Jan De Munck

Bonding effectiveness and sealing ability of fiber-post bonding

OBJECTIVES To evaluate the push-out bond strength and the sealing ability of five adhesive cements routinely used for fiber-post bonding. METHODS Fifty extracted single-rooted teeth were randomly divided in five groups and restored using Parapost FiberLux and the following luting agents: Panavia 21 (PAN), Clearfil Esthetic Cement (CLF), Variolink II (VAR), RelyX Unicem (UNI) and experimental GC self-adhesive cement (EGC). After 1 week of water storage at 37 degrees C, three sections (coronal, middle and apical) of 2mm thickness were prepared from each specimen. Sealing ability was quantified with a fluid-filtration system (Flodec) during 10 min, after which the push-out bond strength was immediately measured. Data were analyzed with ANOVA (push-out) and Kruskal-Wallis (sealing ability). RESULTS The push-out bond strength and sealing ability were not significantly different among the coronal, middle and apical sections for each luting agent. The highest push-out bond strength was measured for CLF (14.60+/-3.63 MPa), which was not significantly different from PAN (12.57+/-2.45 MPa), but significantly higher than VAR (11.09+/-4.09 MPa), UNI (11.29+/-4.31 MPa) and EGC (7.65+/-4.79 MPa). When evaluating the sealing ability, significant differences were not found among PAN, CLF and VAR, and between UNI and EGC. The latter luting agents scored significantly lower than the former ones. The push-out bond strength was correlated to the sealing ability (p<0.001). SIGNIFICANCE The self-etching MDP-based cements presented the highest push-out bond strength. Although the bonding effectiveness of self-adhesive cements appears promising, their interaction with root dentin might be too weak to minimize microleakage at the post-cement-dentin interface.

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.

Enzymatic degradation of adhesive-dentin interfaces produced by mild self-etch adhesives

Endogenous matrix metalloproteinases (MMPs) released by adhesive procedures may degrade collagen in the hybrid layer and so compromise the bonding effectiveness of etch-and-rinse adhesives. In this study, endogenous enzymatic degradation was evaluated for several simplified self-etch adhesives. In addition, primers were modified by adding two MMP inhibitors: chlorhexidine, a commonly used disinfectant, but also a non-specific MMP inhibitor; and SB-3CT, a specific inhibitor of MMP-2 and MMP-9. Gelatin zymography of fresh human dentin powder was used to identify the enzymes released by the adhesives. Micro-tensile bond strength (μTBS) testing was used to assess the mechanical properties of resin-dentin interfaces over time. In none of the experimental groups treated with the mild self-etch adhesives was MMP-2 and/or MMP-9 identified. Also, no difference in the μTBS was measured for the inhibitor-modified and the control inhibitor-free adhesives after 6 months of water storage. It is concluded that in contrast to etch-and-rinse adhesives, the involvement of endogenous MMP-2 and MMP-9 in the bond-degradation process is minimal for mild self-etch adhesives.

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 Tukeys 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 air-drying and solvent evaporation on the strength of HEMA-rich versus HEMA-free one-step adhesives

OBJECTIVES The objectives of this study were (1) to clarify the relationship between the duration of air-drying of one-step self-etch adhesives (1-SEAs) and the evaporation degree (ED) of solvents, and (2) to evaluate the effect of ED on the ultimate micro-tensile strength (microTS) of the adhesives. METHODS The ED of one HEMA-rich 1-SEA, Clearfil S3 Bond (Kuraray), and two HEMA-free 1-SEAs, iBond (Heraeus-Kulzer) and G-Bond (GC), was determined without air-drying and after, respectively, 5- and 10-s air-drying using a gravimetric method. Next, the microTS of the adhesives at ED equivalent to 0-, 5- and 10-s air-drying was measured. RESULTS The ED increased with extension of air-drying time. Among the adhesives tested, iBond showed the largest ED, followed by G-Bond and Clearfil S3 Bond in this order. A longer air-drying time for 10-s resulted in a statistically significantly higher microTS for the HEMA-rich Clearfil S3 Bond. The microTS of the latter was higher than that of the other two HEMA-free adhesives for each air-drying time. SIGNIFICANCE Air-drying of 1-SEAs had a significant effect on the degree of solvent evaporation (ED) and also on the mechanical properties (microTS) of the 1-SEAs upon setting. It is therefore beneficial to remove solvents of the 1-SEAs as much as possible by thorough, strong air-drying in order to achieve a strong adhesive layer at the interface.

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.

Is secondary caries with composites a material-based problem?

