The Journal of Adhesive Dentistry, 03/2021

Purpose: A systematic review and meta-analysis was conducted to compare the retention rates of 3-step etch-and-rinse (3ER) adhesives with 1-step self-etch (1SE) adhesives in noncarious cervical lesions (NCCLs). The secondary outcomes were marginal integrity and marginal discoloration. Materials and Methods: Only randomized clinical trials (RCTs) that compared 1SE with 3ER in NCCLs were included. Controlled vocabulary and keywords were combined in the search strategy for PubMed/Medline, LILACS, BBO, Web of Science, Cochrane Library, grey literature, and IADR abstracts (1990–2018). The Cochrane Risk of Bias tool (RoB) was applied to eligible studies. Meta-analyses were conducted for retention rate and secondary outcomes at different follow-up times, using the random effects model. Heterogeneity was assessed with the Cochran Q test and I2 statistics. The GRADE approach was used to assess the quality of the evidence. Results: After the removal of duplicates, title and abstract screening, 18 studies remained. Of these, 15 studies were used for meta-analysis. Fourteen out of these 15 were judged at “unclear” risk and 1 at “low” risk of bias. No significant differences between groups were observed in the different follow-up periods for retention rates 12 to 24 months (p = 0.66), 24 to 36 months (p = 0.21) and 60 months (p = 0.96). A significant difference in marginal integrity was found at 12 to 24 months (p = 0.04) and in marginal discoloration at 12 to 24 months (p = 0.003). Conclusion: There is no evidence that 3-step ER adhesives have better retention rates than 1-step SE adhesives in NCCLs. Keywords: adhesive, meta-analysis, noncarious cervical lesion, performance, randomized clinical trials

Purpose: Mild and intermediately strong 2-step self-etch adhesives (2SEa) have been shown to bond efficiently to dentin. In general, their bonding efficiency to enamel is inferior to that of etch & rinse adhesives (E&Ra). On the other hand, their application procedure is less elaborate, and consequently leaves less room for application mistakes. The aim of this randomized controlled trial was to evaluate the clinical performance of an intermediately strong 2SEa, as compared with that of a 3-step E&Ra after 6 years of clinical functioning. Materials and Methods: 239 non-carious cervical lesions in 50 patients were restored with the nanohybrid composite Herculite XRV (Kerr), bonded in random order either with the 2SEa Optibond XTR (‘O-XTR’, Kerr) or the gold-standard control 3E&Ra Optibond FL (‘O-FL’, Kerr). The restorations were recalled after 1, 2 and 6 years of clinical service and examined for retention, marginal adaptation, marginal discoloration, caries occurrence, and postoperative sensitivity. Statistical analysis was performed using a logistic regression model with generalized estimating equations (2-way GEE model). Results: The patient recall rate at 6 years was 94%. The overall clinical success rate was 81.9% and 80.9% for O-XTR and O-FL, respectively. In total, 42 restorations (21 O-XTR, 21 O-FL) failed because of retention loss, severe abfraction/abrasion/erosion, severe marginal defects and/or discoloration, and/or caries. A retention rate of 92.9% and 88.9% was recorded for O-XTR and O-FL, respectively. Progressive marginal deterioration was observed over the 6-year period. Small clinically acceptable marginal defects were recorded in about 70% of the restorations (O-XTR: 69.9%; O-FL: 74.1%). Regarding marginal discoloration, 37% of the O-XTR and 30.2% of the O-FL restorations showed superficial clinically acceptable marginal discoloration. Six O-XTR and 4 O-FL restorations exhibited caries at the restoration margin. No significant difference was observed between the two groups for any of the evaluated parameters (p > 0.05). Conclusion: After 6 years of clinical service, Class-V restorations bonded with the 2SEa performed clinically equally well as those bonded with the 3E&Ra. Keywords: randomized clinical trial, RCT, Class V, bonding, adhesion, clinical effectiveness

