Guido Vanherle

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 (μTBS) 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 μTBS of any adhesive, while direct exposure resulted in a significantly reduced μTBS 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.

Morphological Aspects of the Resin-Dentin Interdiffusion Zone with Different Dentin Adhesive Systems

Cross-sections of resin-dentin interfaces were etched with an argon-ion beam to make their substructure detectable by scanning electron microscopy. The dentin adhesive systems were categorized morphologically into three groups, and an attempt was made to clarify their adhesive mechanism. The first group of products removed the smear layer. The argon-ion bombardment clearly disclosed a hybrid or resin-impregnated dentin layer. It is hypothesized that conditioning with acidic or chelating agents demineralized the dentin surface-layer to a certain depth, leaving behind a collagen-rich mesh-work. Hydrophilic monomers are then believed to alter this collagen-fiber arrangement in a way that facilitates penetration of the adhesive resin, resulting in a mechanical, intermingled link between collagen and the adhesive resin. The second group preserved the smear layer. In this case, the dentinal tubules were obliterated with globular particles at their orifices and remained patent underneath these smear plugs. This type of adhesive system aims at the incorporation of the smear layer into the hydrophilic monomers, which have an affinity for the organic and/or inorganic components of the underlying dentin. Finally, a third, small group only partly dissolved the smear layer, creating a thin resin-impregnated dentin layer and a resin-impregnated smear plug. This study clearly showed that the application of recent adhesive systems induced structural changes in the dentin surface morphology, creating a retentive interface, called the interdiffusion zone, between the deep, untouched dentin layers and the composite filling material. This resin-dentin interdiffusion zone offers bonding sites for copolymerization with the resin composite and, concurrently, might have protective potential for the pulp tissues.

The clinical performance of adhesives

OBJECTIVES Traditional mechanical methods of retaining restorative materials have been replaced to a large extent by tooth conserving adhesive restorative techniques. Because adhesives have been evolving so rapidly for the last few years, the timing is right for evaluating the clinical status of present day adhesives. DATA SOURCES Current literature with regard to the clinical performance of adhesives has been reviewed. An overview of currently available adhesive systems is provided and a categorization of these adhesives according to their clinical application procedure and their intended mechanism of adhesion is proposed. Parameters of direct relevance to the clinical effectiveness of adhesives are discussed in relation to the clinical effectiveness of todays adhesives. CONCLUSIONS The clinical performance of present day adhesives has significantly improved, allowing adhesive restorations to be placed with a high predictable level of clinical success. Most modern adhesive systems are superior to their predecessors, especially in terms of retention that is no longer the main cause of premature clinical failure. Recent adhesives also appear less sensitive to substrate and other clinical co-variables. As the remaining major shortcoming of modern adhesives, none of these modern systems however appears yet to be able to guarantee hermetically sealed restorations with margins free of discoloration for a long time.

Evidence of Chemical Bonding at Biomaterial-Hard Tissue Interfaces

For many years, glass-polyalkenoate cements have been described as possessing the unique properties of self-adherence to human hard tissues, such as bones or teeth. However, direct experimental evidence to prove the existence of chemical bonding has not been advanced. X-ray Photoelectron Spectroscopy (XPS) was used to analyze the chemical interaction of a synthesized polyalkenoic acid with enamel and synthetic hydroxyapatite. For both enamel and hydroxyapatite, the peak representing the carboxyl groups of the polyalkenoic acid was detected to have significantly shifted to a lower binding energy. De-convolution of this shifted peak disclosed two components with a peak representing unreacted carboxyl groups and a peak suggesting chemical bonding to hydroxyapatite. On average, 67.5% of the carboxyl groups of the polyalkenoic acid were measured to have bonded to hydroxyapatite. XPS of hydroxyapatite also disclosed its surface to be enriched in calcium and decreased in phosphorus, indicating that phosphorus was extracted at a relatively higher rate than calcium. Analysis of these data supports the mechanism in which carboxylic groups replace phosphate ions (PO 4 3-) of the substrate and make ionic bonds with calcium ions of hydroxyapatite. It is concluded that an ultrathin layer of a polyalkenoic acid can be prepared on a hydroxyapatite-based substrate by careful removal of non-bonded molecules. With this specimen-processing method, XPS not only provided direct evidence of chemical bonding, but also enabled us to quantify the percentages of functional groups of the polyalkenoic acids that bonded to calcium of hydroxyapatite.

Porcelain veneers: a review of the literature.

OBJECTIVES Porcelain veneers are steadily increasing in popularity among todays dental practitioners for conservative restoration of unaesthetic anterior teeth. As with any new procedure, in vitro and in vivo investigations are required to assess the ultimate clinical efficacy of these restorations. The current literature was therefore reviewed in search for the most important parameters determining the long-term success of porcelain veneers. DATA SOURCES Laboratory studies focusing on parameters in prediction of the clinical efficacy of porcelain veneers such as the tooth preparation for porcelain veneers, the selection and type of the adhesive system, the quality of marginal adaptation, the resistance against microleakage, the periodontal response, and the aesthetic characteristics of the restorations have been reviewed. The clinical relevance of these parameters was then determined by reviewing the results of short and medium to long-term in vivo studies involving porcelain veneers performed during the last 10 years. CONCLUSIONS The adhesive porcelain veneer complex has been proven to be a very strong complex in vitro and in vivo. An optimal bonded restoration was achieved especially if the preparation was located completely in enamel, if correct adhesive treatment procedures were carried out and if a suitable luting composite was selected. The maintenance of aesthetics of porcelain veneers in the medium to long term was excellent, patient satisfaction was high and porcelain veneers had no adverse effects on gingival health inpatients with an optimal oral hygiene. Major shortcomings of the porcelain veneer system were described as a relatively large marginal discrepancy, and an insufficient wear resistance of the luting composite. Although these shortcomings had no direct impact on the clinical success of porcelain veneers in the medium term, their influence on the overall clinical performance in the long term is still unknown and therefore needs further study.

