Annelies Van Ende

Bulk-filling of high C-factor posterior cavities: Effect on adhesion to cavity-bottom dentin

OBJECTIVES To evaluate the effect of bulk-filling high C-factor posterior cavities on adhesion to cavity-bottom dentin. METHODS A universal flowable composite (G-ænial Universal Flo, GC), a bulk-fill flowable base composite (SDR Posterior Bulk Fill Flowable Base, Dentsply) and a conventional paste-like composite (Z100, 3M ESPE) were bonded (G-ænial Bond, GC) into standardized cavities with different cavity configurations (C-factors), namely C=3.86 (Class-I cavity of 2.5mm deep, bulk-filled), C=5.57 (Class-I cavity of 4mm deep, bulk-filled), C=1.95 (Class-I cavity of 2.5mm deep, filled in three equal layers) and C=0.26 (flat surface). After one-week water storage, the restorations were sectioned in 4 rectangular micro-specimens and subjected to a micro-tensile bond strength (μTBS) test. RESULTS Highly significant differences were found between pairs of means of the experimental groups (Kruskal-Wallis, p<0.0001). Using the bulk-fill flowable base composite SDR (Dentsply), no significant differences in μTBS were measured among all cavity configurations (p>0.05). Using the universal flowable composite G-ænial Universal Flo (GC) and the conventional paste-like composite Z100 (3M ESPE), the μTBS to cavity-bottom dentin was not significantly different from that of SDR (Dentsply) when the cavities were layer-filled or the flat surface was build up in layers; it was however significantly lower when the Class-I cavities were filled in bulk, irrespective of cavity depth. SIGNIFICANCE The filling technique and composite type may have a great impact on the adhesion of the composite, in particular in high C-factor cavities. While the bulk-fill flowable base composite provided satisfactory bond strengths regardless of filling technique and cavity depth, adhesion failed when conventional composites were used in bulk.

TEM Characterization of a Silorane Composite Bonded to Enamel/Dentin

OBJECTIVES The low-shrinking composite composed of combined siloxane-oxirane technology (Filtek Silorane, 3M ESPE, Seefeld, Germany) required the development of a specific adhesive (Silorane System Adhesive, 3M ESPE), in particular because of the high hydrophobicity of the silorane composite. The purpose of this study was to characterize the interfacial ultra-structure at enamel and dentin using transmission electron microscopy (TEM). METHODS Non-demineralized/demineralized 70-90 nm sections were prepared following common TEM specimen processing procedures. RESULTS TEM revealed a typical twofold build-up of the adhesive resin, resulting in a total adhesive layer thickness of 10-20 microm. At bur-cut enamel, a tight interface without distinct dissolution of hydroxyapatite was observed. At bur-cut dentin, a relatively thin hybrid layer of maximum a few hundreds of nanometer was formed without clear surface demineralization. No clear resin tags were formed. At fractured dentin, the interaction appeared very superficial (100-200 nm). Distinct resin tags were formed due to the absence of smear plugs. Silver-nitrate infiltration showed a varying pattern of both spot- and cluster-like appearance of nano-leakage. Traces of Ag were typically detected along some part of the enamel-adhesive interface and/or between the two adhesive resin layers. Substantially more Ag-infiltration was observed along the dentin-adhesive interface of bur-cut dentin, as compared to that of fractured dentin. CONCLUSIONS The nano-interaction of Silorane System Adhesive should be attributed to its relatively high pH of 2.7. The obtained tight interface at both enamel and dentin indicates that the two-step self-etch adhesive effectively bridged the hydrophilic tooth substrate with the hydrophobic silorane composite.

