Microtensile bond strengths of an etch&rinse and self-etch adhesive to enamel and dentin as a function of surface treatment

In light of the current trend towards "minimal invasive" dentistry, diverse cavity preparation techniques have been introduced as an alternative or addition to common bur instrumentation. This study investigated whether diamond sonoabrasion (SonicSys Micro, Kavo), air abrasion (Prep Start, Danville) and Er:YAG laser irradiation (Fidelis) produce surfaces at enamel/dentin that are equally receptive to bonding as traditional mid-grit diamond-bur (Komet) and 600-grit SiC-paper prepared surfaces, of which the latter two served as controls. An etch&rinse adhesive (OptiBond FL, Kerr) applied with and without prior acid-etching and a self-etch adhesive (Clearfil SE, Kuraray) were employed to bond the restorative composite (Z100, 3M ESPE) to the diversely prepared enamel and dentin surfaces. The microtensile bond strength (microTBS) was determined after 24 hours of storage in water at 37 degrees C. The results indicated that the manner of preparation of enamel and dentin prior to bonding procedures significantly influenced the bonding effectiveness of both the etch&rinse and the self-etch adhesive. Using an etch&rinse adhesive, separate acid-etching of air-abraded and Er:YAG-irradiated enamel and dentin surfaces remains mandatory. Bonding to diamond-sonoabraded and air-abraded enamel and dentin was, in general, not different from bonding to conventional diamond-bur prepared surfaces, whereas, bonding to Er:YAG-irradiated enamel and dentin surfaces in general resulted in a significantly lower bonding effectiveness compared to bonding to diamond-bur prepared surfaces.     

Influence of Er,Cr:YSGG laser treatment on microtensile bond strength of adhesives to enamel

The current trend towards minimum-intervention dentistry has introduced laser technology as an alternative technique for cavity preparation. This study assessed the null hypothesis that enamel prepared either by Er,Cr:YSGG laser or conventional diamond bur is equally receptive to adhesive procedures. The buccal and lingual surfaces of 35 sound human molars were prepared with Er,Cr:YSGG laser or a medium-grit diamond bur. One etch&rinse (OptiBond FL) and three self-etch adhesives (Adper Prompt L-Pop, Clearfil SE Bond and Clearfil S3 Bond) were applied on laser-irradiated and bur-cut enamel, followed by the application of a 5-6 mm build-up of Z100. The micro-tensile bond strength (microTBS) was determined after 24 hours of storage in water at 37 degrees C. Prepared enamel surfaces and failure patterns were evaluated using a stereomicroscope and a field-emission-gun scanning electron microscope (Feg-SEM). The pTBS to laser-irradiated enamel was significantly lower than to bur-cut enamel (p<0.05), with the exception of Clearfil S3 Bond, which bonded equally effectively to both substrates. The latter presented the highest microTBS on laser-irradiated enamel, though it was not statistically different from the microTBS of OptiBond FL. SEM analysis revealed significant morphological alterations of the laser-irradiated enamel surface, such as areas of melted and recrystalized hydroxyapatite and deep extensive micro-cracks. In conclusion, the bonding effectiveness of adhesives to laser-irradiated enamel depends not only on the structural substrate alterations induced by the laser, but also on the characteristics of the adhesive employed.     

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.     

Effect of fracture strength of primer-adhesive mixture on bonding effectiveness.

OBJECTIVE: The purpose of this study was to measure the micro-tensile bond strength (microTBS) of two adhesives to dentin and to correlate this microTBS with the micro-tensile fracture strength (microTFS) of primer-adhesive mixtures of the two adhesives. METHODS: The three-step etch&rinse adhesive OptiBond FL (Kerr) and the two-step self-etch adhesive Clearfil SE Bond (Kuraray) were used to bond Filtek Z100 (3M ESPE) to twenty mid-coronal dentin surfaces. The microTBS was determined at 1 and 24 h after light-curing. In addition, the microTFS of primer-adhesive mixtures (primer:adhesive=1:3 by weight) and of the pure adhesives (controls) were measured after the same time intervals. RESULTS: The microTBS to dentin of OptiBond FL at 24 h was significantly higher than at 1 h and than the microTBS of Clearfil SE Bond at 24 h. The mean microTFS of the primer-adhesive mixtures was always lower than the microTFS of the respective adhesives. The highest reduction in microTFS due to mixing primer with the adhesive resin was measured for Clearfil SE Bond. Both the microTFS of the primer-adhesive mixtures and the pure adhesives of OptiBond FL and Clearfil SE Bond increased with time. SIGNIFICANCE: The early 1 h microTBS to dentin was lower than the 24 h microTBS for OptiBond FL, but not for Clearfil SE Bond. Differences in polymerization efficiency as well as in the resulting interfacial strength may explain such varying early bond strengths to dentin.     

