Retention of tooth-colored restorations in non-carious cervical lesions—a systematic review

Objectives

The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs).

Methods

Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013.

Results

Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed.

Conclusion

The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.     

Self-etch adhesives for the bonding of orthodontic brackets: faster, stronger, safer?

Objectives

This study aimed to evaluate the performance of accelerating procedures for bonding of orthodontic brackets in vitro by comparing different adhesives (etch-and-rinse, self-etch) and polymerization procedures (curing devices, time). The performance was characterized by three parameters: (1) the bond strength achieved, (2) the incidence of enamel damage, and (3) the extent of residual composite on the tooth.

Materials and methods

Bracket bonding was performed on 500 extracted human teeth after application of either an etch-and-rinse adhesive or a one-step self-etch adhesive. Two different two-component self-etch adhesives (Clearfil SE and Transbond Plus) and two single-component self-etch adhesives (Ideal and iBond) were investigated after using different polymerization procedures (light-emitting diode for 10 or 20 s or plasma arc curing device for 3 or 6 s). The bond strength, incidence of enamel damage, and extent of residual composite on the tooth were measured.

Results

Single-component self-etch adhesives gave the lowest bond strengths. No significant difference in bond strength could be detected between the two-component self-etch adhesives and the etch-and-rinse method. There was a 70.3 % risk for enamel damage at bond strengths above 12 MPa, but only 5 % risk below 12 MPa and no risk below 8.2 MPa. The risk of enamel damage increased by an odds ratio increment of 1.3 for each additional MPa above 8.2 MPa.

Conclusion

Single-component self-etch adhesives showed the lowest bond strengths, caused limited enamel damage, and generally left less residual composite on the tooth.

Clinical relevance

The nature of the adhesive greatly influences the resultant bond strength, the risk of enamel damage, and the extent of residual composite on the teeth.     

Bonding properties of universal adhesives to root canals prepared with different rotary instruments

Statement of problem

Preparation of coronal dentin by using a diamond rotary instrument usually results in higher bond strength values than preparation with tungsten carbide burs, but information is lacking about the influence of rotary instruments on root canals before the bonding of fiber posts.

Effect of interim cement application on bond strength between resin cements and dentin: Immediate and delayed dentin sealing

Statement of problem

Despite the advances in materials and techniques, adhesion to dentin is challenging because of the complex composition of dentin’s mineral, organic, and fluid phases.

Hydrolytic stability of three-step etch-and-rinse adhesives in occlusal class-I cavities

Objectives

A dental adhesive without small and hydrophilic monomers such as 2-hydroxyethyl methacrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) would be beneficial in order to avoid contact allergies. However, these monomers are important to increase infiltration and polymerization of the adhesive. Therefore, the purpose of this study was to evaluate the bonding effectiveness and bond durability of a more hydrophobic and biocompatible adhesive as compared to a conventional three-step etch-and-rinse adhesive.

Methods

Sixteen non-carious human third molars were used to determine the micro-tensile bond strength testing (μTBS) and interfacial ultrastructure by transmission electron microscopy (TEM) of the more hydrophobic cmf adhesive system (Saremco) adhesive as compared to the control OptiBond FL (Kerr).

Results

The more hydrophobic and biocompatible three-step etch-and-rinse adhesive was able to produce a reasonable short-time bonding effectiveness. In the long term, the collagen fibrils in the hybrid layer were not effectively protected and were prone to hydrolytic degradation. As a result, long-term bonding effectiveness of this novel adhesive was very low.

Conclusions

Application of a more hydrophobic adhesive without altering the application procedure considerably results in a reduced durability of the created bond

Clinical relevance

Omitting small and hydrophilic components from the adhesive formulation may impair the durability of your composite restoration.     

Shear bond strength of two adhesive systems bonded to Er:YAG laser-prepared dentin

Dentinal surfaces prepared with an Er:YAG laser have distinctly different characteristics compared to those prepared with conventional instruments. The objective of this study was to evaluate the shear bond strength of a total-etch adhesive system and a self-etch adhesive system to dentin, prepared conventionally or with an Er:YAG laser. Specimens that were prepared with a diamond bur and treated with the total-etch adhesive showed the highest mean bond strength, followed by specimens prepared with the laser and treated with the total-etch adhesive, specimens prepared with a diamond bur and treated with the self-etch adhesive, and specimens prepared with the laser and treated with the self-etch adhesive, but there were no differences among the groups (P > 0.05). These data indicate that the tested adhesive systems promote similar shear bond strengths, whether the dentin is prepared with a diamond bur or an Er:YAG laser, and that an Er:YAG laser is a suitable cavity preparation method that promotes an adequate surface for a posterior adhesive procedure.     

