Clinical effectiveness of direct resin composite restorations bonded using one-step or two-step self-etch adhesive systems: A three-year multicenter study.

The purpose of this multicenter clinical study was to compare the mid-term clinical effectiveness of direct resin composite restorations using one-step or two-step self-etch adhesives (1-SEAs or 2-SEAs). In total, 352 restorations of class I-V cavities and non-carious cervical lesions in vital teeth (1-SEAs; 52 cases, 2-SEAs; 300 cases) were placed at nine university hospitals and evaluated according to the modified USPHS criteria at baseline, and after 1, 2, and 3 years. The recall rates were 86.6% (1 year), 80.1% (2 years), and 62.2% (3 years). Two restorations failed due to fracture during the follow-up, and there was no significant difference in survival rates between 1-SEAs (97.6%) and 2-SEAs (99.4%). However, 2-SEAs exhibited significantly lower occurrences of discoloration, marginal discoloration, fracture, and plaque retention. Moreover, the subjects reported a significantly lower postoperative hypersensitivity and higher overall satisfaction at all evaluation periods if 2-SEAs were used.

Microtensile bond strength of self-adhesive luting cements to ceramics.

The purpose of this paper was to compare the bond strengths of the self-adhesive luting cements between ceramics and resin cores and examine their relation to the cement thickness. Three self-adhesive luting cements (Smartcem, Maxcem, and G-CEM) and a resin cement (Panavia F 2.0) for control were used in the paper. The thickness of the cements was controlled in approximately 25, 50, 100, or 200 µm. Each 10 specimens were made according to the manufacturers' instructions and stored in water at 37°C. After 24 hours, microtensile bond strength (µTBS) was measured. There were significant differences in cements. Three self-adhesive cements showed significantly lower µTBSs than control that required both etching and priming before cementation (Tukey, P < 0.05). The cement thickness of 50 or 100 µm tended to induce the highest µTBSs for each self-adhesive luting cements though no difference was found.

Clinical survey of cervical tooth lesions in first-appointment patients.

OBJECTIVE: To investigate the relationship between cervical lesions and patient age, brushing method and bruxism based on a clinical survey of first-appointment patients. METHODS: Two hundred and nine patients (118 male, 91 female) who had unfilled cervical lesions were examined. Information on patient age, teeth with lesions, classification of the lesions, brushing method and bruxism was obtained. The data were analysed statistically. RESULTS: Cervical lesions started to develop in the first premolar teeth in the early twenties and became more prevalent with age. A habit of bruxism was associated with an increase in cervical lesions. Brushing was not directly associated with the development of cervical lesions. CONCLUSION: This study suggests that cervical lesions should be treated at an early stage to prevent further problems.

Clinical evaluation and interfacial morphology observation of Xeno III self-etching resin bonding and restorative system.

This study was a clinical trial of a one-step, total priming and bonding system, Xeno III. Thirty restorations were placed in minimally invasive V-shaped, Class V cervical cavities. Immediately after placement, baseline records were made after restorations were assessed using modified Ryge/USPHS criteria. Subsequently, restorations were evaluated at recall intervals up to 18 months. Additionally, the measurement of tensile bond strength and the FE-SEM observation of resin-tooth interface were performed in vitro. At 18 months, all restorations were classified as clinically satisfactory and assigned with an Alpha rating. Tensile bond strength of Xeno III was not significantly different from that of Clearfil SE Bond. Resin-enamel/dentin interface was very tight, with the presence of a very thin hybrid layer at the superficial dentin. Based on the results obtained, the Xeno III resin bonding system seemed promising as a one-step, self-etch adhesive.

Short- and long-term in vitro study of the bonding of eight commercial adhesives to normal and deproteinized dentin.

