Filler Mixed Into Adhesives Does Not Necessarily Improve Their Mechanical Properties.

OBJECTIVES: To investigate the influence of filler type/loading on the micro-tensile fracture strength (µTFS) of adhesive resins, as measured 'immediately' upon preparation and after 1-week water storage ('water-stored'). METHODS: The morphology and particle-size distribution of three filler particles, referred to as 'Glass-S' (Esschem Europe), 'BioUnion' (GC), and 'CPC_Mont', were correlatively characterized by SEM, TEM, and particle-size analysis. These filler particles were incorporated into an unfilled adhesive resin ('BZF-29unfilled', GC) in different concentrations to measure the 'immediate' µTFS. After 1-week water storage, the 'water-stored' µTFS of the experimental particle-filled adhesive resins with the most optimum filler loading, specific for each filler type, was measured. In addition, the immediate and water-stored µTFS of the adhesive resins of three experimental two-step universal adhesives based on the same resin matrix but varying for filler type/loading, coded as 'BZF-21' (containing silica and bioglass), 'BZF-29' (containing solely silica), and 'BZF-29_hv' (highly viscous with a higher silica loading than BZF-29), and of the adhesive resins of the gold-standard adhesives OptiBond FL ('Opti-FL', Kerr) and Clearfil SE Bond 2 ('C-SE2', Kuraray Noritake) was measured along with that of BZF-29unfilled (GC) serving as control/reference. Statistics involved one-way and two-way ANOVA followed by post-hoc multiple comparisons (α<0.05). RESULTS: Glass-S, BioUnion, and CPC_Mont represent irregular fillers with an average particle size of 8.5-9.9 µm. Adding filler to BZF-29unfilled decreased µTFS regardless of filler type/loading. One-week water storage reduced µTFS of all adhesive resins except BZF-21, with the largest reduction in µTFS recorded for BZF-29unfilled. Among the three filler types, the µTFS of the 30 wt% Glass-S and 20 wt% BioUnion filled adhesive resin was not significantly different from the µTFS of BZF-29unfilled upon water storage. CONCLUSIONS: Adding filler particles into adhesive resin did not enhance its micro-tensile fracture strength but appeared to render it less sensitive to water storage as compared to the unfilled adhesive resin investigated.

Influence of airborne particle abrasion on dentin bonding effectiveness of a 2-step universal adhesive.

OBJECTIVE: To determine the effect of airborne particle abrasion (APA) on micro-tensile bond strength (µTBS) to dentin using different air-abrasion/polishing powders. METHODS: The bonding effectiveness of G2 Bond Universal (G2B), used in etch-and-rinse (E&R) and self-etch mode (SE), was tested on bur-cut dentin and dentin air abraded/polished using six different powders (aluminum oxide 29 µm (AO29) and 53 µm (AO53), aluminum trihydroxide (AT), sodium bicarbonate (SB), sodium bicarbonate soft (SBsoft) and bioactive glass (BG); Velopex). Adhesive-composite resin specimens were immersed in distilled water at 37 °C for one week and cut into microspecimens. Half of the specimens were subjected to 50,000 thermocycles (aged). Immediate and aged µTBS to dentin were measured. Statistical analysis was performed using linear mixed-effects (LME) modeling (p < 0.05). RESULTS: Comparing the aged bond strengths to air-abraded/polished dentin with bur-cut dentin, pretreatment with SB and SBsoft in combination with G2B used in E&R mode, and BG air polishing in combination with both application modes (E&R, SE), resulted in a significantly higher bond strength. Dentin bond strength was only significantly lower when air abraded with AO29 and using G2B in SE mode. Aging did not significantly influence bond strength for both application modes (E&R, SE), except for AO29 and AT-treated dentin, where bond strengths decrea sed significantly using G2B in SE mode. In general, G2B reached significantly higher bond strengths on air-abraded/polished dentin in E&R mode than in SE mode. CONCLUSION: Air-abrasion/polishing did not impair dentin bond strength using G2B, except when dentin was air abraded with AO29 and using G2B in SE mode. Air polishing positively influenced the bond strength to dentin in specific groups. CLINICAL SIGNIFICANCE: APA is safe concerning bonding to dentin. The E&R application mode is preferred using G2B as adhesive on air-abraded/polished dentin. Air polishing with BG positively influenced dentin bond strength for both application methods.