Self-etching aspects of a three-step etch-and-rinse adhesive

Purpose

The purpose of this study is to assess the marginal adaptation of cavities restored with a three-step etch-and-rinse adhesive, OptiBond FL (OFL) under different application protocols.

Materials and methods

Twenty-four class V cavities were prepared with half of the margins located in enamel and half in dentin. Cavities were restored with OFL and a microhybrid resin composite (Clearfil AP-X). Three groups (n?=?8) that differed in the etching technique were tested with thermomechanical loading, and specimens were subjected to quantitative marginal analysis before and after loading. Micromorphology of etching patters on enamel and dentin were observed with SEM. Data was evaluated with Kruskal–Wallis and Bonferroni post hoc test.

Results

Significantly lower percent CM (46.9?±?19.5) were found after loading on enamel in group 3 compared to group 1 (96.5?±?5.1) and group 2 (93.1?±?8.1). However, no significant differences (p?=?0.30) were observed on dentin margins.

Conclusions

Etching enamel with phosphoric acid but avoiding etching dentin before the application of OFL, optimal marginal adaptation could be obtained, evidencing a self-etching primer effect.

Clinical relevance

A reliable adhesive interface was attained with the application of the three-step etch-and-rinse OFL adhesive with a selective enamel etching, representing an advantage on restoring deep cavities.     

One-day bonding effectiveness of new self-etch adhesives to bur-cut enamel and dentin

Self-etch adhesives try to solve difficulties commonly associated with the clinical application of etch-and-rinse adhesives. Their application procedure is considered less time-consuming and, more importantly, less technique-sensitive. The main objective of this study was to determine the bonding effectiveness to and the interaction with enamel/dentin of three contemporary one- and two-step self-etch adhesives by microtensile bond strength testing (microTBS), Fe-SEM and TEM when compared to a control two-step self-etch and a three-step etch-and-rinse adhesive. The one-step self-etch adhesive, Adper Prompt (3M ESPE), scored the lowest microTBS of all experimental and control adhesives tested. Conversely, the two-step self-etch adhesives Clearfil SE (Kuraray) and OptiBond Solo Plus Self-Etch (Kerr) approached the values obtained by the three-step etch-and-rinse control (OptiBond FL, Kerr) when bonded to enamel and dentin. Ultramorphological characterization showed that interfacial morphology and the pH of the self-etch primer/adhesive are strongly associated. The interaction with dentin varied from the formation of a submicron, hydroxyapatite-containing hybrid layer for the "mild" self-etch adhesive Clearfil SE to a 3-5 microm thick, hydroxyapatite-depleted hybrid layer for the "strong" self-etch adhesive Adper Prompt. The two-step self-etch adhesives AdheSE and OptiBond Solo Plus Self-Etch presented with a hybrid layer with a hydroxyapatite-depleted top part and a hydroxyapatite-containing base part and were therefore classified into a new group of self-etch adhesives, namely "intermediary strong" self-etch adhesives.     

Influence of caries infiltrant contamination on shear bond strength of different adhesives to dentin

Objectives

To analyze whether the contamination with a caries infiltrant system impairs the adhesive performance of etch-and-rinse and self-etching adhesives on dentin.

Materials and methods

Dentin contamination with the caries infiltrant system (Icon, DMG) was simulated by applying either hydrochloric acid (15 % HCl, Icon Etch, 15 s), the resin infiltrant (Icon infiltrant, 4 min), or both prior to the application of the respective adhesives (each group n?=?10). In the control groups, the etch-and-rinse adhesive (Optibond FL, Kerr) and the self-etching adhesive (iBOND Self Etch, Hereaus) were applied without former contamination with the infiltrant system. Additionally, the adhesive performance of the resin infiltrant alone was tested. Shear bond strength of a nano-hybrid composite was analyzed after thermocycling (5,000×, 5–55°C) of the specimens and analyzed by ANOVA/Scheffé post hoc tests (p?<?0.05) and Weibull statistics. Failure mode was inspected under a stereomicroscope at?×?25 magnification.

