Issis Luque-Martinez

Influence of a hydrophobic resin coating on the bonding efficacy of three universal adhesives

OBJECTIVES To evaluate the effect of an additional hydrophobic resin coating (HE) on the resin-dentine microtensile bond strengths (μTBS), nanoleakage (NL), and in situ degree of conversion (DC) of three universal adhesives used in the etch-and-rinse (ER) and the self-etch (SE) modes. METHODS Sixty caries-free extracted third molars were divided into 12 groups according to the combination of the factors adhesive (All-Bond Universal [ABU]; G-Bond Plus [GBP] and Scotchbond Universal [SBU]), adhesive strategy (ER and SE), and the use of HE (Heliobond; yes or no). After restorations were constructed, specimens were stored in water (37°C/24h) and sectioned into resin-dentine beams (0.8mm(2)) to be tested under tension (0.5mm/min). Selected beams from each tooth were used for DC quantification and for NL evaluation. Data from each adhesive were analyzed with two-way ANOVA and Tukeys test (α=0.05). RESULTS ABU and GBP resulted in higher μTBS in the ER mode. The use of HE increased the μTBS of ABU and GBP only in the SE mode. Lower NL was observed for SBU and ABU in the ER mode+HE, and for GBP in the SE mode+HE. SBU and GBP showed higher DC when used in the ER mode, which was increased with HE application. The DC of ABU was similar in all conditions. CONCLUSIONS The conversion of 1-step SE to 2-step SE may increase the μTBS and DC of current universal adhesives. The reduction in the NL is more dependent on the adhesive composition than on the bonding strategy.

A new universal simplified adhesive: 36-Month randomized double-blind clinical trial

STATEMENT OF THE PROBLEM It is still debatable which technique should be used with universal adhesives, either etch-and-rinse (wet or dry) or self-etch strategy (with or without selective enamel etching). PURPOSE OF THE STUDY To evaluate the 36-month clinical performance of Scotchbond Universal Adhesive (SU, 3M ESPE) in non-carious cervical lesions (NCCLs) using two evaluation criteria. METHODS/MATERIALS Thirty-nine patients participated in this study. Two-hundred restorations were assigned to four groups: ERm: etch-and-rinse+moist dentin; ERd: etch-and-rinse+dry dentin; Set: selective enamel etching; and SE: self-etch. The same composite resin was inserted for all restorations in up to 3 increments. The restorations were evaluated at baseline and at 6-, 18-, and 36-months using both the FDI and the USPHS criteria. Statistical analyses were performed with Friedman repeated measures ANOVA by rank and McNemar test for significance in each pair (α=0.05). RESULTS Eight restorations (ERm: 1; ERd: 1; Set: 1 and SE: 5) were lost after 36 months, but only significant for SE when compared with baseline (p=0.02 for either criteria). Marginal staining occurred in 6.8% of the restorations (groups ERm, ERd, and Set) and 17.5% of the restorations (group SE), with significant difference for each group when compared with baseline using the FDI criteria (p<0.04), while statistical significance was reached only for SE when compared with baseline using the USPHS criteria (p<0.03). Twenty-eight and 49 restorations were scored as bravo for marginal adaptation using the USPHS and FDI criteria, respectively, with significant difference for each group when compared with baseline (p<0.05). CONCLUSIONS While there was no statistical difference among bonding strategies when a universal adhesive was used, there were signs of degradation when the universal adhesive was applied in SE mode. The FDI criteria remain more sensitive than the USPHS criteria, especially for the criteria marginal staining and marginal adaptation.

Effects of solvent evaporation time on immediate adhesive properties of universal adhesives to dentin