A classification of dental composites according to their morphological and mechanical characteristics

The on-going search for a biologically acceptable restorative material has brought a confusing variety of composites on the dental market. In the present study, commercially available composites are categorized as a function of their mean particle size, filler distribution, filler content, Youngs modulus, surface roughness, compressive strength, surface hardness, and filler morphology. Out of this information, it can be concluded that the materials of choice for restoring posterior cavities at present are the Ultrafine Compact-Filled Composites because their intrinsic surface roughness, Youngs modulus and, indirectly, their filler content, compressive strength, and surface hardness are comparable to the same properties of enamel and dentin. The Ultrafine Midway-Filled Composites seem to be very satisfactory materials for anterior use.

Comparative Physico-mechanical Characterization of New Hybrid Restorative Materials with Conventional Glass-ionomer and Resin Composite Restorative Materials

The recently developed hybrid restorative materials contain the essential components of conventional glass ionomers and light-cured resins. The objective of this study was to determine several physical and mechanical properties of eight such materials in comparison with two conventional glass ionomers, one micro-filled, and one ultrafine compact-filled resin composite. The two resin composites and two of the three polyacid-modified resin composites could be polished to a higher gloss than the conventional as well as the resin-modified glass ionomers. After abrasion, surface roughness increased for all materials, but not at the same extent, being the least for the conventional resin composites and one polyacid-modified resin composite, Dyract. In contrast to the latter resin composites, of which the surface roughness is principally determined by the presence of protruding filler particles above the resin matrix, roughness of conventional and resin-modified glass ionomers results from both protruding filler particles and intruding porosities. The mean particle size of the hybrid restorative materials fell between the smaller mean particle size of the resin composites and the larger one of the conventional glass ionomers. The micro-hardness and Youngs modulus values varied substantially among all eight hybrid restorative materials. For all the resin-modified glass-ionomer restorative materials, the Youngs modulus reached a maximum value one month after mixing and remained relatively stable thereafter. The Youngs modulus of the conventional and the polyacid-modified resin composites decreased slightly after one month. The conventional glass-ionomer materials undoubtedly set the slowest, since their Youngs modulus took six months to reach its maximum. The flexural fatigue limit of the hybrid restorative materials is comparable with that of the micro-filled composite. From this investigation, it can be concluded that the physico-mechanical properties vary widely among the eight hybrid restorative materials, indicating that these materials probably have yet to achieve their optimum properties. Their mechanical strength is inadequate for use in stress-bearing areas, and their appearance keeps them from use where esthetics is a primary concern.

Quantitative in vivo Wear of Human Enamel

In this study, the attrition wear, also called occlusal-contact-area wear, of human enamel was measured quantitatively with a computerized three-dimensional measuring technique over a period of four years. Tooth replicas from a clinical trial were used. A running-in wearperiod after restorative treatment, followed by steady-state wear, was suggested. The average steady-wear rate on occlusal contact areas was about 29 μm per year for molars and about 15 μm per year for premolars.

A TEM Study of Two Water-based Adhesive Systems Bonded to Dry and Wet Dentin

To keep the exposed collagen scaffold penetrable to resin, it has been recommended that the conditioned dentin surface be maintained in a visibly moist condition, a clinical technique commonly referred to as wet bonding. In this study, resin-dentin interfaces produced with two water-based adhesive systems-OptiBond (OPTI, Kerr) and Scotchbond Multi-Purpose (SBMP, 3M)-were compared by transmission electron microscopy, following the application of either a dry- or a wet-bonding technique. The hypothesis advanced was that the ultramorphology of the hybrid layer would differ depending on which bonding method was applied. A morphologically well-organized hybrid layer of collagen fibrils intermingled with resin in tiny interfibrillar channels was consistently formed by the OPTI system. The SBMP system was found to produce a hybrid layer with a more variable ultrastructure, less distinctly outlined collagen fibrils, and a characteristic electron-dense phase located at its surface. No major differences in hybrid layer ultrastructure were observed when the two adhesive systems investigated were bonded to either dry or wet dentin. When the adhesives were dry-bonded, no ultrastructural evidence of collapsed demineralized collagen, incompletely or not at all infiltrated by resin, could be detected. In addition, when the two adhesives were bonded to wet dentin, no signs of overwetting phenomena, that would have indicated that water was ineffectively removed, were apparent. It has been hypothesized that the amount of water provided with the hydrophilic primer solution of either of the two adhesive systems investigated suffices to re-hydrate and re-expand the gently air-dried and collapsed collagen network. Further research should be directed to determine whether this hypothesized self-rewetting effect can be extrapolated to other adhesive systems that provide water-based primers.

Mechanical properties and filler fraction of dental composites

Several mechanical properties of experimental composites and an unfilled resin were studied. The dynamic Youngs modulus was measured with a non-destructive dynamic method. The Youngs modulus and also the transverse strength were determined statically by means of three-point bending. The hardness was studied by means of Wallace indentation depth measurements, and in vitro wear resistance was assessed under stress-bearing conditions. An exponential regression of the results measured for each property as a function of the volumetric filler fraction was appraised. An excellent correlation was found with each property. This exponential mixture rule is proposed for the study of the mechanical properties of isotropic dental composites.