Results

Contamination with the resin infiltrant alone did not impair shear bond strength, while contamination with hydrochloric acid or with hydrochloric acid and the resin infiltrant reduced shear bond strength (MPa) of the adhesives (Optibond FL: 20.5?±?3.6, iBOND Self Etch: 17.9?±?2.6) significantly. Hydrochloric acid contamination increased the number of adhesive failures. The adhesive performance of the caries infiltrant system alone was insufficient.

Conclusion

The contamination with the caries infiltrant system impaired the shear bond strength of conventional dental adhesives.

Clinical relevance

Contamination of the caries infiltrant system on dentin should be avoided due to the detrimental effect of hydrochloric acid etching.     

Tensile bond strength of indirect composites luted with three new self-adhesive resin cements to dentin

Objective

The aims of this study were to evaluate the tensile bond strengths between indirect composites and dentin of 3 recently developed self-adhesive resin cements and to determine mode of failure by SEM.

Material and Methods

Exposed dentin surfaces of 70 mandibular third molars were used. Teeth were randomly divided into 7 groups: Group 1 (control group): direct composite resin restoration (Alert) with etch-and-rinse adhesive system (Bond 1 primer/adhesive), Group 2: indirect composite restoration (Estenia) luted with a resin cement (Cement-It) combined with the same etch-and-rinse adhesive, Group 3: direct composite resin restoration with self-etch adhesive system (Nano-Bond), Group 4: indirect composite restoration luted with the resin cement combined with the same self-etch adhesive, Groups 5-7: indirect composite restoration luted with self-adhesive resin cements (RelyX Unicem, Maxcem, and Embrace WetBond, respectively) onto the non-pretreated dentin surfaces. Tensile bond strengths of groups were tested with a universal testing machine at a constant speed of 1 mm/min using a 50 kgf load cell. Results were statistically analyzed by the Student''s t-test. The failure modes of all groups were also evaluated.

Results

The indirect composite restorations luted with the self-adhesive resin cements (groups 5-7) showed better results compared to the other groups (p<0.05). Group 4 showed the weakest bond strength (p>0.05). The surfaces of all debonded specimens showed evidence of both adhesive and cohesive failure.

Conclusion

The new universal self-adhesive resins may be considered an alternative for luting indirect composite restorations onto non-pretreated dentin surfaces.     

Bond strength of self-etch adhesives to dentin prepared with three different diamond burs.

OBJECTIVES: To evaluate the micro-tensile bond strength (mu TBS) of a control etch-and-rinse and three self-etch (strong, mild, ultra-mild) adhesive systems to dentin prepared with three different grit size of diamond burs. METHODS: Dentin surfaces were created from mid-coronal sound dentin in extracted, human third molars. The teeth were ground with high-speed medium grit (100 microm), fine grit (30 microm), or extra-fine grit (15 microm) diamond bur. Resin composite (Z100) was bonded to the surfaces using Optibond FL, Adper Prompt L-Pop, Clearfil SE Bond, or Clearfil S3 Bond. Rectangular micro-specimens were prepared using the slow-speed diamond saw and tested in tensile to determine the mu TBS. Failure analysis was performed using a stereo-microscope and Fe-SEM. Data were analyzed by two-way analysis of variance and Tukey's HSD test (p<0.05). RESULTS: The etch-and-rinse adhesive yielded high micro-tensile values (58-69 MPa), irrespective of the diamond burs used. The bond strength values were comparable for Adper Prompt L-Pop and Clearfil SE Bond irrespective of the burs used. The mu TBS values were significantly higher as the particle size of diamond burs is smaller for Clearfil S3 Bond. Most failures were recorded as interfacial failure when the fine and extra-fine diamond burs were used. SIGNIFICANCE: Overall, different grit-sized diamond burs did not affect the mechanical properties of the interface, except for the ultra-mild one step self-etch adhesive. This adhesive performed significantly better when a smaller grit size was used to prepare dentin surface.     

Effect of silane contamination on dentin bond strength

Statement of problem

Intraoral repair of porcelain or other silica-based ceramics typically requires the use of silane in the repair protocol. Some porcelain intraoral repairs also involve bonding to exposed or involved tooth tissues including dentin. A study is needed to evaluate whether the cross-contamination of dentin with silane affects bond strength to this tissue.

