The effect of cavity disinfectants on the micro-shear bond strength of dentin adhesives.

OBJECTIVES: This study was carried out to examine the effect of application of four different disinfecting agents on the micro-shear bond strength (µ-SBS) of an etch-and-rinse and self-etch adhesive systems. MATERIALS AND METHODS: One hundred flat dentin surfaces of human molars were produced by wet grinding the buccal surfaces. Specimens were randomly assigned to five groups according to the disinfectant used: Group I: Control (no disinfectant); Group II: 5.25% sodium hypochlorite based; Group III: 2% chlorhexidine based (Consepsis), Group IV: 0.1% benzalkoniumchloride based (Tubulicid red) and Group V: 3% doxycycline based (Biopure, MTAD). Specimens were bonded using either Adper Single Bond 2 or Clearfil S(3) Bond, which were employed according to the manufacturer's instructions. Resin composite microcylinders were bonded using Tygon(®) tubes for µ-SBS testing. The modes of failure were noted after visual examination using a binocular stereomicroscope at ×25 magnification. Failures were classified as adhesive, or mixed. µ-SBS results were analyzed using two-way ANOVA followed by Tukey's post-hoc test. RESULTS: Dentin disinfectants tested significantly negated the bonding of Adper Single bond 2 and the groups were ranked; Group I > Group V = Group IV > Group II = Group III, meanwhile they enhanced significantly the µ-SBS values upon using Clearfil S(3) Bond and were ranked; Group II > Group III = Group IV = Group V > Group I. Most failures were adhesive with the Adper single bond adhesive system. Mixed modes of failure were evident with Clearfil S(3) bond. CONCLUSIONS: The disinfectants tested should not be used with Adper Single Bond 2 when applied before the etching step, However they could be used safely prior to bonding with Clearfil S(3) Bond.

Efficacy of microtensile versus microshear bond testing for evaluation of bond strength of dental adhesive systems to enamel.

OBJECTIVE: The aim of the study was to evaluate the efficacy of the microtensile bond test (microTBS) and the microshear bond test (microSBS) in ranking four dental adhesives according to bond strength to enamel and identify the modes of failure involved. MATERIALS AND METHODS: Forty-four caries-free human molars were randomly assigned to one of two bond strength testing methods: 20 teeth were used for microTBS test and 24 teeth for microSBS test. Flat enamel surfaces were created by wet grinding. Four adhesive systems were applied to the ground enamel surfaces; a two-step self-etch (Clearfil SE Bond, SEB), two all-in-one self-etch (Adper Prompt L-Pop, APL; Hybrid Bond, HB) and a two-step etch-and-rinse (Adper Single Bond, ASB). Resin composite (Z100) was applied over the adhesive. The microTBS and microSBS were determined after 24h of storage in water at 37 degrees C. The mode of failure was determined by light microscope and SEM. Data was analyzed with ANOVA, Tukey's and Chi-square tests. RESULTS: microTBS test ranked the adhesives as follows: SEB=ASB=APL>HB, while microSBS test ranked the adhesives as follows: ASB>SEB=APL>HB. The highest percentage failure mode with microTBS testing was cohesive in enamel or at the DEJ: SEB (95%), APL (65%) and ASB (65%). As for HB, adhesive failure (95%) was the common finding. The predominant failure mode in case of the microSBS was adhesive (APL 50%, SEB 58.3%, ASB 75% and HB 91.7%). SIGNIFICANCE: Ranking appears to be test-dependant and microSBS test appears to be more accurate in differentiating among the stronger adhesives.

Bond efficacy and interface morphology of self-etching adhesives to ground enamel.