OBJECTIVE To evaluate the microtensile bond strengths (μTBS) and nanoleakage (NL) of three universal or multi-mode adhesives, applied with increasing solvent evaporation times. METHODS One-hundred and forty caries-free extracted third molars were divided into 20 groups for bond strength testing, according to three factors: (1) Adhesive - All-Bond Universal (ABU, Bisco, Inc.), Prime&Bond Elect (PBE, Dentsply), and Scotchbond Universal Adhesive (SBU, 3M ESPE); (2) Bonding strategy - self-etch (SE) or etch-and-rinse (ER); and (3) Adhesive solvent evaporation time - 5s, 15s, and 25s. Two extra groups were prepared with ABU because the respective manufacturer recommends a solvent evaporation time of 10s. After restorations were constructed, specimens were stored in water (37°C/24h). Resin-dentin beams (0.8mm(2)) were tested at 0.5mm/min (μTBS). For NL, forty extracted molars were randomly assigned to each of the 20 groups. Dentin disks were restored, immersed in ammoniacal silver nitrate, sectioned and processed for evaluation under a FESEM in backscattered mode. Data from μTBS were analyzed using two-way ANOVA (adhesive vs. drying time) for each strategy, and Tukeys test (α=0.05). NL data were computed with non-parametric tests (Kruskal-Wallis and Mann-Whitney tests, α=0.05). RESULTS Increasing solvent evaporation time from 5s to 25s resulted in statistically higher mean μTBS for all adhesives when used in ER mode. Regarding NL, ER resulted in greater NL than SE for each of the evaporation times regardless of the adhesive used. A solvent evaporation time of 25s resulted in the lowest NL for SBU-ER. SIGNIFICANCE Residual water and/or solvent may compromise the performance of universal adhesives, which may be improved with extended evaporation times.

Immediate adhesive properties to dentin and enamel of a universal adhesive associated with a hydrophobic resin coat

OBJECTIVES To evaluate the effect of acid etching and application of a hydrophobic resin coat on the enamel/dentin bond strengths and degree of conversion (DC) within the hybrid layer of a universal adhesive system (G-Bond Plus [GB]). METHODS A total of 60 extracted third molars were divided into four groups for bond-strength testing, according to the adhesive strategy: GB applied as a one-step self-etch adhesive (1-stepSE); GB applied as in 1-stepSE followed by one coat of the hydrophobic resin Heliobond (2-stepSE); GB applied as a two-step etch-and-rinse adhesive (2-stepER); GB applied as in 2-stepER followed by one coat of the hydrophobic resin Heliobond (3-stepER). There were 40 teeth used for enamel microshear bond strength (μSBS) and DC; and 20 teeth used for dentin microtensile bond strength (μTBS) and DC. After restorations were constructed, specimens were stored in water (37°C/24 h) and then tested at 0.5 mm/min (μTBS) or 1.0 mm/min (μSBS). Enamel-resin and dentin-resin interfaces from each group were evaluated for DC using micro-Raman spectroscopy. Data were analyzed with two-way analysis of variance for each substrate and the Tukey test (α=0.05). RESULTS For enamel, the use of a hydrophobic resin coat resulted in statistically significant higher mean enamel μSBS only for the ER strategy (3-stepER vs 2-stepER, p<0.0002). DC was significantly improved for the SE strategy (p<0.00002). For dentin, the use of a hydrophobic resin coat resulted in significantly higher dentin mean μTBS only for the SE strategy (2-stepSE vs 1-stepSE, p<0.0007). DC was significantly improved in groups 2-stepSE and 3-stepER when compared with 1-stepSE and 2-stepER, respectively (p<0.0009). CONCLUSIONS The use of a hydrophobic resin coat may be beneficial for the selective enamel etching technique, because it improves bond strengths to enamel when applied with the ER strategy and to dentin when used with the SE adhesion strategy. The application of a hydrophobic resin coat may improve DC in resin-dentin interfaces formed with either the SE or the ER strategy. On enamel, DC may benefit from the application of a hydrophobic resin coat over 1-stepSE adhesives.

Does active application of universal adhesives to enamel in self-etch mode improve their performance?