Relationship between nanoleakage and microtensile bond strength at the resin-dentin interface

To evaluate the correlation between microtensile dentin bond strength (microTBS) and silver ion penetration, two total-etch 3-step and one self-etch 2-step system were investigated. OptiBond FL adhesive was applied to flat occlusal dentin on six non-carious human molars, and a resin composite "crown" was formed in 2 mm increments. After 24-hour water storage, the teeth were sectioned with a low-speed diamond saw to obtain four-square sticks (approximately 2 mm X 2 mm) per tooth. Cylindrical tensile test specimens were formed with an 0.5 mm2 cross-sectional area. Nail varnish was applied to the dentin within 0.5-1.0 mm of the interface before immersing in 50% silver nitrate for 15 minutes. Following silver fixation, tensile testing was performed in a Zwick UTM at 1 mm/minute using a passive gripping fixture to obtain 72-hour microTBS [23.9 MPa]. The percentage area of silver penetration was measured on debonded specimens using light microscopy and Image-Pro Plus Software [89%]. The procedures were repeated using Scotchbond Multi-Purpose Plus [microTBS = 27.8 MPa; nanoleakage = 67%] and Clearfil SE bond [microTBS = 36 MPa; nanoleakage = 55%]. No significant correlation between microtensile bond strength and nanoleakage was found for all systems. A weak-to-moderate negative relationship was found between microTBS and nanoleakage for OptiBond FL (Spearman r = -0.3844). No correlation was found for the remaining adhesive systems. The correlation between these two common laboratory measurements appears to be adhesive-system dependent.     

Dentin and enamel bond strengths of dual-cure composite luting agents used with dual-cure dental adhesives

OBJECTIVE: The purpose of this in vitro study was to evaluate and compare dentin and enamel bond strengths obtained with dual-cure composite luting agents when used with dual-cure dental adhesives. METHODS: Human molars were ground flat to expose enamel (n=80) or dentin (n=80). Specimens in each substrate group were randomly assigned to eight treatment sub-groups, according to four adhesive-luting agent combinations and two test conditions (with or without thermocycling). Pre-polymerized composite resin posts (TPH Spectrum) were luted to either the enamel or dentin surfaces with one of the following adhesive-luting agent combinations: (1) Xeno IV Dual Cure (dual-cure self-etch adhesive) and Calibra (dual-cure luting agent); (2) Prime & Bond NT Dual Cure (dual-cure total-etch adhesive) and Calibra; (3) OptiBond All-in-One Dual Cure (dual-cure self-etch adhesive) and Nexus 2 Dual Syringe (dual-cure luting agent); (4) OptiBond Solo Plus Dual Cure (dual-cure total-etch adhesive) and Nexus 2 Dual Syringe. For each treatment sub-group, half the specimens (n=10) were tested after 24h storage in water at 37 degrees C, and the other half (n=10) were tested after thermocycling for 1800 cycles between water baths held at 5 and 55 degrees C, with a dwell time in each bath of 30s, and a transfer time of 10s. Bond strengths were measured in shear mode, and expressed in MPa. The fracture mode (adhesive, cohesive, mixed) was examined. Data were analyzed for statistical significance with a factorial ANOVA and post hoc tests. RESULTS: Mean enamel bond strengths ranged from 8.4MPa for non-thermocycled OptiBond All-in-One|Nexus 2 to 35.5MPa for non-thermocycled Prime & Bond NT|Calibra. Mean dentin bond strengths ranged from 14.5MPa for non-thermocycled OptiBond Solo Plus|Nexus 2 to 30.9MPa for thermocycled Xeno IV|Calibra. The fracture mode was predominantly adhesive for all groups. CONCLUSIONS: On enamel, the total-etch adhesives performed better than their self-etch counterparts, while in dentin, the opposite was found, i.e., the self-etch adhesives performed better than their total-etch counterparts. Thermocycling for 1800 cycles did not affect the SBS of the materials tested to dentin and enamel.     