OBJECTIVE: The aims of this study were to investigate the influence of deproteinization of dentin on the shear bond strength (SBS) mediated by eight dentin adhesives, and to evaluate the long-term durability of the SBSs. The hypotheses were that deproteinization of dentin would not affect the capacity for adherence, and that in contrast to the SBSs to collagen-rich surfaces, the SBSs to deproteinized surfaces would be stable during a 1-year period of storage in water. MATERIAL AND METHODS: Ground surfaces of human dentin were either rinsed with water (normal dentin) or treated with sodium hypochlorite (deproteinized dentin). The dentin surfaces were analyzed by Fourier transform-infrared spectroscopy (FT-IR) using horizontal attenuated total reflectance (HATR). In addition, the SBS to normal and deproteinized dentin treated with the adhesives was measured after 24 h or 1 year of storage in water. RESULTS: The IR absorption peaks at approximately 1,640, 1,560, and 1,240 cm(-1) were assigned to the collagen matrix and peaks at about 1,000 cm(-1) were assigned to the phosphate group in hydroxyapatite. From the relative magnitude of the peaks, it was determined that the utilized deproteinization method was effective. Furthermore, the normal dentin group showed SBS values ranging from 10 to 39 MPa and the deproteinized dentin group showed SBS values ranging from 13 to 30 MPa. CONCLUSIONS: According to the statistical analysis, the results only partly supported the hypotheses: it was found that the influence on bond strength of deproteinization of dentin surfaces and the effect of 1 year of storage in water depended on the composition of the dentin adhesive.

Staining of hybrid composites with coffee, oolong tea, or red wine.

This study examined the surface staining mechanism of a photopolymerized composite by coffee, oolong tea, and red wine. Dental composite was subjected to an experimental 24-hour staining cycle: 17-hour immersion in artificial saliva solution containing 0.3% mucin followed by 7-hour immersion in coffee, tea, or wine. After one, two, and four weeks, digital images of the composite surface were analyzed in grayscale mode with an imaging analyzer. Specimens polished but not immersed were used as a baseline measurement for color change. Additionally, the effects of mechanical brushing and chlorhexidine on drink-induced staining were examined. Wine caused the most severe staining, followed by tea and coffee. After four weeks of immersion, brushing reduced surface staining by wine. On the contrary, chlorhexidine increased the staining effect of tea and coffee (p<0.05) when compared to the control specimens. In conclusion, we showed that common drinks stained the dental composite, but each by a specific mechanism that depended on external conditions such as the presence of chlorhexidine.

Effect of double-application of all-in-one adhesives on dentin bonding.

OBJECTIVES: To evaluate the effect of double-application of all-in-one adhesives using the micro-shear bond test. METHODS: The occlusal surfaces of extracted human third molars were ground perpendicular to the long axis of each tooth to expose a flat dentin surface. Three commercially available and one experimental bonding system were used in this study: Adper Prompt L-Pop (APL, 3M ESPE), REACTMER BOND (RB, Shofu), XENO III (Xeno, Dentsply-Sankin) and newly developed OBF-2 (OB2, Tokuyama Dental). These adhesives were applied on the dentin surfaces by either the manufacturers' instructions or by an experimental method (single-application or double-application). Resin composite was then placed and light-cured for 40s. After 24h immersion in water, a micro-shear bond test was carried out and the fractured dentin surfaces were observed microscopically. The data were analyzed by one-way ANOVA and Tukey's HSD tests (p<0.05). RESULTS: The mean bond strengths of APL, RB, Xeno and OB2 with single-application were 22.7, 28.3, 30.3 and 34.6MPa, respectively. The mean bond strengths of APL, RB, Xeno and OB2 with double-application were 29.5, 27.2, 29.6 and 32.5MPa, respectively. There were no statistically significant differences in micro-shear bond strengths between the single- and double-application methods for each adhesive system (p>0.05). The morphological observation of the fractured dentin surfaces revealed differences between the single- and double-application groups especially for APL and OB2. CONCLUSIONS: Micro-shear bond strengths of all-in-one adhesives in this study showed no statistically significant differences between the single-application and the double-application method.

Reduced irradiation time in slow-curing of resin composite using an intensity-changeable light source.