Bonding performance of experimental HEMA-free two-step universal adhesives to low C-factor flat dentin.

OBJECTIVES: Experimental two-step universal adhesives (2-UAs) providing a particle-filled hydrophobic adhesive resin with a significant film thickness to hydrophobically seal the adhesive interface were designed and synthesized. This study aimed to characterize their interfacial interaction with dentin, to determine whether the 2-UA formulations achieve durable bonding to low C-factor flat dentin and to measure their water sorption. METHODS: Bonding effectiveness of 2-UAs that combine a 10-MDP-based primer with hydrophobic adhesive resins differing only for filler (BZF-21, BZF-29, and BZF-29_hv) were comparatively investigated with the commercial adhesive Clearfil SE Bond 2 (C-SE2, Kuraray Noritake). Adhesive-dentin interfaces were characterized with TEM. Adhesive-resin disks were immersed in distilled water at 37 °C for 1 week, 6 months and 1 year to measure water sorption and solubility. 'Immediate' and 'aged' micro-tensile bond strength (µTBS) of the adhesives applied in etch-and-rinse (E&R) and self-etch (SE) bonding mode to low C-factor flat dentin were measured. Statistical analyses involved linear mixed-effects (LME) modelling and Kruskal-Wallis testing (p < 0.05). RESULTS: TEM revealed that E&R hybrid layers were more sensitive to aging than SE hybrid layers. Lower water sorption was recorded for all UAs compared with C-SE2. The immediate µTBS of BZF-21 and BZF-29 was not significantly different from that of C-SE2. The 1-year aged µTBS of all 2-UAs was significantly lower than that of C-SE2, except for BZF-29 applied in E&R mode. A significant reduction in µTBS upon 1-year aging was recorded for BZF-21 and BZF-29 applied in E&R mode. A significant difference in µTBS between E&R and SE bonding modes was recorded for all adhesives except BZF-21. SIGNIFICANCE: Experimental 2-UAs with a hydrophobic adhesive-resin design produced± 20-µm thick adhesive-resin layers, absorbed less water and resulted in bonding performance that was more aging-resistant when applied in SE than in E&R bonding mode. The silica-filled BZF-29 2-UA revealed the most comparable bonding performance with C-SE2 in a low C-factor condition (flat dentin).

Multiparameter evaluation of acrylamide HEMA alternative monomers in 2-step adhesives.

OBJECTIVE: As frequently added to adhesives, the mono-functional monomer 2-hydroxyethyl methacrylate (HEMA) acts as co-solvent and improves surface wetting. Nevertheless, HEMA promotes watersorption and hydrolysis at adhesive interfaces, affecting bond durability to dentin. This study investigated if two acrylamide co-monomer alternatives could replace HEMA in experimental adhesive-resin formulations as part of 3/2-step universal adhesives applied, respectively, in etch-and-rinse (E&R) and self-etch (SE) bonding modes. METHODS: Upon priming dentin with the 10-MDP-based Clearfil SE Bond 2' primer ('C-SE2p'; Kuraray Noritake), three experimental adhesive resins, consisting of 50 wt.% Bis-GMA, 15 wt.% TEGDMA, and either 35 wt.% diethyl acrylamide ('DEAA'), hydroxyethyl acrylamide ('HEAA') or HEMA ('HEMA+'), were applied. The control HEMA-free adhesive resin contained 60 wt.% Bis-GMA and 40 wt.% TEGDMA ('HEMA-'). All adhesives were evaluated for 'immediate' and 'aged' micro-tensile bond strength (µTBS) to dentin upon, respectively, 1-week (1w) and 6-month (6m) water storage, TEM adhesive-dentin interfacial interaction, 24-h and 6m three-point bending, contact-angle wetting, viscosity and watersorption. RESULTS: Linear mixed-effects model statistics revealed significantly better bonding performance of the adhesives applied in E&R than SE mode, except for DEAA_1w, with the highest µTBSs recorded for DEAA and HEMA- applied in SE mode. In E&R mode, aging did not significantly reduce DEAA's µTBS. Best wetting on primed dentin was recorded for HEMA+, significantly better than DEAA, further HEAA and HEMA-, these directly related to their viscosity. HEAA absorbed significantly more water than all other adhesive-resin formulations. HEMA->DEAA>HEAA>HEMA+ was the significant order for 6m bending strength. CONCLUSIONS: The acrylamide co-monomer DEAA could replace HEMA, while HEAA not.

Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions.

OBJECTIVE: The objective of this randomized controlled clinical trial was to evaluate the 13-year clinical performance of a mild two-step self-etch adhesive in non-carious cervical lesions with and without prior selective phosphoric acid-etching of the enamel cavity margins. METHODS: A total of 100 non-carious cervical lesions in 29 patients were restored with Clearfil AP-X (Kuraray Noritake). The composite restorations were bonded following two different approaches: (1) application of Clearfil SE Bond (Kuraray Noritake) following a self-etch approach (CSE-NE); (2) selective phosphoric acid-etching of enamel cavity margins before application of Clearfil SE Bond (CSE-E). The restorations were evaluated after 6 months, 1, 2, 3, 5, 8 and 13 years of clinical service regarding retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality and post-operative sensitivity. RESULTS: The patient recall rate at 13 years was 62%. Six restorations, 4 of the CSE-NE group and 2 of the CSE-E group, were clinically unacceptable due to loss of retention (1 CSE-NE, 1 CSE-E), a severe marginal defect (2 CSE-NE, 1 CSE-E) and caries occurrence in combination with a severe marginal defect (1 CSE-NE) leading to a clinical success rate of 86% (CSE-NE) and 93% (CSE-E). Ageing of the restorations was characterized by a further increase in the percentage of restorations with a clinically acceptable small marginal defect (CSE-NE: 87%; CSE-E: 83%) and/or superficial marginal discoloration (CSE-NE: 53%; CSE-E: 56%). The presence of small marginal defects (CSE-NE: 86%; CSE-E: 68%) and superficial marginal discoloration (CSE-NE: 41%; CSE-E: 20%) at the incisal enamel side was more frequently noticed in the CSE-NE group than in the CSE-E group. The difference, however, was not statistically significant (McNemar, p>0.05). SIGNIFICANCE: After 13 years, the clinical effectiveness of Clearfil SE Bond in non-carious Class-V lesions remained excellent, with selective acid-etching of the enamel cavity margins only having some minor positive effect on marginal integrity and absence of marginal discoloration.

Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions (NCCLs) in terms of restoration retention as a function of time. METHODS: Medline Ovid and IADR abstracts were reviewed for NCCLs clinical trials from 1950 to 2013. The reference list of all eligible trials and relevant review articles was checked to find additional studies. The review did not have any language restrictions. Only randomized controlled clinical trials that evaluated at least two adhesives for a follow-up period of at least 18 months were included. Materials with adhesive potential were categorized into 6 main classes: 3-step etch&rinse adhesives (3E&Ra's), 2-step etch&rinse adhesives (2E&Ra's), 2-step self-etch adhesives (2SEa's), 1-step self-etch adhesives (1SEa's), glass-ionomers (GI's) and self-adhesive composites (SAC's). The first four can bond restorative composite to tooth tissue. Both 2SEa and 1SEa were further sub-divided in 'mild' and 'intermediately strong (1/2SEa_m), with a pH≥1.5, and 'strong' (1/2SEa_s), with a pH<1.5. From the restoration retention rates as a function of time the average annual failure rate (AFR) per adhesive and adhesive class was calculated. RESULTS: The lowest AFR scores [mean (SD)] were recorded for GI [2.0 (1.4)] shortly followed by 2SEa_m [2.5 (1.5)], 3E&Ra [3.1 (2)] and 1SEa_m [3.6 (4.3)] (Tukey Contrasts: p>0.05). Significantly higher AFR scores were recorded for 1SEa_s [5.4 (4.8)], 2E&R [5.8 (4.9)], and 2SEa_s [8.4 (7.9)] (p>0.05). In addition, significant differences in AFR were noticed between adhesives of the same class (Kruskal-Wallis sum test: p>0.05), except for GI (p=0.7) and 2SEa_m (p=0.1). Finally, selective enamel etching did not significantly influence the retention rate of SEa (AFR SEa_etch=0.43 (0.49), AFR SEa_non-etch=1.43 (1.77). SIGNIFICANCE: The adhesive approach significantly influences the clinical effectiveness of adhesives in NCCLs. Within each class, except for GI, there was a wide variation in clinical bonding effectiveness.