Bonding to ground versus unground enamel in fluorosed teeth.

OBJECTIVES: To determine the effect of grinding on the bonding effectiveness of a self-etch and an etch-and-rinse adhesive to fluorosed enamel. METHODS: The teeth were classified using the Thylstrup and Fejerskov index (TFI). Fluorosed teeth (TFI=5) obtained from Isparta (Turkey) and control teeth (TFI=0) obtained from Leuven (Belgium) were used. Using a depth-marking diamond bur, 0.3mm of enamel was removed from mid-buccal and mid-palatal/lingual surfaces of the teeth, whereas the area adjacent to the ground area was left unprepared. A two-step self-etch (Clearfil Protect Bond, Kuraray) and a three-step etch-and-rinse adhesive (Optibond FL, Kerr) were used to bond the resin composite to the ground and unground enamel. Rectangular micro-specimens were prepared using the slow-speed diamond saw and tested in tensile to determine the micro-tensile bond strength (microTBS). RESULTS: The microTBS to unground fluorosed enamel was significantly lower than to ground fluorosed enamel for Clearfil Protect Bond (15.8+/-15.2 and 45.0+/-12.4MPa, p<0.0001) and for Optibond FL (35.5+/-21.4 and 50.5+/-12.3MPa, p<0.05), respectively. In control teeth, Clearfil Protect Bond bonded better to ground enamel (p<0.01), whereas OptiBond FL exhibited a similar bonding effectiveness to ground and unground enamel (p=0.0634). SIGNIFICANCE: Preparation of enamel improved the resin-enamel bond strength in fluorosed teeth. The bonding effectiveness to unground enamel was lower in fluorosed teeth than in control teeth for the self-etch adhesive tested.     

Microleakage study of different adhesive systems in Class V cavities prepared by Er,Cr:YSGG laser and bur preparation

This study sought to compare the microleakage of composite resin restorations using two different dentin adhesive systems and two different modes of cavity preparation: a high-speed handpiece and an Er,Cr:YSGG laser. Twenty-five caries-free permanent human premolars were assigned randomly into five groups of five. A high-speed handpiece was used to prepare Class V cavities on the buccal and lingual surfaces of 10 randomly selected teeth. Class V cavities were cut on the buccal and lingual surfaces of the remaining 15 teeth using the Er,Cr:YSGG laser system. Fifty cavities were prepared with enamel and dentin margins 1.0 mm below the cemento-enamel junction and assigned into five groups: I, II, and III by the Er,Cr:YSGG laser and IV and V by the high-speed handpiece. In all groups, the differences between gingival and occlusal leakage scores were statistically significant (p < 0.05). The occlusal and gingival scores of groups I and IV demonstrated statistically significant differences (p < 0.05). The lased group with additional acid etching revealed less microleakage than groups III and IV (p < 0.05). Both self-etch and total-etch adhesive systems demonstrated acceptable microleakage scores when used on Er,Cr:YSGG laser-prepared cavities; however, additional acid etching after Er,Cr:YSGG laser preparation is recommended.     

Influence of dentin cavity surface finishing on micro-tensile bond strength of adhesives.