Five-year clinical performance of a HEMA-free one-step self-etch adhesive in noncarious cervical lesions

Objectives

The objective of this randomized controlled trial was to evaluate the clinical performance of a 2-hydroxyethyl methacrylate (HEMA)-free one-step adhesive.

Materials and methods

Two hundred sixty-seven cervical lesions in 52 patients were restored with the composite Gradia Direct (GC), bonded with either the one-step self-etch adhesive G-Bond (GC) or the three-step etch-and-rinse adhesive Optibond FL (Kerr) in a random order. The restorations were evaluated for retention, marginal integrity, marginal discoloration, and caries occurrence after 5 years. Specific statistics were used to account for the clustered data (multiple restorations per patient).

Results

The clinical success rate for G-Bond (87.4 %) was not significantly different from that of Optibond FL (90.9 %). Both adhesives showed progressive marginal deterioration, but G-Bond exhibited more small enamel defects and marginal discoloration, and unlike previous recalls, several restorations failed because of deep microleakage. Large sclerotic lesions were a significant risk factor for retention loss with G-Bond. Irrespective of the adhesive, almost all restorations with retention loss were located in the lower jaw.

Conclusion

After 5 years of clinical service, restorations bonded with the HEMA-free one-step adhesive did not need repair or replacement more often than those with the three-step etch-and-rinse adhesive, and both adhesives had a high retention rate (>90 %). There were indications that G-Bond did not (self-)etch enough in some clinical situations, as G-Bond exhibited more incisal defects and marginal discolorations, and sclerotic lesions were at higher risk of retention loss.

Clinical relevance

The clinical performance of the HEMA-free one-step adhesive was clinically acceptable after 5 years.     

Tetrahydrofuran as solvent in dental adhesives: cytotoxicity and dentin bond stability

Objectives

The aim of this study was to investigate the cytotoxicity and 1-year dentin bond stability of solvated etch-and-rinse dental adhesives based on tetrahydrofuran (THF), acetone, or ethanol, containing water or not.

Materials and methods

Seven primers were prepared using the following solvents: THF, acetone, ethanol, water, THF/water, acetone/water, and ethanol/water. Bovine dentin was used, and specimens for microtensile bond strength (μTBS) test were prepared. Specimens were tested after storage in distilled water for 24 h or 1 year. Cytotoxicity of the solvents was evaluated in 3T3/NIH mouse fibroblasts using a colorimetric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay after exposure for 24 h.

Results

No significant differences were detected among solvents after storage for 24 h, except for the water-based group, which showed the lowest μTBS values. After storage for 1 year, the THF-based adhesive system resulted in more stable bonds. Yet, THF showed an intermediate cytotoxicity when compared with the other solvents, being less toxic than phosphate monomer and similar to 2-hydroxyethyl methacrylate.

Conclusion

THF seems to be a suitable solvent for adhesive systems.

Clinical relevance

THF is a promising solvent that can be used to improve dentin bond stability.     

Effect of carbodiimide (EDC) on the bond stability of etch-and-rinse adhesive systems

Objective

Recent studies supported the use of protein cross-linking agents during bonding procedures to inactivate endogenous dentin proteases, preventing dentin collagen degradation thus improving bond durability. The aim of this study was to evaluate the effect of a 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)-containing conditioner on the stability of the adhesive interface created by two etch-and-rinse adhesives.

Methods

Human dentin was etched with 35% phosphoric acid, treated with 0.3 M EDC-containing conditioner followed by a three-step or a two-step etch-and-rinse adhesive. Adhesives were applied to control specimens without EDC pre-treatment. Specimens were subjected to microtensile bond strength test and pulled to failure after 24 h or 1 year of storage and interfacial nanoleakage expression was evaluated and quantified by light microscopy. Additionally, to investigate endogenous dentin matrix metalloproteinase activity a zymographic assay was performed on protein extracts obtained from phosphoric-acid-etched dentin powder with or without EDC treatment.

Results

The use of the EDC-containing conditioner did not affect immediate bond strength to dentin but contributed to preserve the bond strength after 1 year (p < 0.05) for both tested adhesives. No difference was found in the interfacial nanoleakage expression that increased after aging irrespective from the treatment. EDC pre-treatment inhibited dentin endogenous MMPs as assayed with the zymography.

Significance

In conclusion, the results of the study provide proof that EDC can produce long-term inactivation of MMPs in acid-etched dentin matrices contributing to bond strength preservation over time. Future studies are needed to support the use of EDC in vivo.     