Possibility to shorten the total irradiation time in slow-curing with an intensity-changeable light source, Curetron 7 (CT-7), was investigated for four hybrid-type resin composites. Irradiation condition with CT-7 was assigned as 10 or 20 seconds at low light intensity (230 mW/cm2) and followed by 20 or 10 seconds at high intensity (600 mW/cm2) respectively (i.e., a total of 30 seconds). For a reference, irradiation was carried out for 30 seconds using a halogen lamp (900 mW/cm2). After irradiation, mechanical properties of the cured composites--in terms of microhardness and flexural strength--were evaluated. Also, cavity adaptation was examined in standardized, cylindrical dentin cavities treated with an adhesive system. Compared to the reference irradiation, slow-curing with CT-7 produced acceptable mechanical properties and better adaptation. These results suggested that total exposure time of slow-curing with CT-7 could be shortened to 30 seconds.

In vitro sealing performance of two one-step adhesive systems in cervical cavities.

PURPOSE: To evaluate the effects of 1) wall grinding status, 2) thermal stress, and 3) time of polishing on sealing performance of two one-step bonding systems in cervical cavities. MATERIALS AND METHODS: Semicircular cavities with dimensions of 3 x 3 x 1.5 mm were prepared along the CEJ of extracted human premolars. In experiment 1, the cavity walls were additionally ground with round steel diamond burs (regularly ground) or finished with superfine diamond burs. The cavities were treated with AQ Bond (AQ) or One-up Bond F (OB) and filled with a resin composite. Then thermocycling (5 degrees C to 55 degrees C, 1000 x) was performed. In experiment 2, the regularly ground cavities were used. After restoration, the teeth were subjected to thermocycling (1,000 to 5,000 x). In experiment 3, the restorations in the regularly ground cavities were polished immediately or 24 h after filling. No thermocycling was carried out in this group. All specimens were immersed in a dye solution for 2 h. Microleakage at coronal and apical walls was evaluated on the longitudinal sections of the restorations. RESULTS: For OB, the cavities finished with superfine burs exhibited more microleakage at the coronal wall than the regularly ground cavity (p < 0.05). The leakage at the coronal walls increased with the number of thermal cycles for both systems (p < 0.05). The delayed polishing generated better adaptation at the apical wall of AQ and at the coronal wall of OB (p < 0.05). CONCLUSION: Grinding status, thermocycling, and time of polishing had influences on the sealing performance of the two one-step adhesive systems.

Comparison of bonding efficacy of an all-in-one adhesive with a self-etching primer system.

The aim of this study was to compare the bonding efficacy of an all-in-one adhesive with that of a self-etching primer system by measuring microleakage after thermocycling and the microtensile bond strength (microTBS) to enamel and dentin. Circular class V cavities along cement-enamel junctions were prepared in 20 extracted human premolars. Each 10 teeth were bonded with either AD Bond (AD) or Clearfil SE Bond (SE), and filled with a resin composite (Charisma). After thermocycling and staining with 0.5% basic fuchsin, the microleakage at the coronal and apical walls was evaluated using longitudinal sections. In addition 20 premolars were used to measure microTBS at 24 h after bonding for these adhesives to enamel and dentin that corresponded to the coronal and apical walls of the class V cavities. AD showed more microleakage than SE in the coronal walls, but there was less microleakage in the apical walls and no difference in apical leakage between the two adhesives. microTBS (SD) in MPa to enamel and dentin were 25.2 (7.3) and 68.3 (9.4) for AD, and 35.8 (7.4) and 76.4 (7.8) for SE, respectively. AD gave a lower microTBS to enamel than did SE. The results suggested that the poor adaptation at the coronal wall in AD might be caused by the lower bond strength to enamel.

Voids formation along the bonding interface between a smeared dentin surface and all-in-one adhesives.