The current trend toward minimal-invasive dentistry has introduced innovative techniques for cavity preparation. Chemical vapor deposition (CVD) and laser-irradiation technology have been employed as an alternative to the common use of regular burs in high-speed turbines. OBJECTIVES: The purpose of this study was to assess the influence of alternative techniques for cavity preparation on the bonding effectiveness of different adhesives to dentin, and to evaluate the morphological characteristics of dentin prepared with those techniques. METHODS: One etch&rinse adhesive (OptiBond FL, Kerr) and three self-etch systems (Adper Prompt L-Pop, 3M ESPE; Clearfil SE Bond, Kuraray; Clearfil S3 Bond, Kuraray) were applied on dentin prepared with a regular bur in a turbine, with a CVD bur in a turbine, with a CVD tip in ultrasound and with an Er,Cr:YSGG laser. The micro-tensile bond strength (microTBS) was determined after storage in water for 24h at 37 degrees C, and morphological evaluation was performed by means of field-emission-gun scanning electron microscopy (Feg-SEM). RESULTS: Feg-SEM evaluation revealed different morphological features on the dentin surface after the usage of both the conventional and alternative techniques for cavity preparation, more specifically regarding smear-layer thickness and surface roughness. CVD bur-cut, CVD ultra-sonoabraded and laser-irradiated dentin resulted in lower microTBSs than conventionally bur-cut dentin, irrespective of the adhesive employed. SIGNIFICANCE: The techniques, such as CVD diamond-bur cutting, CVD diamond ultra-sonoabrasion and laser-irradiation, used for cavity preparation may affect the bonding effectiveness of adhesives to dentin, irrespective of their acidity or approach.     

Effect of water storage on the bonding effectiveness of 6 adhesives to Class I cavity dentin

Adhesive-dentin interfaces degrade with time. This study determined the effect water storage may have on the bonding effectiveness of adhesives to occlusal Class I cavity-bottom dentin. Six adhesives, all representing contemporary classes of adhesives, were applied: a 3-step (OptiBond FL, Kerr) and 2-step (Scotchbond 1*, 3M ESPE) etch-and-rinse adhesive, a 2-step (Clearfil SE, Kuraray) and 1-step (Adper prompt, 3M ESPE) self-etch adhesive and a 2-step (FujiBond LC, GC) and 1-step (Reactmer, Shofu) resin-modified glass-ionomer adhesive. Bonding effectiveness was assessed by microtensile bond strength testing (MTBS) and electron microscopy (Feg-SEM and TEM). The MTBS was determined after 1 day and 1 year water storage of the entire restored cavity (indirect exposure of the adhesive-dentin interface to water) and prepared microTBS-beams (direct exposure of the adhesive-dentin interface to water). The hypotheses tested were: (1) resin-dentin bonds formed at the bottom of Class I cavities resist 1-year water storage and (2) an adjacent composite-enamel bond protects the composite-dentin bond against degradation. Non-parametric Kruskal-Wallis analysis statistically analyzed the microTBSs. The first hypothesis was rejected, as only the microTBS of OptiBond FL and Clearfil SE did not significantly decrease after 1-year direct and/or indirect water storage. The second hypothesis was corroborated, as the bonding effectiveness of most simplified adhesives (Scotchbond 1, Adper Prompt, FujiBond LC and Reactmer) approached 0 (because of the frequent pre-testing failures) after 1-year direct water exposure. The second hypothesis concluded that the 3-step etch-and-rinse adhesive must still be regarded the "gold standard." Though microTBS decreased significantly, Clearfil SE, as a 2-step self-etch adhesive, was the only simplified adhesive to perform reliably after 1-year direct water exposure.     

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.     

Four-year water degradation of total-etch adhesives bonded to dentin

Resin-dentin bonds degrade over time. The objective of this study was to evaluate the influence of variables like hybridization effectiveness and diffusion/elution of interface components on degradation. Hypotheses tested were: (1) There is no difference in degradation over time between two- and three-step total-etch adhesives; and (2) a composite-enamel bond protects the adjacent composite-dentin bond against degradation. The micro-tensile bond strength (microTBS) to dentin of 2 three-step total-etch adhesives was compared with that of 2 two-step total-etch adhesives after 4 years of storage in water. Quantitative and qualitative failure analyses were conducted correlating Fe-SEM and TEM. Indirect exposure to water did not significantly reduce the microTBS of any adhesive, while direct exposure resulted in a significantly reduced microTBS of both two-step adhesives. It is concluded that resin bonded to enamel protected the resin-dentin bond against degradation, while direct exposure to water for 4 years affected bonds produced by two-step total-etch adhesives.     