Nanoparticle release from dental composites.

Dental composites typically contain high amounts (up to 60 vol.%) of nanosized filler particles. There is a current concern that dental personnel (and patients) may inhale nanosized dust particles (<100 nm) during abrasive procedures to shape, finish or remove restorations but, so far, whether airborne nanoparticles are released has never been investigated. In this study, composite dust was analyzed in real work conditions. Exposure measurements of dust in a dental clinic revealed high peak concentrations of nanoparticles in the breathing zone of both dentist and patient, especially during aesthetic treatments or treatments of worn teeth with composite build-ups. Further laboratory assessment confirmed that all tested composites released very high concentrations of airborne particles in the nanorange (>10(6)cm(-3)). The median diameter of airborne composite dust varied between 38 and 70 nm. Electron microscopic and energy dispersive X-ray analysis confirmed that the airborne particles originated from the composite, and revealed that the dust particles consisted of filler particles or resin or both. Though composite dust exhibited no significant oxidative reactivity, more toxicological research is needed. To conclude, on manipulation with the bur, dental composites release high concentrations of nanoparticles that may enter deeply into the lungs.

3-year clinical effectiveness of one-step adhesives in non-carious cervical lesions.

OBJECTIVES: Despite representing an important component of current dental adhesives, HEMA has been said to negatively influence the long-term stability of adhesion to dentine and enamel. The aim of this randomised clinical trial was to evaluate the 3-year clinical performance of two one-step self-etch adhesives. METHODS: Thirty patients had 175 non-carious cervical lesions restored with composite (Gradia Direct Anterior, GC) using either the HEMA-rich adhesive Clearfil Tri-S Bond (C3S; Kuraray) or the HEMA-free adhesive G-Bond (GB; GC). The restorations were evaluated by two examiners at baseline, 6, 12, 24 and 36 months regarding retention, caries recurrence, marginal integrity and discoloration and post-operative sensitivity. The data were statistically analysed with GEE and McNemar tests (p<0.05). RESULTS: The recall rate at 6 and 12 months was 100% and decreased to 96.7% at 24 and 36 months. At 3 years, the retention rate was 93.8% for C3S and 98.8% for GB (p=0.14). A pairwise comparison showed no significant differences between the two adhesives for all the parameters evaluated, irrespective of the recall (p>0.05). After 3 years, both adhesives presented an increase in the percentage of clinically acceptable marginal discoloration (C3S: 32.9% and GB: 26.8%) normally associated to clinically acceptable marginal defects (C3S: 35.8% and GB: 26.5%). Only 1 dentine margin of a GB restoration presented a severe marginal defect (1.2%) and 1 C3S restoration presented caries recurrence. The overall 3-year clinical success rate was 92.6% for C3S and 97.6% for GB (p=0.16). CONCLUSION: Both one-step self-etch adhesives presented an equally favourable clinical effectiveness at 3 years. CLINICAL SIGNIFICANCE: HEMA is a monomer frequently present in dental adhesives in order to increase their wettability and hydrophilicity. However, this monomer negatively influences hydrolytic stability and durability of the adhesive interface complex. In this 3-year clinical trial no significant difference in bonding effectiveness was noticed between a HEMA-rich and HEMA-free one-step adhesive.

Meta-analytical review of parameters involved in dentin bonding.

Bond-strength testing is the method most used for the assessment of bonding effectiveness to enamel and dentin. We aimed to disclose general trends in adhesive performance by collecting dentin bond-strength data systematically. The PubMed and EMBASE databases were used to identify 2,157 bond-strength tests in 298 papers. Most used was the micro-tensile test, which appeared to have a larger discriminative power than the traditional macro-shear test. Because of the huge variability in dentin bond-strength data and the high number of co-variables, a neural network statistical model was constructed. Variables like 'research group' and 'adhesive brand' appeared most determining. Weighted means derived from this analysis confirmed the high sensitivity of current adhesive approaches (especially of all-in-one adhesives) to long-term water-storage and substrate variability.

Eight-year clinical evaluation of a 2-step self-etch adhesive with and without selective enamel etching.