It has been reported that the adhesive resin layer of all-in-one adhesives is permeable and allows the formation of a water channel or water tree. The effects of a smear layer on the ultra-structure of bonding interface created with three all-in-one adhesives and a resin composite were evaluated in this study. Dentin surface was ground with of 180-, 600-, or 2000-grit SiC paper to produce different smear layer thickness. The bonding interfaces were observed under a transmission electron microscope without demineralization. Voids of various sizes and water channels were found at the bottom of the adhesive resin layer along the bonding interface of SiC 180-grit dentin, while SiC 2000-grit dentin did not produce any voids. The results showed that the voids were possibly related to water that had penetrated from the underlying dentin. A smear layer may have an adverse influence on the bonding performance of all-in-one adhesives to dentin.

Effect of slow-curing on cavity wall adaptation using a new intensity-changeable light source.

OBJECTIVE: The purpose of the study was to investigate the effects of a new intensity-changeable light source Curetron 7 (CT-7) devised for the slow-curing on cavity wall adaptation in the adhesive composite restorations, as well as the microhardness of the cured composite. METHODS: Microhardness of both top and bottom surfaces was measured by an indentation method for 2mm thick cylindrical specimens, and cavity adaptation was evaluated in cylindrical dentin cavities (slashed circle 3.5x1.5mm(2)) of human extracted molars bonded to a hybrid resin composite. The irradiation was done with CT-7, VIP or Candelux (CDX) under the following five conditions: CT1, 600mW/cm(2)x30s (CT-7); CT2, 230mW/cm(2)x20s+600mW/cm(2)x20s (CT-7); CT3, 230mW/cm(2)x20s+pause x 10s+600mW/cm(2)x20s (CT-7); VIP, 300mW/cm(2)x3s+pause x 3min+600mW/cm(2)x30s (VIP); CDX, 200mW/cm(2)x10s+600mW/cm(2)x30s. RESULTS: Five irradiation conditions had no influence on the microhardness for either top or bottom surface (Scheffe, p>0.05). In conditions CT3, VIP and CDX, top surfaces were harder than bottom surfaces (Student's t-test, p<0.05). The statistical analysis revealed no difference in adaptation among the locations along the cavity walls for each irradiation conditions (Kruskal-Wallis, p>0.05). In comparison of poled data for each condition, the best adaptation was seen in condition CT3, and the second in condition VIP (Kruskal-Wallis, p<0.05). SIGNIFICANCE: These results proved the efficacy of the slow-curing method combined with the interval between two irradiations with low intensity and high intensity. CT-7 could be useful for the adhesive composite restorations.

Relation of enamel prism orientation to microtensile bond strength.

PURPOSE: To evaluate the effect of enamel prism orientation on microtensile bond strengths (MTBS) to enamel using two current bonding systems. MATERIALS AND METHODS: The crown segments of extracted human third molars were cut mesio-distally to obtain buccal and lingual halves. One of the halves was cut horizontally at the middle of the crown to make a flat enamel surface parallel to prism orientation (parallel specimen). The other half was ground at the equator of the crown to produce a flat enamel surface perpendicular to the prism orientation (perpendicular specimen). Each surface was ground with 600 grit silicone carbide paper, treated with Clearfil Liner Bond IIsigma (LB) or Single Bond (SB) according to the manufacturers' instructions and resin composite, AP-X or Z100, respectively, was built up onto it. After storage in water at 37 degrees C for 24 hours, all bonded specimens were sectioned and trimmed for measuring MTBS. In MTBS, the parallel specimens were stressed perpendicular to the prism long axis and the perpendicular specimens were stressed parallel to the prism axis. RESULTS: MTBS of specimens stressed perpendicular to the prism long axis were 11.93 +/- 5.56 MPa for LB and 10.97 +/- 1.80 MPa for SB. MTBS of specimens stressed parallel to the prism axis in LB and SB were 19.07 +/- 6.35 MPa and 23.99 +/- 9.20 MPa, respectively. For each prism orientation, no difference in MTBS was found between the bonding systems (P> 0.05). Both systems showed lower MTBS in specimens stressed perpendicular to the prism long axis than in specimens stressed parallel to the prism axis.