Purpose: To evaluate the push-out bond strength (PBS) of glass-fiber posts (GFP) in different root canal zones (cervical, middle, and apical), bonded with experimental simplified adhesives (ESAs) containing different initiator systems (camphorquinone [CQ] or phenylpropanodione [PPD]) with or without diphenyl iodonium hexafluorophosphate (DPI), in combination with a DPI-containing composite cement. Materials and Methods: ESA blends were prepared with bisphenol glycidyl methacrylate (bis-GMA), triethylene glycol dimethacrylate (TEG-DMA), 1,3-glycerol dimethacrylate (GDMA), 2-hydroxyethyl methacrylate (HEMA), and ethanol, then divided into 12 experimental groups (n = 10) according to the initiator systems (CQ, PPD, or CQ + PPD) and the presence or absence of DPI. The roots of 120 extracted bovine incisors were prepared with #5 Largo drills and the GFP were cemented with each ESA and experimental composite cements containing 0.05 mol% of DPI. The push-out bond strength (PBS) test was performed after 24 h of storage. Failure patterns were analyzed under a stereomicroscope. Data were analyzed with split-plot two-way ANOVA and Tukey’s test (α = 0.05). Results: PBS was significantly higher for DPI-containing ESAs in all regions evaluated, with the group containing 0.5 CQ + 1 PPD + 0.5 DPI exhibiting the highest PBS. There was no statistically signficant difference among groups without DPI. Most failures were classified as adhesive at the cement-dentin interface. Conclusions: The combination of an adhesive and a composite cement containing DPI salt can improve GFP bonding to root dentin, even in the apical region. Keywords: adhesive bond strength, adhesive cementation, fiber posts, photoinitiators, polymerization.

Purpose: To evaluate the effects of pretreatment with different crosslinking agents on glass-fiber-post adhesive luting. Materials and Methods: Single-rooted human teeth (n = 20) were randomly assigned to four groups: proanthocyanidins (PA) from grape-seed extract, cardol and cardanol (separated from cashew nut-shell liquid) and negative control (hydroethanolic solution). The solutions were applied on 37% phosphoric acid-etched dentin for 60 s. Glass-fiber posts were cemented using a three-step etch-and-rinse adhesive (Scotchbond Multi-Purpose, 3M Oral Care) and composite cement (RelyX ARC, 3M Oral Care). Slices for the push-out bond strength test were cut and tested after 24-h or 6-month storage in distilled water. The dentin underlying the adhesive layer was analyzed by micro-Raman spectroscopy to evaluate vibrational formation of collagen crosslinks. Three additional slices per group were also made and the adhesive in-situ degree of conversion (DC) was analyzed by micro-Raman spectroscopy. The results were analyzed using two-way ANOVA and Tukey’s test (p < 0.05). Results: No statistically significant changes in bond strength were found over time for any of the groups, except with cardol, which increased bond strength (8.4 ± 3.9 MPa at 24 h to 15.0 ± 2.9 MPa after 6 months, p < 0.001) after aging. The formation of peaks at 1117 cm-1 and 1235 cm-1 showed the presence of collagen crosslinks for all three biomodification agents. The DC outcomes showed no statistically significant differences between groups (p = 0.514). Conclusion: Biomodification agents did not impair adhesive polymerization. Cardol demonstrated a positive influence on intraradicular dentin bonding for glass-fiber post luting. Keywords: bond strength, fiber post, root dentin, biomodification agents, Anacardium occidentale

Purpose: To investigate the effects of several etching products prior to the application of a one-step self-etch adhesive (1-SEA) or two-step self-etch adhesive (2-SEA) on enamel by microshear bond strength (µSBS) testing and observation of the adhesive-enamel interface. Materials and Methods: Ground human enamel surfaces were randomly assigned to one of eight groups according to the combination of surface treatments (either no conditioner [NC], ME [Multi Etchant], EC [Enamel Conditioner], or KE [K-etchant Gel]) and adhesive (ADU [Adhese Universal] or SE2 [Clearfil SE Bond 2]). All groups were further divided into two subgroups: 0 or 10,000 thermal cycles (TC). Then, the µSBS test was performed. The adhesive-enamel interface after acid-base challenge and the surface structure after conditioner application were also observed. Results: With 10,000 TCs, there was no statistically significant difference between ME-ADU and NC-ADU. On the other hand, the µSBS of EC-ADU or KE-ADU was significantly higher than that of NC-ADU, while that of ME-SE2 was significantly lower than NC-SE2. There was no significant difference between EC-SE2, NC-SE2, and KE-SE2. Formation of an acid-base resistance zone (ABRZ) was confirmed in all groups. However, funnel-shaped erosion, which indicates interfacial defects, was observed in the NC-ADU, ME-ADU, and ME-SE2 groups. Conclusion: For enamel bonding, application of EC or KE prior to ADU increased the bond strength and created a stable adhesive-enamel interface. On the other hand, SE2 also had stable shear bond strength and interface without the use of conditioners. However, ME decreased the bonding performance of SE2. Keywords: enamel, selective-etching, acid-base resistance zone, microshear bond strength test