PURPOSE: This study compared the microshear bond strengths to ground enamel of three one-step self-etching adhesive systems, a self-etching primer system and an etch-and-rinse adhesive system. MATERIALS AND METHODS: Three self-etching adhesives, Futurabond DC (Voco), Clearfil S Tri Bond (Kuraray) and Hybrid bond (Sun-Medical), a self-etching primer, Clearfil SE Bond (Kuraray), and an etch-and-rinse system, Admira Bond (Voco), were selected. Thirty human molars were used. The root of each tooth was removed and the crown was sectioned into halves. The convex enamel surfaces were reduced by polishing on silicone paper to prepare a flat surface. The bonding systems were applied on this surface. Prior to adhesive curing, a hollow cylinder (2.0 mm height/0.75 mm internal diameter) was placed on the treated surfaces. A resin composite was then inserted into the tube and cured. After water storage for 24 h, the tube was removed and shear bond strength was determined in a universal testing machine at a crosshead speed of 0.5 mm/min. The results were analyzed with ANOVA and the Tukey.-Kramer test at a 59 degrees confidence level. The enamel of five additional teeth was ground, and the etching component of each adhesive was applied and removed with absolute ethanol instead of being light cured. These teeth and selected fractured surfaces were examined by SEM. RESULTS: Adhesion to ground enamel of the Futurabond DC (25 +/- 3.5 MPa) and Clearfil SE Bond (23 +/- 2.9 MPa) self-etching systems was not significantly different from the etch-and-rinse system Admira Bond (27 +/- 2.3 MPa). The two self-etching adhesives Clearfil S Tri bond and Hybrid Bond demonstrated significantly lower bond strengths (14 +/- 1.4 MPa; 11 +/- 1.9 MPa) with no significant differences between them (p < 0.05). CONCLUSION: Bond strengths to ground enamel of self-etching adhesive systems are dependent on the type of adhesive system. Some of the new adhesive systems showed bond strength values comparable to that of etch-and-rinse systems. There was no correlation between bond strength and morphological changes in enamel.

Evaluation of proximal contact tightness of Class II resin composite restorations.

OBJECTIVE: The objective of the current study was to compare in-vitro the proximal contact tightness (PCT) of Class II resin composite restorations (RCR) placed with different established and new placement techniques. METHODS: 105 ivorine lower left first molars with standardized MO cavities were randomly divided into seven groups (n = 15) as follows: SRing: sectional matrix and separation ring (Garrison Dental); CRing: circumferential matrix (1101-c, KerrHawe SA) with separation ring; CWedge: circumferential matrix with a wedge only; COptra: circumferential matrix and OptraContact (Vivadent); CCerana: circumferential matrix and a Cerana insert (Nordiska Dental); CElliot: circumferential matrix and Elliot separator (PFINGST & Co) and Walser: Walser matrix O-type (Dr Walser Dental GmbH). In all the groups, the matrix band was secured using a wooden wedge except for the Walser group, following manufacturer's recommendations. A Tofflemire retainer (Kerr Corporation) was used to apply the circumferential matrix band whenever it was used. All the prepared teeth were restored with resin composite (Premise, Kerr) mounted in a manikin head to simulate the clinical environment. PCT was measured using the Tooth Pressure Meter (University of Technology, Delft). The data were analyzed using one-way ANOVA and Tukey post-hoc tests (p < 0.05). RESULTS: Compared to the control group (SRing) (6.64 +/- 1.06N), all other systems resulted in significantly lower PCT values (p < 0.001). Within the circumferential matrix groups, CRing (4.01 +/- 0.53N) and CElliot (4.29 +/- 1.08N) showed significantly tighter contacts compared to the CWedge (0.37 +/- 0.22N), COptra (0.91 +/- 0.49N), CCerana (2.99 +/- 1.98N) and Walser (1.34 +/- 0.55N) (p < 0.05) group. Between CWedge and COptra, no significant difference was found (p = 0.57). CONCLUSION: The use of separation rings with sectional matrices provides superior contacts when placing Class II RCRs.

Influence of thermal and mechanical load cycling on the microtensile bond strength of self-etching adhesives.