Fracture toughness versus micro-tensile bond strength testing of adhesive-dentin interfaces

OBJECTIVE To assess interfacial fracture toughness of different adhesive approaches and compare to a standard micro-tensile bond-strength (μTBS) test. METHODS Chevron-notched beam fracture toughness (CNB) was measured following a modified ISO 24370 standard. Composite bars with dimensions of 3.0×4.0×25 mm were prepared, with the adhesive-dentin interface in the middle. At the adhesive-dentin interface, a chevron notch was prepared using a 0.15 mm thin diamond blade mounted in a water-cooled diamond saw. Each specimen was loaded until failure in a 4-point bend test setup and the fracture toughness was calculated according to the ISO specifications. Similarly, adhesive-dentin micro-specimens (1.0×1.0×8-10 mm) were stressed in tensile until failure to determine the μTBS. RESULTS A positive correlation (r(2)=0.64) was observed between CNB and μTBS, which however was only nearly statistically significant, mainly due to the dissimilar outcome of Scotchbond Universal (3M ESPE). While few μTBS specimens failed at the adhesive-dentin interface, almost all CNB specimens failed interfacially at the notch tip. Weibull moduli for interfacial fracture toughness were much higher than for μTBS (3.8-11.5 versus 2.7-4.8, respectively), especially relevant with regard to early failures. SIGNIFICANCE Although the ranking of the adhesives on their bonding effectiveness tested using CNB and μTBS corresponded well, the outcome of CNB appeared more reliable and less variable. Fracture toughness measurement is however more laborious and requires specific equipment. The μTBS nevertheless appeared to remain a valid method to assess bonding effectiveness in a versatile way.

3D volumetric displacement and strain analysis of composite polymerization

OBJECTIVE The present study aimed at a better understanding of the internal shrinkage patterns within different cavity sizes. METHODS Ten cylindrical cavities in two sizes were filled with a flowable composite and scanned using X-ray micro-computed tomography (μ-CT) before filling, before and after polymerization. Three-dimensional (3D) non-rigid image registration was applied to sets of two subsequent μ-CT images, before and after polymerization in order to calculate the displacements and strains caused by polymerization shrinkage. RESULTS 3D volumetric displacement analysis disclosed a main vertical component for both the small and large cavities, however in the latter the downward direction reversed to an upward direction from a depth of approximately 2mm due to debonding at the bottom. Air bubbles and voids in the restorations increased upon polymerization, causing a reverse in strain in the surrounding areas. SIGNIFICANCE Polymerization-induced shrinkage stress in composite restorations cannot be measured directly. This exploratory study revealed more information on cavity-size dependent shrinkage patterns and opens the way to more extensive studies using different composite materials and varying geometric cavity configurations.

Interfacial fracture toughness of aged adhesive-dentin interfaces.

OBJECTIVE To assess interfacial fracture toughness of different adhesive approaches and compare to a standard micro-tensile bond-strength (μTBS) test after 6 months water storage. METHODS Chevron-notched beam fracture toughness (CNB) was determined using a modified ISO 24370:2005 standard. Adhesive-dentin micro-specimens (1.0 mm × 1.0 mm × 8-10 mm) were stressed in tensile until failure to determine the micro-tensile bond strength (μTBS). RESULTS The highest mean μTBS and interfacial fracture toughness were measured for the multi-step adhesives Clearfil SE Bond (Kuraray Noritake) and OptiBond FL (Kerr). While large differences were observed in the bond strength values (from 7.4 to 27.2 MPa) of the one-step self-etch adhesives tested, interfacial fracture toughness was less different (from 0.7 to 1.0 MPam(1/2)). The adhesive with the lowest mean toughness (All-bond Universal, Bisco) had however the highest Weibull reliability, which might be a better parameter in regard to more consistent clinical performance. The self-adhesive composite Vertise Flow (Kerr) scored significantly lower at all levels. SIGNIFICANCE Although the ranking of the adhesives tested using CNB and μTBS corresponded well, the outcome of CNB appeared more reliable and less variable.

3D-microleakage assessment of adhesive interfaces: exploratory findings by μCT.