Adhesion of 10-MDP containing resin cements to dentin with and without the etch-and-rinse technique

PURPOSE

This study evaluated the adhesion of 10-MDP containing self-etch and self-adhesive resin cements to dentin with and without the use of etch-and-rinse technique.

MATERIALS AND METHODS

Human third molars (N=180) were randomly divided into 6 groups (n=30 per group). Conventional (Panavia F2.0, Kuraray-PAN) and self-adhesive resin cements (Clearfil SA, Kuraray-CSA) were bonded to dentin surfaces either after application of 3-step etch-and-rinse (35% H₃PO₄ + ED Primer) or two-step self-etch adhesive resin (Clearfil SE Bond). Specimens were subjected to shear bond strength test using the universal testing machine (0.5 mm/min). The failure types were analyzed using a stereomicroscope and quality of hybrid layer was observed under a scanning electron microscope. The data (MPa) were analyzed using two-way ANOVA and Tukey''s tests (α=.05).

RESULTS

Overall, PAN adhesive cement showed significantly higher mean bond strength (12.5 ± 2.3 - 14.1 ± 2.4 MPa) than CSA cement (9.3 ± 1.4 - 13.9 ± 1.9 MPa) (P<.001). Adhesive failures were more frequent in CSA cement groups when used in conjunction with two-step self-adhesive (68%) or no adhesive at all (66%). Hybrid layer quality was inferior in CSA compared to PAN cement in all conditions.

CONCLUSION

In clinical situations where bonding to dentin substrate is crucial, both conventional and self-adhesive resin cements based on 10-MDP can benefit from etch-and-rinse technique to achieve better quality of adhesion in the early clinical period.     

Slow progression of dentin bond degradation during one-year water storage under simulated pulpal pressure

Objectives

To evaluate the dentin bond durability of simplified adhesives after one-year (1 y) under water storage and simulated pulpal pressure.

Methods

Class I cavities were prepared in sixty human third molars with the pulpal wall located in mid-coronal dentin. The roots were cut off to expose the pulpal chamber, and the teeth were assembled in a pulpal pressure simulator device. A two-step etch-and-rinse adhesive (Single Bond 2/SB), a two-step self-etch adhesive (Clearfil SE Bond/CSE), a three-step self-etch adhesive (Adper Scotchbond SE/SSE) and three all-in-one adhesives (Adper Easy Bond/EB, Clearfil S³ Bond/S3 and Adhese One/AO) were applied according to manufacturer? instructions. No enamel pre-etching was used for the self-etch systems. The cavities were filled with a composite (Z250, 3M ESPE) in four to five horizontal increments and individually cured. Immediately after the final cure, pulpal pressure was set to 15 cm H₂O. After 24 h and 1 y under simulate pulpal pressure the teeth were cut following a ‘nontrimming’ microtensile test technique (n = 30) and tested in tension. Kruskall–Wallis and post hoc multiple comparisons were used at α = 0.05. Weibull statistics was applied to SB, CSE and EB. Fractographic analysis of debonded specimens was performed using scanning electron microscopy.

Results

At 24 h and 1 y periods, SB showed higher bond strength means than all the others adhesives tested. CSE was not statistically different from EB at 24 h and from EB and SB at 1 y. EB showed bond strength statistically higher than the other three self-etch adhesives, which were not statistically different from each other at 24 h. AO showed significantly lower bond strength than all tested materials after 1 y. For all adhesives the mean bond strength at 1 y were not statistically different from the values measured at 24 h (p > 0.05). Shifts in failure mode patterns and Weibull modulus decrease indicate some degree of bond degradation after the 1 y storage period.

Conclusion

One-year of simulated pulpal pressure did not affect dentin bond strength of simplified adhesives in Class I restorations. Signs of degradation were only revealed by fractographic analysis and reliability parameters.     

Effect of universal adhesive etching modes on bond strength to dual-polymerizing composite resins

Statement of problem

Information is lacking as to the effect on bond strength of the etching modes of universal adhesives when they are used to bond dual-polymerizing composite resins to dentin.

Analysis of pre-test failures and bond-strengths of seven adhesive systems to bovine dentine: A nine-year novice/beginner operator study

Objective

The aims were to evaluate, via multi-year student cohorts: (i) the incidence of pre-test failures and (ii) shear bond strengths of single- and multi-step adhesives to bovine dentin.