PURPOSE: To evaluate the influence of thermal and mechanical load cycling on the microtensile dentin bond strength of two self-etching and one total-etch adhesives. METHODS: The adhesive materials were: a two-step self-etch adhesive (Clearfil SE Bond), a one-step self-etch adhesive (Hybrid Bond), and a total-etch one-step adhesive (Admira Bond). Sixty freshly extracted human third molars were used. In each tooth, a Class I cavity (4 x 4 mm) was prepared in the occlusal surface with the pulpal floor extending about 1 mm into dentin. The teeth were divided into three groups (n=20). Each group was restored with the resin composite Clearfil APX using one of the adhesives. After restoration, 10 teeth in each group were thermocycled between 5 degrees C and 55 degrees C, (dwell time 3 minutes, 5,000 cycles). The same teeth were then mounted in a fatigue loading machine to receive an intermittent load of 125 N at 52 cycles/minute for 4,000 cycles. Subsequently, each tooth was sectioned longitudinally, bucco-lingually and mesio-distally to get rectangular slabs 1-1.2 mm in thickness for the microtensile test. Each slab was then placed in a universal testing machine and tensile load was applied at a cross-head speed of 0.05 mm/minute. RESULTS: Without loading procedures, there was no significant difference in the bond strength of the tested adhesives. In contrast to Admira Bond and Clearfil SE Bond, fatigue loading resulted in a significant reduction of the bond strength for Hybrid Bond when compared to the unloaded restorations.

Performance of five commercially available tooth color-measuring devices.

PURPOSE: Visual tooth color assessment is neither accurate nor precise due to various subjective and objective factors. As newly developed tooth color-measuring devices for dental application provide the possibility of a more objective means of color determination, their performances in vitro and in vivo must be evaluated. The objective of this study was to evaluate the accuracy and precision of five commercially available tooth color-measuring devices in standardized and in clinical environments. MATERIALS AND METHODS: In an in vitro study, standards (A1, A2, A3, A3.5, and A4 shade tabs of Vita Lumin) were measured five times with five electronic devices (ShadeScan, Easyshade, Ikam, IdentaColor II, and ShadeEye) by two operators. In an in vivo study, the right upper central incisors of 25 dental students were measured with the same electronic devices by a single operator. Vita shade tab codes were expressed as CIE (International Commission on Illumination) L*a*b* values and in terms of the precision and accuracy of DeltaE color differences. The Mann-Whitney statistical test was used to analyze the differences between the two operators in the in vitro study, and the Kruskal-Wallis one-way analysis of variance on ranks with the post-hoc Tukey test was used to analyze the accuracy and precision of electronic devices. RESULTS: No statistically significant difference was found between the different operators in the in vitro study. The obtained precision was Easyshade > ShadeScan approximately equal Ikam > IdentaColor II > ShadeEye. The obtained accuracy was Easyshade > ShadeScan approximately equal Ikam > ShadeEye > IdentaColor II. In the in vivo study, the Easyshade and the Ikam were the most precise, and the ShadeEye and the IdentaColor II were more precise than the ShadeScan. With respect to accuracy, there was no statistical difference between the ShadeScan, Ikam, and the Easyshade. The IdentaColor II was considered inaccurate (DeltaE(a)= 3.4). CONCLUSIONS: In the clinical setting, the Easyshade and Ikam systems were the most reliable. The other devices tested were more reliable in vitro than in vivo.

Contraction stress and bond strength to dentinfor compatible and incompatible combinations of bonding systems and chemical and light-cured core build-up resin composites.