OBJECTIVES: The objective of this randomized controlled clinical trial was to evaluate the 8-year clinical performance of a mild 2-step self-etch adhesive in non-carious Class-V lesions with and without prior selective phosphoric acid-etching of the enamel cavity margins. METHODS: A total of 100 non-carious Class-V lesions in 29 patients were restored with Clearfil AP-X (Kuraray). The composite restorations were bonded following two different approaches: (1) application of Clearfil SE (Kuraray) following a self-etch approach (control group; C-SE non-etch), (2) selective phosphoric acid-etching of the enamel cavity margins before application of Clearfil SE (experimental group; C-SE etch). The restorations were evaluated after 6 months, 1, 2, 3, 5 and 8 years of clinical service regarding their retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality and post-operative sensitivity. RESULTS: The recall rate at 8 years was 76%. Only two restorations, one of the C-SE non-etch group and one of the C-SE etch group, were clinically unacceptable due to loss of retention leading to a retention rate and a clinical success rate of 97% in both groups. Aging of the restorations was characterized by an increase in the percentage of restorations with a small but clinically acceptable marginal defect (C-SE non-etch: 92%; C-SE etch: 84%) and/or a superficial marginal discoloration (C-SE non-etch: 44%; C-SE etch: 28%). At the enamel side, the presence of small marginal defects (C-SE non-etch: 86%; C-SE etch: 65%) and superficial marginal discoloration (C-SE non-etch: 11%; C-SE etch%) was more frequently noticed in the control group than in the experimental group. The difference, however, was only statistically significant for the presence of superficial marginal discoloration (McNemar, p=0.01). SIGNIFICANCE: After 8 years of clinical functioning, the clinical effectiveness of Clearfil SE remained excellent, with selective acid-etching of the enamel cavity margins only having some minor positive effect on marginal integrity and absence of marginal discoloration at enamel.

Filler debonding & subhybrid-layer failures in self-etch adhesives.

The mechanisms behind bond degradation are still largely unknown, in particular with respect to self-etch adhesives. One-step adhesives have been especially documented with problems, such as insufficient polymerization, water-uptake and subsequent plasticization, water- and enzyme-induced nanoleakage, and/or the presence of voids due to phase-separation or osmosis. It was hypothesized that these shortcomings may weaken the adhesive layer and, as such, may jeopardize long-term bonding. In contrast to the control three-step etch & rinse adhesive, the bond strength to dentin of both one-step and two-step self-etch adhesives decreased after six-month water storage. TEM revealed not only that they exhibited filler de-bonding within the adhesive resin layer, due to hydrolysis of the filler-matrix coupling, but also that they failed predominantly directly under the hybrid layer at dentin, in spite of the presence of interfacial droplets and nanoleakage in the adhesive layer. These failures just under the hybrid layer may be attributed to insufficient encapsulation of surface smear.

Relationship between bond-strength tests and clinical outcomes.

One often alleges that laboratory bond-strength testing cannot predict clinical effectiveness of adhesives. Major argument to sustain this claim is the wide variation in bond-strength values recorded for one specific adhesive among different research institutes worldwide. The main reason for these inconsistent bond-strength measurements is supposedly the current lack of a standard bond-strength testing protocol. This paper (and presentation) aimed to report on an extensive literature review with regard to the different laboratory bond-strength test methods and their data provided, along with a second extensive literature review on clinical effectiveness data of adhesives in terms of retention rates of adhesive Class-V restorations. Combining both systematic reviews, we have subsequently searched for a potential relationship between bond-strength data and clinical outcomes.

Bonding effectiveness and interfacial characterization of a nano-filled resin-modified glass-ionomer.