OBJECTIVES To evaluate the effect of adhesion strategy on the enamel microshear bond strengths (μSBS), etching pattern, and in situ degree of conversion (DC) of seven universal adhesives. METHODS 84 extracted third molars were sectioned in four parts (buccal, lingual, proximal) and divided into 21 groups, according to the combination of the main factors adhesive (AdheSE Universal [ADU], All-Bond Universal [ABU], Clearfil Universal [CFU], Futurabond U [FBU], G-Bond Plus [GBP], Prime&Bond Elect (PBE), and Scotchbond Universal Adhesive [SBU]), and adhesion strategy (etch-and-rinse, active self-etch, and passive self-etch). Specimens were stored in water (37°C/24h) and tested at 1.0mm/min (μSBS). Enamel-resin interfaces were evaluated for DC using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a field-emission scanning electron microscope (direct and replica techniques). Data were analyzed with two-way ANOVA and Tukeys test (α=0.05). RESULTS Active self-etch application increased μSBS and DC for five out of the seven universal adhesives when compared to passive application (p<0.001). A deeper enamel-etching pattern was observed for all universal adhesives in the etch-and-rinse strategy. A slight improvement in etching ability was observed in active self-etch application compared to that of passive self-etch application. Replicas of GBP and PBE applied in active self-etch mode displayed morphological features compatible with water droplets. The DC of GBP and PBE were not affected by the application/strategy mode. CONCLUSIONS In light of the improved performance of universal adhesives when applied actively in SE mode, selective enamel etching with phosphoric acid may not be crucial for their adhesion to enamel. CLINICAL SIGNIFICANCE The active application of universal adhesives in self-etch mode may be a practical alternative to enamel etching in specific clinical situations.

Degradation of dentin-bonded interfaces treated with collagen cross-linking agents in a cariogenic oral environment: An in situ study

OBJECTIVES To evaluate the effect of treatment using collagen cross-linking agents as primer on resin-dentin bond interfaces subjected to cariogenic oral environment (COE). METHODS Each of forty human teeth had two cavities (4×4×1.5mm) prepared within enamel margins. These cavities were acid-etched and treated by the primers containing one of the following treatment agents (6.5% proanthocyanidins, 0.1% riboflavin-UVA activated light, 5% glutaraldehyde or distilled water as a control group). After that the cavities were bonded and restored with resin composite. One restoration for each tooth was tested immediately (IM) and another was included in an intra-oral palatal device that was placed in each mouth of ten adult volunteers for 14 days in COE. After 14 days, the teeth were removed and each restoration was sectioned to obtain a slice for Knoop microhardness (KHN) and resin-dentin bonded sticks for microtensile bond strength (μTBS) and nanoleakage (NL) evaluation. Data were evaluated by two-way ANOVA and Tukeys tests (α=0.05). RESULTS After 14days in a COE, the KHN was reduced for all groups, except for the glutaraldehyde group; however, the proanthocyanidins group retained the highest KHN in IM and after COE (p<0.05). The μTBS was not reduced after COE for the proanthocyanidins and glutaraldehyde groups, however only the proanthocyanidins treatment did not increase the NL after COE (p>0.05). CONCLUSION The in situ study model seems to be a suitable short-term methodology to investigate the degradation of the bonding interfaces under a more realistic condition. Under COE, the proanthocyanidins and glutaraldehyde treatments produced stable interfaces that are worth further clinical investigation.

The effect of proanthocyanidin-containing 10% phosphoric acid on bonding properties and MMP inhibition

OBJECTIVES This study evaluated the effect of etching using 2% proanthocynidin-containing 10% phosphoric acid 2% PA/10% PhA vs. 35% phosphoric acid 35% PhA on immediate (IM) and 6-months (6M) resin-enamel microshear bond strength (μSBS), resin-dentin microtensile bond strength (μTBS), nanoleakage (NL) and as well as in situ MMP inhibition potential. METHODS The dentin surface of human were exposed and then etched using 35% phosphoric acid for 15s or 2% PA/10% phosphoric acid for 30s. After rinsing with water, the dentin was bonded with Single Bond Plus (3M ESPE) and composite build-ups were constructed, followed by polymerization. The teeth were sectioned and the bonds were testing for microtensile bond strength (μTBS) and by SEM for NL analysis at IM and 6M. For MMP activity, resin-dentin slices were prepared for in situ zymography, and analyzed under confocal microscopy. For μSBS, others teeth had flattened enamel surfaces etched according the experimental groups and prepared to microshear procedure. The specimens were tested IM and after 6M by microshear bond strength. The data were submitted to two-way repeated measures ANOVA and Tukeys test (α=0.05). RESULTS Acid-etching using the 2% PA/10% phosphoric acid did not lower the μTBS in IM (p>0.05) compared to the control 35% phosphoric acid group. However, after 6M, only the 2% PA/10% PhA etched dentin had remained stable the resin-dentin bond strength (p<0.05). Bonds made with 35% PhA showed significant increase in NL% after 6M (p<0.05). Dentin bonds made with 2% PA/10% phosphoric acid showed no increase in NL% after 6 months. The MMP activity within the resin-dentin interface was almost completely reduced after 2% PA/10% PhA etching, while the 35% PhA exhibited intense MMP activity. For μSBS, the type of etchant and the storage period did not affect the resin-enamel bond strengths (p>0.05). SIGNIFICANCE Ten percent phosphoric acid containing 2% PA can produce stable resin-dentin and enamel-resin interfaces, without requiring additional steps in the bonding procedure. Future studies for longer evaluation time are required.