Effects of Nd: YAG laser, air-abrasion and acid-etching on human enamel and dentin

The effects of the Nd:YAG laser, air-abrasion and acid-etching systems on mineral content and surface morphology of cut dentin and enamel were examined in 10 extracted human teeth. Enamel specimens were lased for two seconds at a fluence of 0.75 J and a frequency of 15 Hz, air-abraded for two seconds with 50 micron Al-oxide and etched for 60 seconds with 37% ortho-phosphoric acid. Dentinal specimens were subjected to the same procedure for half the time. Untreated areas of the same specimens served as the control. Morphologically, the lased dentin showed an apparently melted surface with partial obstruction of the dentin tubules, as well as cracks along the lased surface. Air-abrasion created very irregular surfaces on enamel and dentin. Dentin tubules were observed on the acid-etched dentin samples but not the air-abraded surfaces. The Nd:YAG laser created the most surface irregularity on both enamel and dentin. Laser treatment appeared to alter the chemical structure and surface morphology of the dentin and enamel.     

Tensile bond strength of Er, Cr: YSGG laser-irradiated human dentin to composite inlays with two resin cements

The purpose of this study was to investigate the tensile bond strength of composite inlays to human dentin with two different cavity preparation tools (bur versus Er, Cr: YSGG laser) and with two different bonding procedures (total-etch: Variolink II versus self-etch: Maxcem). The specimens were divided into four groups: bur-cut/Variolink II, bur-cut/Maxcem, laser-ablated/Variolink II, and laser-ablated/Maxcem. The following characteristics were then investigated: morphological change, dentin-resin cement interface, surface roughness, and tensile bond strength. Results demonstrated that the tensile bond strengths of the four groups were 19.11 +/- 5.88 MPa, 8.54 +/- 2.38 MPa, 13.72 +/- 3.43 MPa, and 12.11 +/- 3.71 MPa, respectively. We concluded that Variolink II provided higher tensile bond strength to composite inlays than Maxcem. On the other hand, the bond strength of Variolink II with dentin cavity prepared by Er, Cr: YSGG laser was statistically lower than that prepared by bur.     

Aggressiveness of self-etch adhesives on unground enamel

Manufacturers of mild self-etch adhesives advocate the adjunctive use of phosphoric acid etching when bonding to unground enamel. This study tested the null hypothesis that there is no difference between the recently introduced, more aggressive self-etch adhesives and a total-etch adhesive in bonding to unground enamel. The ultrastructure and microtensile bond strengths (microTBS) of Xeno III (Dentsply) and Simplicity (Apex Dental Materials), bonded to unground enamel, were examined after thermocycling. Clearfil SE Bond (Kuraray), a mild self-etch adhesive, was used as the negative control, and One-Step (BISCO), a total-etch adhesive bonded to phosphoric acid-etched unground enamel, was used as the positive control. Differences in the thickness of enamel hybrid layers were observed and the aggressiveness of apatite dissolution in the four adhesives.     

Bonding of an auto-adhesive luting material to enamel and dentin

OBJECTIVES: The objectives of this study were (1) to assess the bonding performance of a new auto-adhesive cement (RelyX Unicem, 3M ESPE) to enamel and dentin, using a standard micro-tensile bond strength (microTBS) test set-up, and (2) to evaluate the interaction of this material with dentin by means of high-resolution electron microscopy. METHODS: The microTBS of RelyX Unicem with and without prior acid etching was determined to enamel and dentin after 24 h of water storage and compared to the bonding effectiveness of the control cement (Panavia-F, Kuraray). In addition, diamond-knife cut interfaces of RelyX Unicem and Panavia-F bonded to dentin were examined using field-emission scanning (Fe-SEM) and transmission electron microscopy (TEM). RESULTS: The microTBS of RelyX Unicem to enamel was significantly lower than that of the control cement, whereas no significant difference was found when both cements were bonded to dentin. Acid etching prior to the application of RelyX Unicem raised the enamel microTBS to the same level as that of the control, but was detrimental for the dentin bonding effectiveness. The latter must be attributed to inadequate infiltration of the collagen mesh as revealed by Fe-SEM and TEM. Morphological evaluation additionally revealed that RelyX Unicem only superficially interacted with enamel and dentin, and that application using some pressure is required to ensure close adaptation of the cement to the cavity wall. SIGNIFICANCE: (1) RelyX Unicem should always be applied with some pressure, to ensure that the relatively high viscous cement intimately adapts to the cavity wall; (2) The cement only interacted superficially with dentin and enamel; (3) The best bonding effectiveness with this new auto-adhesive cement was obtained by selectively acid-etching enamel prior to luting.     