UNLABELLED: Glass-ionomers (GIs) exhibit excellent clinical bonding effectiveness, but still have shortcomings such as polishability and general aesthetics. The aims of this study were (1) to determine the micro-tensile bond strength (microTBS) to enamel and dentin of a nano-filled resin-modified GI (nano-RMGI; Ketac N100, 3M-ESPE), and (2) to characterize its interfacial interaction with enamel and dentin using transmission electron microscopy (TEM). METHODS: The nano-RMGI was used both with and without its primer, while a conventional RMGI restorative material (conv-RMGI; Fuji II LC, GC) and a packable conventional GI cement (conv-GI; Fuji IX GP, GC) were used as controls. After bonding to freshly extracted human third molars, microspecimens of the interfaces were machined into a cylindrical hourglass shape and tested to failure in tension. Non-demineralized TEM sections were prepared and examined from additional teeth. RESULTS: The microTBS to both enamel and dentin of nano-RMGI and conv-GI were not statistically different; the microTBS of non-primed nano-RMGI was significantly lower, while that of conv-RMGI was significantly higher than that of all other groups. TEM of nano-RMGI disclosed a tight interface at enamel and dentin without surface demineralization and hybrid-layer formation. A thin filler-free zone (<1 microm) was formed at dentin. A high filler loading and effective filler distribution were also evident, with localized areas exhibiting nano-filler clustering. CONCLUSIONS: The nano-RMGI bonded as effectively to enamel and dentin as conv-GI, but bonded less effectively than conv-RMGI. Its bonding mechanism should be attributed to micro-mechanical interlocking provided by the surface roughness, most likely combined with chemical interaction through its acrylic/itaconic acid copolymers.

A randomized controlled clinical trial of a HEMA-free all-in-one adhesive in non-carious cervical lesions at 1 year.

OBJECTIVES: One-step self-etch adhesives are the most recent generation of adhesives introduced onto the market. The objective of this randomized controlled clinical trial was to test the hypothesis that a one-step self-etch adhesive performs equally well as a conventional three-step etch&rinse adhesive (gold standard). METHODS: Fifty-two patients had 267 non-carious cervical lesions restored with Gradia Direct Anterior (GC). These composite restorations were bonded either with the 'all-in-one' adhesive G-Bond (GC) or with the three-step etch&rinse adhesive Optibond FL (Kerr). The restorations were evaluated after 6 and 12 months clinical service regarding their retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality and post-operative sensitivity. Retention loss, severe marginal defects and/or discoloration that needed intervention (repair or replacement) and the occurrence of caries were considered as clinical failures. A logistic regression analysis with generalized estimating equations was used to account for the clustered data (multiple restorations per patient). RESULTS: The recall rate at 1 year was 98%. The statistical analysis revealed a relatively low patient factor, indicating that supplementary information could be obtained from the additional restorations placed per patient. The retention rate for G-Bond was 98.5% compared to 99.3% for Optibond FL, due to the retention loss of two and one restorations, respectively. There were no significant differences between the two adhesives regarding the evaluated parameters except for the presence of small enamel marginal defects with G-Bond. CONCLUSIONS: After 12 months, the simplified one-step G-Bond and the three-step Optibond FL were clinically equally successful, even though both adhesives were characterized by progressive degradation of marginal adaptation, and G-Bond exhibited more small enamel marginal defects.

The role of HEMA in one-step self-etch adhesives.

UNLABELLED: In spite of its high allergenic potential, 2-hydroxyethyl methacrylate (HEMA), a low-molecular-weight monomer, is frequently used in adhesives for its positive influence on the bond strength. In addition, the presence of HEMA in one-component one-step adhesives can prevent phase separation. OBJECTIVES: In search of improved bonding effectiveness, the 24-h bond strength of four experimental one-step self-etch adhesives with different concentrations of HEMA to bur-cut enamel and dentin was determined using a micro-tensile bond strength protocol. METHODS: The tested experimental adhesives (Exp-0, Exp-10, Exp-19 and Exp-36) only differed in their concentration of HEMA, which was 0, 10, 19 and 36%, respectively. With an increasing concentration of HEMA, the concentration of acetone was decreased. Besides bond strength, the adhesives were also examined by light-microscopy for phase separation. The interface was investigated by SEM and TEM. RESULTS: Regarding bond strength, Exp-10 performed best. Even though Exp-36 was the only adhesive formulation that did not exhibit phase separation on a glass plate, it yielded the lowest bond strength. Accordingly, droplets could be observed by SEM and TEM in the adhesive layers of all adhesives, except for Exp-36 on enamel. CONCLUSION: A small amount of HEMA (10%) improved the bond strength of a one-step self-etch adhesive. When added in higher concentrations, this beneficial effect of HEMA on the bond strength is lost due to increased osmosis, which resulted in many droplets; due to reduced polymerization conversion; and sub-optimal physico-mechanical properties of the resultant poly-HEMA containing adhesive interface.

