial, and distal dentin surfaces of 36 human molars were abraded to directly below the enamel with #600 SiC papers. The teeth were divided into two main test groups. In the first test group (FT), the cements were kept in a refrigerator (6 ± 2°C) for three months and then used for the test. The remainder of the cements was kept at a constant room temperature of 19 ± 2°C for an additional three months, and then used again for the second test group (ST). Each test group comprised 6 teeth and 24 dentin sections. The cements Clearfil SA (CSA), G-Cem (GC), and Bis-Cem (BC) were applied to the surfaces according to the manufacturers' recommendations. After application of the cements to the flat dentin surfaces and light curing, shear bond strengths were determined at a crosshead speed of 0.5 mm/min. Bond strengths were then calculated and expressed in MPa. Data were analyzed with Kruskal-Wallis and Wilcoxon Signed Rank tests. To investigate the cement/ dentin interfaces using SEM, the buccal surfaces of three additional teeth were used for each test group. Results: The bond strength values of cement groups were significantly different for the FT and ST groups (p < 0.01). GC showed the highest bond strength values of all materials. There was a difference between the bond strength values of the two testing periods for all materials (p < 0.01). Bond strengths significantly decreased after storage at room temperature. Conclusion: Storage temperatures considerably affect the shelf life of self-adhesive resin cements. Keywords: Clearfil SA, Bis-Cem, G-Cem, SEM, shelf life, storage time

Purpose: To evaluate the bond strength of resin to zirconia treated with different surface conditioning methods. Materials and Methods: Sintered zirconia was surface treated to create 7 groups. Ceramic liner (L) was fired onto three groups of zirconia and subsequently received the following treatments: hydrofluoric acid etching (L/ HFE), alumina particle abrasion (L/APA), and alumina particle abrasion with hydrofluoric acid etching (L/APAHFE). All three groups were silane treated immediately prior to bonding. Two other zirconia groups received alumina particle abrasion with and without silane coupling (AP-S and AP). Another group underwent selective infiltration etching, in which the specimens received porcelain powder firing, ultrasonic etching with HF for 15 min, then rinsing under running water for 15 min, followed by silane treatment (SIE). The control group was zirconia as-sintered (ZAS). Twenty composite resin cylinders were luted to each group with a resin cement. Each group was divided into two subgroups (n=10) and subjected to 2 storage conditions: 24 h water storage or 21 days with 6000 thermocycles between 5°C and 55°C. Shear bond strength testing (SBS) was performed, followed by statistical analysis of the results using one-way ANOVA (p < 0.05). Results: After 21 days of thermocycling, AP and ZAS groups spontaneously debonded prior to testing. The remaining groups showed a decrease in mean shear bond strength between 11.7% and 58.5% after thermocycling, except the L/HFE group, which increased by 11.7%. L/HFE showed the highest bond strength at both test intervals, and at 21 days was significantly higher than that of the AP-S and L/APA-HFE groups, which in turn were higher than that of the L/APA group, which was higher than that of the SIE group (p < 0.05). Conclusion: The etched, fired ceramic liner with silane treatment provided the strongest and most durable bond under the conditions tested. Alumina particle abrasion degraded the durability of the ceramic liner. Alumina particle abrasion, as-sintered zirconia, and SIE did not provide durable bond strengths. Keywords: zirconia, resin cement, shear bond strength

Purpose: To assess the resin microtensile bond strength (MTBS) and the degree of conversion (DC) of indirect composite resin restorations polymerized with light and heat. Materials and Methods: Two direct (Filtek Z100 and Premise) and one indirect (Premise Indirect) composite resins were polymerized with a combination of light and heat (138°C for 20 min). For MTBS, 42 cylinders were fabricated (n = 7). After the surface treatment, cylinders were bonded to each other using adhesive resin (Optibond FL). Specimens were stored in water for 24 h. Another 15 cylinders (n = 5) were fabricated for determining degree of conversion using Fourier Transform Infrared Spectrometry immediately and at 24 h. The MTBS and the DC was submitted to two-way ANOVA. The interaction with existing data was explored with univariate ANOVA and two-way ANOVA. Tukey's HSD post-hoc test was used to detect pairwise differences (α = 0.05). Results: The MTBS to light and heat polymerized Z100 was 75.7 MPa, significantly higher than that to Premise (58.6 MPa) and Premise Indirect (63.9 MPa). The immediate DC for Z100, Premise, and Premise Indirect were 51.0%, 68.7%, and 61.8%, respectively. The DC at 24 h ranged from 53.4% (Z100) to 72.8% (Premise Indirect) and significantly increased for Premise Indirect only. Comparison with previously published data revealed that the heat treatment increased both MTBS and DC of Premise and Premise Indirect. Conclusion: Z100 showed better bond strength but lower DC. Heat treatment and a 24-h delay before delivery can benefit DC of Premise Indirect. The increase in DC of Premise and Premise Indirect did not affect their bond strength. Keywords: adhesion, bond strength, direct composite resin, dental materials, indirect composite resin, degree of conversion

Purpose: To evaluate the marginal adaptation and fracture load of composite resin onlays reinforced with different substructures. Materials and Methods: Thirty-two extracted, caries-free premolars were selected for this study and endodontically treated. Group 1 was used as the control group, and the teeth were restored only with as-manufactured composite resin overlays. Group 2 teeth were restored with composite resin overlays with 3 fiber-reinforced composite (FRC) layers placed horizontally on the bottom of the restoration. Group 3 teeth were restored with composite resin overlays with 6 fiber-reinforced composite (FRC) layers placed as in group 2. Group 4 teeth were restored with composite resin overlays and FRC placed with an anatomical design. All specimens underwent SEM evaluation of their marginal adaptation before and after thermocycling and cyclic mechanical loading. All specimens were then subjected to a fracture test, recording the value for the initial (IF) and final (FF) failure. Differences in the means were compared using matched-pairs t-tests and one-way ANOVA. The level of significance was set at α = 0.05. Results: No statistically significant difference between the four groups in terms of marginal adaptation was observed at the tooth/luting composite and luting composite/overlay interfaces before and after loading. The fracture loads of IF and FF, from most to least resistant were: group 4 (1431.8 ± 294.3 N / 1710.1 ± 326.6 N), group 3 (1428.1 ± 251.4 N / 1467.9 ± 242.4 N), group 2 (852.6 ± 413.5 N / 1058.1 ± 251.5 N) and group 1 (899.8 ± 352.7 N / 923.5 ± 318.8 N). Significant differences (p = 0.026) were observed comparing group 1 to groups 2 and 3, and group 1 to 4. Three irreparable fractures were found in group 3, four in group 2, and five in groups 1 and 4. Conclusions: The presence or absence of reinforcement and the different configuration of the reinforcement fibers affect fracture strength but only partially the failure modality. The presence or absence of reinforcement does not alter marginal adaptation. Keywords: FRC, endodontically treated teeth, glass fibers, fracture, marginal adaptation, onlays