OBJECTIVES To explore the feasibility of a 3D-microleakage protocol for the evaluation of various configurations of adhesive-tooth interfaces. METHODS Three different kinds of specimens were prepared: (1) a Class-I composite restoration placed without any bonding to maximize gap formation at the interface; (2) a glass-fiber post cemented with a self-adhesive composite cement into a prepared root canal; and (3) inlay MOD composite restorations placed with either a 1-step self-adhesive or a 2-step etch-and-rinse composite cement. After silver-nitrate (AgNO3) infiltration, the specimens were scanned using a Skyscan 1172 X-ray microtomograph (μCT; Skyscan Bruker) at 100kV, 100μA and 7.8-9.5μm resolution. Projection images were reconstructed, after which maximum-intensity projections (MIPs) and 3D-volumetric renderings were produced. For the inlays, an additional conventional stereomicroscopic (SM) microleakage evaluation was accomplished after specimen sectioning. RESULTS MIPs and 3D-renderings from specimens (1) and (2) revealed strongly varying microleakage patterns along the marginal gap/interface. For the specimens of setup (3), the high radiopacity of the 2-step composite cement hindered evaluation of the MIPs. MIP-microleakage patterns along the enamel margin of the restoration cemented with the 1-step composite cement corresponded well to the stereomicroscopic images. SIGNIFICANCE The reported μCT-protocol revealed good sensitivity to detect AgNO3 infiltration at the adhesive-tooth interface when considerable microleakage was present. When microleakage was less apparent and spread in a more diffuse pattern, evaluation with μCT was less sensitive compared to stereomicroscopic evaluation.

Limited interaction of a self-adhesive flowable composite with dentin/enamel characterized by TEM

OBJECTIVES A new category of composite which does not require any acid etching or bonding protocol prior to application has been introduced. The purpose of this study was to characterize the interfacial ultra-structure at enamel and dentin surfaces by means of transmission electron microscopy (TEM). METHODS Non-carious human third molars were randomly divided into 6 groups (bur-cut dentin, SiC-ground dentin, fractured dentin, bur-cut enamel, SiC-ground enamel, and un-cut enamel). After preparation of the respective surfaces, the self-adhesive flowable composite (Vertise Flow, Kerr) was applied. Non-demineralized/demineralized and non-stained/stained sections of 70-90nm were prepared following common TEM-specimen processing procedures. Additional specimens were immersed in an ammoniacal silver nitrate solution. RESULTS The composite-dentin interface was free of voids and no de-bonding occurred during specimen preparation. For bur-cut and SiC-ground dentin, no surface demineralization was observed and the smear contained residual hydroxyapatite. On fractured dentin (i.e. without smear interference), a very thin interaction area of 100-200nm without apparent signs of surface demineralization was seen. When the composite was bonded to enamel, a distinct separation between the self-adhesive composite and enamel was present in all three groups. A tight interaction, yet without distinct dissolution of hydroxyapatite, could only be seen in some regions at bur-cut enamel where smear was absent or sparse. Silver nitrate infiltration was associated with the presence of smear. SIGNIFICANCE The self-adhesive composite showed limited interaction with smear-covered substrates and aprismatic enamel, which explains its inferior diminished bonding capacity in comparison with current adhesives.

Strain development in bulk-filled cavities of different depths characterized using a non-destructive acoustic emission approach

OBJECTIVES (1) To evaluate the effect of cavity depth and composite type on the interfacial debonding in bulk-filled cavities. (2) To correlate the theoretical shrinkage stress and the level of interfacial debonding determined by acoustic emission (AE). METHODS 80 sound molars were divided in two groups to receive a Class-I cavity (3.5×3.5mm) with 2.5- or 4.0-mm depth. The cavities were restored with either a conventional paste-like (Filtek Z100, 3M ESPE), a conventional flowable (G-ænial Universal Flo, GC), a bulk-fill paste-like (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent) or a bulk-fill flowable (SDR, Dentsply) composite (n=10). AE signals were recorded from the start of curing for 20min. The cumulative number of AE events was correlated with the theoretical maximum shrinkage stress induced by each composite. Two samples from each group were scanned using micro-computed tomography (μCT) and qualitatively evaluated. RESULTS Both composite type and cavity depth had a significant influence on the number of AE. The conventional paste-like composite generated significantly more AE than the other composites. The AE number increased sigmoidally in function of time, with a more rapid increase after a few seconds for the conventional composites than for the bulk-fill composites. A strong linear correlation was found between the predicted shrinkage stress values and the total number of AE events for both cavities depth. Representative μCT images showed larger de-bonding areas for 4.0-mm cavities and for conventional composites. SIGNIFICANCE Premature interfacial or cohesive cracks can already develop during placement/curing of the composite. This might compromise the restoration integrity and in turn affect its survival in the long term. The amount AE events increased linearly with the theoretical maximum shrinkage stress of the composites.