Technique sensitivity of water-free one-step adhesives.

OBJECTIVES: All-in-one adhesives have been associated with water-related problems, such as phase-separation, polymerization-inhibition and reduced shelf life. In this study we investigated whether these problems could be avoided by a water-free self-etch adhesive that requires a 'wet-bonding' application procedure. Additionally, the technique-sensitivity of such a system was evaluated. METHODS: The micro-tensile bond strength (muTBS) of a water-free and a water-containing experimental one-step adhesive (EXP) bonded to either 'air-dried', 'blot-dried' or 'overwet' bur-cut enamel and dentin was determined. Likewise, the muTBS of a commercial water-free adhesive Absolute2 (Denstply-Sankin) was determined. The interfacial interaction of the adhesives was evaluated by SEM and TEM. RESULTS: In the blot-dried group, both water-free adhesives obtained the highest bond strength and the bond strength of the water-free EXP was comparable to that of the water-containing EXP bonded to an air-dried surface. When they were applied to overwet surfaces, the water-free adhesives tended towards a lower bond strength. This was partly attributed to the presence of phase-separation (or 'overwet') droplets in the adhesive layer. Unexpectedly, even on air-dried dentin, the water-free adhesives were able to demineralize dentin, however to a limited extent, hence impairing the bond strength. SIGNIFICANCE: Water-free one-step adhesives are a valuable alternative for conventional water-containing one-step adhesives. However, water-related problems in these adhesives are not ruled out, as they are eventually also mixed with water during the application procedure. As such, they partially fail to meet their objective. In addition, their bonding procedure, which involves 'wet bonding', is more technique-sensitive than dry bonding.

Bond durability of composite luting agents to ceramic when exposed to long-term thermocycling.

PURPOSE: This study evaluated the effect of thermocycling on the microtensile bond strength of four adhesive luting agents to GN-I CAD-CAM ceramic. The hypothesis tested was that thermocycling did not affect bonding effectiveness, irrespective of the luting agents used. MATERIALS AND METHODS: Ceramic specimens of two different sizes (6x8x3 mm; 13x8x4 nm) were fabricated from GN-I CAD-CAM ceramic blocks (GC) using a low-speed diamond saw. Two different sized porcelain discs were bonded with one of the four composite luting agents (Linkmax [LM], Panavia [PN], RelyX Unicem [UN] and Variolink II [VL]) according to the manufacturer's instructions. The specimens were stored for 24 hours in distilled water at 37 degrees C and subjected to 0; 10,000; 20,000 and 40,000 thermocycles prior to microTBS testing. Two-way analysis of variance was used to test the influence of luting cement, thermocycling and interaction between both (p < 0.05). The Tukey HSD test determined statistical differences in microTBS for each luting composite between the different thermocycling conditions (p < 0.05). The mode of failure was determined at a magnification of 50x using a stereomicroscope (Wild M5A). RESULTS: Two-way ANOVA revealed that microtensile bond strength was affected by the luting cement, thermocycling and a combination of both. No difference in bond strength between Linkmax, Panavia F and Variolink II was noticed after 24 hours of water storage (LM: 47.6 MPa; PN: 41 MPa; VL: 36 MPa). RelyX Unicem scored significantly lower than Linkmax and Panavia F (UN: 24.2 MPa). The influence of thermocycling on bond strength was different for the four luting cements. Using Variolink II, the bond strength remained stable after 40,000 thermocycles (43.6 MPa). Linkmax showed a significant decrease in bond strength after 10,000 (26 MPa) and 40,000 thermocycles (14.8 MPa). Panavia F and RelyX Unicem were the most negatively influenced, as all specimens failed prior to testing (pre-testing failures) when the specimens were thermocycled 10,000 and 20,000 times or longer, respectively. Regarding the failure mode, there was a correlation between bond strength and type of failure. Initially, a combination of adhesive and mixed adhesive-cohesive failures was noticed. The percentage of adhesive failures increased, together with a decrease in bond strength. CONCLUSION: It was concluded that there were significant differences among the four resin composite cements in terms of their bonding effectiveness to CAD-CAM ceramic after thermocycling. The varying degrees of bonding effectiveness of these adhesive luting agents highlight the need for material specifications.