OBJECTIVE Secondary caries (SC) is one of the most important reasons for the failure of composite restorations, and thus has wide-reaching implications for the longevity of affected teeth and the health expenditure. Yet, it is currently not known whether secondary caries with composites is a material-based problem. The objective was to review literature with regard to SC around composite restorations to obtain better insights in the mechanisms behind SC with composites. METHODS Using Pubmed and Medline, international literature was searched for all articles about the clinical diagnosis, incidence and prevalence, histopathology and factors involved in the onset and development of SC around composite restorations. Additional studies were included after checking the reference lists of included papers. RESULTS SC with composites is to some extent associated to the restorative material, as significantly more caries occurred with composites than with amalgam. On the other hand, the class of the composite restoration (class V versus others and class I versus class II) was also determining for the development of SC, suggesting also other influencing factors than the material itself. The mechanisms behind the development of SC are much less clear and are most probably multifactorial. Even though the role of gaps an microleakage is questioned by some researchers, there are also indications that interfacial failure may play a role. Interfacial gaps larger than 60 μm seem to predispose interfacial demineralization, and may thus lead to caries. The question is therefore whether such interfacial gaps occur clinically? Initially, a gap may originate through polymerization shrinkage and through failure to obtain a good bond. Higher incidences of SC are observed in practice-based than in university-based studies, which may be attributed to different caries risk profiles of the included patients, or to the technique-sensitive placement procedure of composites. More research is necessary to investigate whether large gaps may arise through degradation processes. Apart from these factors, composites also seem to favor the growth of cariogenic bacteria on their surface, which has been associated with specific surface properties, release of components and lack of antibacterial properties. SIGNIFICANCE Current literature suggests that the restorative material might influence the development of secondary caries in different ways. However, it should be emphasized that patient-related factors remain the most important determinant of secondary caries.

Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a micro-CT investigation.

OBJECTIVES To determine the caries-removal effectiveness (CRE) and minimal-invasiveness potential (MIP) of contemporary caries-removal techniques. METHODS Carious molars were scanned using micro-CT, after which dentine caries was removed by 9 contemporary caries-removal techniques. The micro-CT was repeated and CRE was determined on basis of the relative volume of residual caries and the mineral density (MD) at the cavity floor. MIP was determined by measuring the cavity size relative to the initial size of the caries lesion. RESULTS CRE and MIP varied most for the Er:YAG laser (Kavo) despite its laser-induced fluorescence (LIF) feedback system. Whilst some specimens revealed much residual caries, others showed over-excavation into sound dentine. With the highest Relative Cavity Size, the Er:YAG laser presented the lowest MIP. Rotary/oscillating instruments revealed a more favourable CRE with some tendency towards over-excavation, except for CeraBur (Komet-Brasseler) and Cariex (Kavo) that typically left caries at the cavity floor and cavity walls, respectively. Chemo-mechanical excavation aided by conventional metal excavators (Carisolv, MediTeam; exp. SFC-V and SFC-VIII, 3M-ESPE) combined best CRE with MIP. When however a plastic excavator was used along with exp. SFC-VIII, caries was less completely removed. SIGNIFICANCE Er:YAG-laser aided by LIF resulted in non-selective caries removal. Rotary/oscillating caries removal may lead to over-excavation, especially when burs are combined with Caries Detector (Kuraray). This risk for over-excavation is reduced when a tungsten-carbide bur is solely used. On the contrary, Cariex (Kavo) and CeraBur showed a tendency for under-preparation. Chemo-mechanical methods were most selective in removing caries, whilst preserving sound tissue.

Influence of sintering conditions on low-temperature degradation of dental zirconia

UNLABELLED The effect of sintering conditions and concomitant microstructure of dental zirconia (ZrO2) ceramics on their low-temperature degradation (LTD) behavior remains unclear. OBJECTIVES Therefore, their effect on LTD of dental ZrO2 ceramics was investigated. METHODS Three commercial pre-sintered yttria-stabilized dental zirconia materials were sintered at three temperatures (1450°C, 1550°C and 1650°C) applying three dwell times (1, 2 and 4h). Grain size measurements and LTD tests were performed on polished sample surfaces. LTD tests were performed at 134°C in an autoclave. The amount of monoclinic ZrO2 on the exposed surface was measured by X-ray diffraction (XRD). RESULTS Higher sintering temperatures and elongated dwell times increased the ZrO2 grain size. Simultaneously, a larger fraction of zirconia grains adopted a cubic crystal structure, resulting in a decreased yttria content in the remaining tetragonal grains. Both the larger grain sizes and the lower average stabilizer content made the tetragonal grains more susceptible to LTD. Overall, independent on the commercial dental zirconia grade tested, the specimens sintered at 1450°C for 1h combined good mechanical properties with the best resistance to LTD. SIGNIFICANCE In general, increased sintering temperatures and times result in a higher sensitivity to low-temperature degradation of Y-TZP ceramics.

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.