Purpose: To investigate the influence of the etching strategy of universal adhesives on bond degradation to sound and artificially-induced caries-affected dentin. Materials and Methods: The universal adhesives (Scotchbond Universal Adhesive; All-Bond Universal; Prime&Bond Elect) and adhesives used as controls (Adper Single Bond 2 and Clearfil SE Bond) were applied to sound and artificially-induced caries-affected bovine dentin. Microtensile bond strength was evaluated immediately (24 h) and after one year of water storage (1 year). Representative specimens were also prepared to assess nanoleakage. Bond strength data (MPa) were analyzed using three-way ANOVA and post-hoc Tukey’s test (α = 0.05), considering each substrate separately. Results: Bonding degradation was observed for all universal adhesives on caries-affected dentin, irrespective of the etching strategy. On sound dentin, bonding degradation was observed when adhesives were used on the etch-and-rinse strategy. Conclusion: The universal adhesives were not capable of maintaining bond stability over time on caries-affected dentin. The self-etch strategy seems better able to maintain the durability of adhesive interfaces created on sound dentin. Keywords: universal adhesive, dentin, caries-affected dentin, microtensile bond strength, longevity, nanoleakage

Purpose: To evaluate the effect of different surface modification methods on the microtensile bond strength (μTBS) of four resin-matrix CAD/CAM ceramics after artificial aging. Materials and Methods: Specimens of four CAD/CAM materials (Shofu Block HC, Lava Ultimate, Brilliant Crios, and Vita Enamic) were prepared and divided into four groups. Each group received one of the following treatments: group 1 (INT): no surface modification; group 2: sandblasting with 29-μm Al2O3 particles (SB); group 3: hydrofluoric acid etching (9%) + silane (HF+Si); group 4: sandblasting with 30-μm particles of the CoJet system (CJ). The specimens of each group were luted together in pairs using resin cement (RelyX Ultimate). After one week of water storage (37°C), the sandwich specimens were sectioned into rectangular microspecimens and half of them were immediately subjected to μTBS testing, while the other half was tested after six months. Data were statistically analyzed using FFANOVA including the factors of material, treatment, and storage time, with α = 0.05. Results: After one week, the lowest μTBS was observed for INT, while the highest was found for either mechanical (SB and CJ) or chemical (HF+Si) treatments (p < 0.05). After six months, a significant decrease in μTBS was observed depending on treatment (p < 0.05), while artificial aging significantly influenced the μTBS of all experimental groups (p < 0.05). During the two storage periods, the failure type was mainly interfacial and was associated with the type of surface modification. Conclusion: After artificial aging, the μTBS appeared to depend on srface modification, while the parameter “material” did not influence the results. Consequently, adhesive strategies should be oriented towards surface modification techniques. Keywords: surface modification, resin-matrix CAD/CAM ceramics, artificial aging, microtensile bond strength.

Purpose: To compare the shear bond strength of composite cement to lithium-disilicate glass-ceramic coated zirconia vs to alumina air-abraded zirconia and to analyze the residual stresses on both of lithium-disilicate glass-ceramic coated zirconia vs alumina air-abraded zirconia specimens. Materials and Methods: One hundred eighty zirconia disks (diameters 10 mm and 5 mm, 4.5 mm thick) were divided into two groups: lithium-disilicate glass-ceramic coating followed by hydrofluoric acid etching and Monobond N Primer (LiDi) or alumina air-abrasion (AA). For each group, two different sizes of identically pre-treated zirconia specimens were bonded with Multilink Speed Cement. A total of 90 specimens were stored in distilled water at 37°C for 24 h and then assigned to three subgroups (n = 15/test group): 1. short-term test; 2. thermocycling for 5000 cycles; 3. thermocycling for 10,000 cycles. Bond strength was tested in shear mode and results were analyzed using two-way ANOVA, followed by one-way ANOVA and Tukey’s HSD (α = 0.05). Failure mode and surfaces were analyzed with optical and scanning electron microscopy. X-ray diffraction was used to analyze t-m phase transformation and residual stresses on mechanically pre-treated LiDi and AA surfaces. Results: The LiDi groups recorded higher mean bond strength than AA groups after thermocycling (p < 0.05). Thermocycling did not affect the bond strength of either LiDi or AA groups (p > 0.05). Most of specimens in AA groups exhibited mixed failure. Alumina air-abraded surfaces exhibited higher residual compressive stresses than did surfaces with a lithium-disilicate glass-ceramic coating. Conclusion: Following thermocycling, composite-zirconia bond strength of specimens with a lithium-disilicate glass-ceramic coating was greater than that of alumina air-abraded specimens. Keywords: zirconia, composite cement, shear bond strength, x-ray diffraction (XRD), scanning electron microscopy (SEM)