Restoring cervical lesions with flexible composites.

OBJECTIVES: Flexure at the tooth cervix has been suggested to dislodge cervical restorations more rapidly. The objective of this randomized controlled clinical trial was to test the hypothesis that a higher composite flexibility better withstands tooth flexure stress. METHODS: One hundred and forty-two non-carious cervical lesions were restored with composites with contrasting stiffness. Seventy-one patients randomly received two cervical restorations placed following two out of the three experimental groups: (1) the three-step etch-and-rinse adhesive Permaquick applied with the stiff micro-hybrid composite Amelogen Hybrid (PMQ/A-Hy, Ultradent), (2) Permaquick applied with the more flexible micro-filled composite Amelogen Microfill (PMQ/A-Mi, Ultradent), or (3) the 'golden standard' three-step etch-and-rinse adhesive Optibond FL applied with the micro-hybrid composite Prodigy (O-FL/Pro, Kerr). RESULTS: The recall rate at 7 years was 80%. No statistically significant difference was found for any of the parameters evaluated neither between both adhesives, nor between both composites (McNemar, p>0.05). Eleven percent of the O-FL/Pro restorations were clinically unacceptable due to loss of retention (5.5%) and severe marginal discoloration (5.5%). In the PMQ-group, 22% of the PMQ/A-Mi restorations (8% loss of retention, 5% severe enamel margin defects, 3% severe dentin margin defects, 6% severe marginal discoloration, 3% extreme sensitivity) and 19% of the PMQ/A-Hy restorations (13% loss of retention, 3% severe enamel margin defects, 3% severe marginal discoloration) needed repair or replacement. SIGNIFICANCE: The clinical performance of the three adhesive/composite combinations was good and reliable during the 7-year clinical trial. It was concluded that the composite stiffness does not affect the clinical longevity of cervical composite restorations.

Effects of ceramic surface treatments on the bond strength of an adhesive luting agent to CAD-CAM ceramic.

OBJECTIVES: The objective of this study was to evaluate the effect of different surface treatments on the micro-tensile bond strength (microTBS) of an adhesive luting agent to CAD-CAM ceramic. The hypothesis tested was that neither of the surface treatments would produce higher bond strength of the adhesive luting agent to CAD-CAM ceramic. METHODS: Ceramic specimens of two different sizes (6 mm x 8 mm x 3 mm; 13 mm x 8 mm x 4 mm) were fabricated from ProCAD ceramic blocs (Ivoclar-Vivadent) with a low-speed diamond saw. The ceramic blocks were divided into seven groups and submitted to the following surface treatments: group 1: no treatment; group 2: etching with 37% H(3)PO(4); group 3: etching with 37% H(3)PO(4)+silane; group 4: etching with 37% H(3)PO(4)+silane+adhesive resin; group 5: etching with 4.9% HF acid; group 6: etching with 4.9% HF acid+silane; group 7: etching with HF acid+silane+adhesive resin. After surface treatment, two differently sized porcelain disks were bonded together with a composite luting agent (Variolink II, Ivoclar-Vivadent). The specimens were stored for 24h in distilled water at 37 degrees C prior to microTBS testing. One-way analysis of variance was used to test the influence of surface treatment and Scheffe multiple comparisons test determined pair-wise statistical differences (p<0.05) in microTBS between the experimental groups. RESULTS: The mean microTBSs (standard deviation) are: group 1: 12.8 (+/-4.6)MPa; group 2: 19.1 (+/-5.0)MPa; group 3: 27.4 (+/-11.1)MPa; group 4: 34.0 (+/-8.9)MPa; group 5: 37.6 (+/-8.4) MPa; group 6: 34.6 (+/-12.8)MPa; group 7: 34.5 (+/-5.1)MPa. Statistical significant differences were found between group 1 and groups 3-7, and between group 2 and groups 4-7. All specimens of groups 1-4 exhibited adhesive failures, while a combination of adhesive and mixed (adhesive and cohesive) failures was observed in the specimens of groups 5-7. CONCLUSIONS: The results show that surface treatment is important to bond to ceramic and suggests that etching is needed preferably with hydrofluoric acid than with phosphoric acid.