Influence of Er,Cr:YSGG laser treatment on the microtensile bond strength of adhesives to dentin

PURPOSE: In light of the concept of minimally invasive dentistry, erbium lasers have been considered as an alternative technique to the use of diamond burs for cavity preparation. The purpose of this study was to assess the bonding effectiveness of adhesives to Er,Cr:YSGG laser-irradiated dentin using irradiation settings specific for cavity preparation. MATERIALS AND METHODS: Fifty-four midcoronal dentin surfaces, obtained from sound human molars, were irradiated with an Er,Cr:YSGG laser or prepared with a diamond bur using a high-speed turbine. One etch-and-rinse (Optibond FL/Kerr) and three self-etching adhesives (Adper Prompt L-Pop/3M ESPE, Clearfil SE Bond/Kuraray, and Clearfil S3 Bond/Kuraray) were used to bond the composite to dentin. The microtensile bond strength (microTBS) was determined after 24 h of storage in water at 37 degrees C. The Kruskal-Wallis test was used to determine pairwise statistical differences (p < 0.05). Prepared dentin surfaces, adhesive interfaces, and failure patterns were analyzed using a stereomicroscope and Field-emission gun Scanning Electron Microscopy (Feg-SEM). RESULTS: Significantly lower microTBS was observed to laser-irradiated than to bur-cut dentin (p < 0.05), irrespective of the adhesive employed. Feg-SEM photomicrographs of lased dentin revealed an imbricate patterned substrate and the presence of microcracks at the dentin surface. CONCLUSION: Morphological alterations produced by Er,Cr:YSGG laser-irradiation adversely influence the bonding effectiveness of adhesives to dentin.     

Bonding effectiveness of adhesive luting agents to enamel and dentin.

OBJECTIVES: The bonding effectiveness of five adhesive luting agents to enamel and dentin using different application procedures was determined using a micro-tensile bond strength protocol (microTBS). METHODS: Enamel/dentin surfaces of human third molars were flattened using a high-speed diamond bur. Composite resin blocks (Paradigm, 3M ESPE) were luted using either Linkmax (LM; GC), Nexus 2 (NX; Kerr), Panavia F (PN; Kuraray), RelyX Unicem (UN; 3M ESPE) or Variolink II (VL; Ivoclar-Vivadent), strictly following manufacturers' instructions. For some luting agents, modified application procedures were also tested, resulting in four other experimental groups: Prompt L-Pop+RelyX Unicem (PLP+UN; 3M ESPE), Scotchbond Etchant+RelyX Unicem (SE+UN; 3M ESPE), Optibond Solo Plus Activator+Nexus 2 (ACT+NX; Kerr) and K-Etchant gel+Panavia-F (KE+P; Kuraray). The experimental groups were classified according to the adhesive approach in self-adhesive (UN), etch-and-rinse (ACT+NX, NX, KE+P, SE+UN and VL when bonded to enamel) and self-etch adhesive luting agents (LM, PLP+UN, PN and VL when bonded to dentin). The specimens were stored for 24h in distilled water at 37 degrees C prior to microTBS testing. The Kruskal-Wallis test was used to determine pairwise statistical differences (p<0.05) in microTBS between the experimental groups. RESULTS: When bonded to enamel, ACT+NX (15 MPa) and UN (19.6 MPa) scored significantly lower than VL (49.3 MPa), LM (49.2 MPa), PN (35.4 MPa) and SE+UN (35.2 MPa), while PLP+UN (23.5 MPa) showed a significantly lower microTBS than VL (49.3 MPa) and LM (49.2 MPa). No significant differences were noticed between VL (49.3 MPa), LM (49.2 MPa), NX (37.9 MPa), KE+PN (38.8 MPa), PN (35.4 MPa) and SE+UN (35.2 MPa). Regarding the bonding effectiveness to dentin, all luting agents bonded equally effectively (UN: 15.9 MPa; LM: 15.4 MPa; PN: 17.5 MPa; NX: 22.3 MPa), except VL (1.1 MPa), SE+UN (5.9 MPa) and ACT+NX (13.2 MPa). VL revealed an exceptionally high number of pre-testing failures, most likely due to a combined effect of not having cured the adhesive separately and an insufficiently light-cured luting agent. SIGNIFICANCE: Following a correct application procedure, the etch-and-rinse, self-etch and self-adhesive luting agents are equally effective in bonding to enamel and dentin. Several factors negatively influenced bond strength such as bonding RelyX Unicem to enamel without prior phosphoric acid etching; no separate light-curing of a light-polymerizable adhesive prior to cementation, use of a light-polymerizing adhesive converted into a dual-polymerizing adhesive, and use of a dual-cure luting agent with a low auto-polymerizable potential.     