OBJECTIVE: Recent studies have shown that adhesives containing acidic monomers combined with composites can adversely effect the polymerization reaction producing low bond strengths. This phenomenon may also occur in making composite build-ups, jeopardizing one of the key factors for a successful core build-up restoration. The aim of this study was to investigate the contraction stress development and bond strength to dentin of core build-up resin composites combined with adhesives of various acidities. In addition the hypothesis tested was that light irradiation through chemical-cured composites during curing does not influence contraction stress or bond strength to dentin. METHODS: The chemical-cured (Clearfil Core) and light-cured (Clearfil Photo Core) core build-up resin composites were combined with two light-cured adhesives, Clearfil SE Bond (pH=1.8) and One-Step Bond (pH=4.3) and two dual-cured adhesives, Clearfil Photo Bond (pH=2.5) and All-Bond 2 (pH=6.1). Contraction stress development (at C=3) was determined for a period of 30 min in a universal testing machine where the opposing bonding surfaces were glass and dentin. After the 30 min period, the specimens were loaded in tension to determine the bond strength to dentin. To test the hypothesis, the combinations of the chemical-cured composites with the four bonding systems were also light irradiated for 40s right at the start of curing. RESULTS: For all composite-adhesive combinations tested, the adhesion to dentin resisted the developing polymerization contraction stresses. Both, dentin as a substrate to bond at and the use of adhesives, were showed to play an important role in keeping the contraction stresses low. The chemical-cured composite (Clearfil Core) combined with the light-cured adhesive SE Bond (pH=1.8) showed for both contraction stress and bond strength significant lower values than the other combinations. The hypothesis was accepted for combinations of the chemical-cured composite with All-Bond 2 and One-Step Bond, but was not supported by combinations with Clearfil SE Bond or Clearfil Photo Bond, as a significant increase in contraction stress was found. The higher values found for bond strength were not significant. SIGNIFICANCE: Besides combinations of chemical-cured core build-up composites with light or dual-cured adhesives as recommended by the manufacturer, also combinations with adhesives of other manufacturers are compatible, provided that the pH is higher than approximately 4.3. Chemical-cured core build-up composites combined with light-cured adhesives with a pH as low as 1.8 lead to a significantly lower stress and bond strength compared to other combinations. Light irradiation during curing through a combination of a chemical-cured composite and a low pH adhesive reactivates polymerization.

Effect of conditioning time of self-etching primers on dentin bond strength of three adhesive resin cements.

OBJECTIVES: To evaluate the effect of increasing the dentin conditioning time with self-etching primers of different aggressiveness (pH) on the microtensile bond strength (muTBS) of three resin cements. MATERIALS AND METHODS: Pre-cured composite blocks were cemented with M-Bond, Bistite II DC, or Panavia F to flat occlusal dentin surfaces of human third molars, which were conditioned with M-Bond or Bistite II-primer for 30, 60 or 180 s or with Panavia-primer for 60 or 180 s. Each dentin-composite block assembly (four in each group) was longitudinally sectioned to obtain 1x1 mm microbars and tested for the muTBS. The morphology of the conditioned dentin surface and the hybrid layer was examined with SEM. RESULTS: Extending the primer conditioning time for Bistite II DC from 30 to 60 s significantly increased the muTBS (p<0.001) but did not further increase from 60 s to 180 s. For M-Bond there was only a significant increase from 30 to 180 s (p<0.05). For Panavia F the primer-conditioning time had no influence on the muTBS. SEM observations of conditioned dentin showed that the Bistite II DC and M-Bond self-etching primers with the lowest pH completely dissolved the dentin smear layer and plugs and formed well-defined hybrid layers. This was not found for Panavia F. SIGNIFICANCE: Dentin bond strength of resin cements using more aggressive self-etching primers is improved by increasing the conditioning time. To enable resin infiltration of highly filled resin cements, sufficient smear layer dissolution is necessary.

The effect of adhesives with various degrees of hydrophilicity on resin ceramic bond durability.