A Comprehensive Laboratory Screening of Three-Step Etch-and-Rinse Adhesives

OBJECTIVES This study evaluated several bonding (microtensile bond strengths [μTBS], nanoleakage [NL], and in situ degree of conversion [ISDC] on dentin) and mechanical properties (ultimate tensile strength [UTS], degree of conversion [DC], water sorption [WS], and solubility [SL] in water) of four three-step etch-and-rinse adhesives in the short term. METHODS A total of 28 molars were used in this study. The dentin surfaces were bonded with the following adhesives: All-Bond 3 (ALB3); Fusion Duralink (FSDL); Optibond FL (OBFL), and Scotchbond Multi-Purpose (SBMP). After each adhesive-system application, composite resin build-ups were added. For bonding tests, specimens were sectioned in order to obtain bonded sticks. The sticks were divided to be tested for μTBS (0.5 mm/min), for NL (n=2), and ISDC (n=2). For NL, they were immersed in 50% silver nitrate and analyzed by scanning election microscopy. For ISDC, the hybrid layer was evaluated by micro-Raman spectroscopy. An hourglass-shaped matrix (UTS) or disk-shaped matrix (WS and SL) was filled with primer and adhesive (1:1 ratio) and light-polymerized. For UTS evaluation, the specimens were tested under tension. For WS and SL, specimens were desiccated and stored in distilled water to evaluate water diffusion kinetics over a 28-day period. The DC of the adhesives was evaluated by Fourier transformed infrared spectroscopy. The data from each test were analyzed by appropriate statistical methods. RESULTS OBFL resulted in the highest μTBS, lower NL, higher ISDC and DC, and higher UTS than other adhesives (p<0.05), as well as lower WS (similar to ALB3 and FSDL) and SL (similar to ALB3 and SBMP) (p>0.05). ALB3 showed a higher NL and the lowest DC value. FSDL showed the highest NL and SL and the lowest ISDC. SBMP showed the lowest pattern of WS (p<0.05)CONCLUSION: OBFL showed the best results in all the properties evaluated, and it can be considered the gold standard of the three-step etch-and-rinse adhesive systems.

Effect of EDTA conditioning on cervical restorations bonded with a self-etch adhesive: A randomized double-blind clinical trial

OBJECTIVE To compare the 18-month retention rates of composite restorations in non-carious cervical lesions [NCCLs] bonded with a self-etch adhesive with and without preliminary conditioning with EDTA. METHODS Forty-eight patients with two similar-sized NCCL were selected and randomly allocated to one of two groups. Two calibrated operators placed 96 restorations with a one-step self-etch adhesive (Adper Easy One, 3M ESPE). Half of the restorations were placed according to the manufacturers instructions while, for the other half, the surfaces of the lesions were conditioned with 17% EDTA for 2 min prior to adhesive application. Two blinded and independent examiners evaluated the restorations at baseline, 6, 12, and 18 months, according to the FDI criteria. The comparison between groups in each period was conducted with the Fishers exact test, and the performance of each group at the different periods was evaluated by McNemars test (α=0.05). RESULTS After 18 months, significantly higher retention rates (95% CI) were observed for the EDTA group (95.5 [84.9-98.7]) than the control group (79.6% [65.5-88.9]) (p=0.02). Significant deterioration of the marginal adaptation and marginal discoloration were observed for both groups over the 18-month evaluation. CONCLUSIONS The preliminary conditioning with EDTA before application of a one-step self-etch adhesive significantly improved the retention rates of composite restorations in cervical lesions. CLINICAL SIGNIFICANCE Conditioning with EDTA is an alternative that improves the 18-month retention rate of cervical restorations bonded with a self-etch adhesive.