Effect of operator skill in relation to microleakage of total-etch and self-etch bonding systems

OBJECTIVES: To evaluate the influence of operator skill on microleakage in class V restorations using two-step bonding systems. METHODS: Two standardized box cavities were made on the buccal and lingual surfaces of 54 human bicuspid teeth, with the cervical margin in dentin. The teeth were randomly assigned to two groups according to the operator's skill. Students group: undergraduate students. Expert group: a dentist with 20 years of clinical experience in dental adhesion. The buccal cavities of each tooth were treated with Prime&Bond NT (two-step total-etch system); the lingual cavities were treated with AdheSE (two-step self-etch system). All cavities were restored by a single calibrated operator with one bulk increment of resin composite (InTens; Ivoclar Vivadent). Specimens were thermocycled, immersed in 2% methylene blue and sectioned in a bucco-lingual plane in the middle of the restorations. They were then examined under a stereomicroscope and scored according to microleakage by two operators who were blind to the specimen preparation. The data was subjected to a multilevel statistical model. RESULTS: The microleakage resulting from the self-etch adhesive was similar in the student and in the expert groups. On the other hand, the total-etch adhesive microleakage within the expert group resulted lower than that within the student group. However, the interaction term skill x adhesive resulted statistically significant at the dentin margin (p=0.0474) but not at the enamel margin (p=0.1267). CONCLUSION: While the total-etch adhesive used in this study showed to be skill-sensitive, the self-etch one proved to be less skill-sensitive in obtaining a reliable seal with dentin.     

Durability of enamel bonding using two-step self-etch systems on ground and unground enamel

This study examined the early and long-term microtensile bond strengths (MTBS) and interfacial enamel gap formation (IGW) of two-step self-etch systems to unground and ground enamel. Resin composite (Filtek Z250) buildups were bonded to proximal enamel surfaces (unground, bur-cut or SiC-treated enamel) of third molars after the application of four self-etch adhesives: a mild (Clearfil SE Bond [SE]), two moderate (Optibond Solo Plus Self-Etch Primer [SO] and AdheSE [AD]) and a strong adhesive (Tyrian Self Priming Etchant + One Step Plus [TY]) and two etch-and-rinse adhesive systems (Single Bond [SB] and Scotchbond Multi-Purpose Plus [SBMP]). Ten tooth halves were assigned for each adhesive. After storage in water (24 hours/37 degrees C), the bonded specimens were sectioned into beams (0.9 mm2) and subjected to microTBS (0.5 mm/minute) or interfacial gap width measurement (stereomicroscope at 400x) either immediately (IM) or after 12 months (12M) of water storage. The data were analyzed by three-way repeated measures ANOVA and Tukey's test (alpha=0.05). No gap formation was observed in any experimental condition. The microTBS in the Si-C paper and diamond bur groups were similar and greater than the unground group only for the moderate self-etch systems (SO and AD). No reductions in bond strength values were observed after 12 months of water storage, regardless of the adhesive evaluated.