OBJECTIVES: To investigate the role of different acid surface-treatments and hydrophilic and hydrophobic bonding agents on resin ceramic bond durability. METHODS: Two resin cements, Tetric Flow and Nexus 2, were applied to CAD/CAM Cerec Vitablocs with six bonding strategies: (1) HF-etching and silanization, (2) HF-etching, silanization and application of a hydrophilic bonding agent, (3) HF-etching, silanization and application of a hydrophobic bonding agent, (4) H3PO4-treatment and silanization, (5) H3PO4-treatment, silanization and application of a hydrophilic bonding agent, and (6) H3PO4-treatment, silanization and application of a hydrophobic bonding agent. The hydrophilic agents were Syntac Single-Component and OptiBond Solo Plus. The hydrophobic agent was Visio Bond. After 1d water storage at 37 degrees C, 1 mm2 microbars were cut for the microtensile bond strength test (microTBS test). The microbars were subjected to a tensile load using a modified testing device immediately after trimming and after 7 and 28d water storage. The fractured specimens were examined with a stereomicroscope and scanning eslectron microscopy to determine the failure mode. RESULTS: HF-etching resulted in significantly higher microTBS than H3PO4-treatments (p < 0.001) The 1d microTBS with hydrophilic bonding agents was significantly higher than with the hydrophobic bonding agent (p < 0.001) but decreased with time after water storage ( p < 0.001) while bonds with the hydrophobic bonding agent remained stable. The percentages of adhesive failures after 1, 7, and 28d were 60, 86, and 94, respectively. SIGNIFICANCE: Bonding agents that contain hydrophilic monomers have a negative influence on the resin ceramic bond durability.

Microtensile bond strength testing of luting cements to prefabricated CAD/CAM ceramic and composite blocks.

OBJECTIVES: To investigate the Microtensile bond strength (microTBS) and failure mode of resin cements bonded to composite and ceramic CAD/CAM blocks following various surface treatments. METHODS: Paradigm composite blocks and Cerec Vitablocs received three surface treatments following the control treatment of surface grinding with 600 SiC grit. (1) Application of adhesive resin (Adh), (2) etching with hydrofluoric acid and silanization (HF+S) or (3) combination of the previous two treatments (HF+S+Adh). Three resin cements (Tetric Flow, Nexus 2, RelyX ARC) were applied to these surfaces and built-up in layers. After 24 h water storage at 37 degrees C, the non-trimming version of microTBS test was used to produce 1 mm(2) microbars. The Microbars were subjected to a tensile load using a modified testing device. The broken specimens were examined with a stereomicroscope and SEM to determine the failure mode. RESULTS: All control and adhesive treated groups of the ceramic substrate showed premature debonding during cutting. The overall mean microTBS for the three resin cements bonded to ceramic following HF+S and HF+S+Adh surface treatment, was 27 and 29.2 MPa and for the resin cements bonded to composite substrate was 42.3 and 54.2 MPa, respectively. The mode of failure was 98% adhesive with composite as a substrate and 68% mixed failures with ceramic as a substrate. CLINICAL SIGNIFICANCE: CAD/CAM restorations fabricated from processed composite blocks may have advantage over the ceramic blocks with regard to the higher bond strength with resin cements.

Porcelain-veneered computer-generated partial crowns.

OBJECTIVE: It would be advantageous to be able to use computer-aided design and manufacturing to fabricate a restoration that can be layered with a conventional porcelain veneer in the occlusal region, thus optimizing esthetics, function, and strength. This case study reports the laboratory technique and the clinical performance of 38 partial crowns fabricated with computer technology and veneered with porcelain. METHOD AND MATERIALS: Twenty-one mandibular and 17 maxillary molars in 27 patients were prepared for partial crowns. The occlusal surfaces were lowered (1.5 to 2.0 mm), deep shoulders (1.5 mm) were prepared around the functional cusps, and 1.0-mm-deep shoulders were prepared in the proximal gingival regions. The nonfunctional cusps were prepared with an occlusal shoulder at approximately a right angle with the axial surfaces of the seat. In the computer-aided design procedure, the occlusal table was reduced to 1.4 mm above the preparation surface. The marginal ridge points, the marginal ridge line, the equator line, and the fissure line heights were adjusted accordingly. RESULTS: The lowest occlusal table thickness was 1.1 mm in six partial crowns, 1.2 mm in 26 partial crowns, and 1.3 mm in six partial crowns. The lowest occlusal table thickness of the porcelain veneers varied between 0.4 and 0.6 mm. The total occlusal table thickness thus was 1.5 mm or more. Clinically, no fractures occurred during an observation period varying between 1 and 4 years after placement. CONCLUSION: Computer-aided design and manufacturing technology is also convenient for partial crown preparation design with shoulder finish lines.