Marcio Vivan Cardoso

Current aspects on bonding effectiveness and stability in adhesive dentistry

Improved dental adhesive technology has extensively influenced modern concepts in restorative dentistry. In light of minimal-invasive dentistry, this new approach promotes a more conservative cavity design, which basically relies on the effectiveness of current enamel-dentine adhesives. Nowadays, the interaction of adhesives with the dental substrate is based on two different strategies, commonly described as an etch-and-rinse and a self-etch approach. In an attempt to simplify the bonding technique, manufacturers have decreased the number of steps necessary for the accomplishment of the bonding procedure. As a consequence, two-step etch-and-rinse and one-step (self-etch) adhesives were introduced and gained rapid popularity in the dental market due to their claimed user-friendliness and lower technique sensitivity. However, many concerns have been raised on the bonding effectiveness of these simplified adhesives, especially in terms of durability, although this tends to be very material dependent. In order to blend all the adhesive components into one single solution, one-step adhesives were made more acidic and hydrophilic. Unfortunately, these properties induce a wide variety of seemingly unrelated problems that may jeopardize the effectiveness and stability of adhesion to the dental substrate. Being more susceptible to water sorption and thus nanoleakage, these adhesives are more prone to bond degradation and tend to fail prematurely as compared to their multi-step counterparts. Incidentally, another factor that may interfere with the bonding effectiveness of adhesives is the technique used for caries removal and cavity preparation. Several tools are on the market today to effectively remove carious tissue, thereby respecting the current trend of minimum intervention. Despite their promising performance, such techniques modify the tooth substrate in different aspects, possibly affecting bonding effectiveness. Altogether, we may conclude that not only the adhesive formulation, but also substrate nature must be taken into account to achieve a stable bonding interface, rendering the restorative treatment more predictable in terms of clinical performance. In this review, we analyse the current theoretical and clinical aspects of adhesion to enamel and dentine, and discuss the diverse possibilities to overcome problems which nowadays still challenge clinicians in their achievement of a more stable and effective bond to tooth enamel and dentine.

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.

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.

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.

Filler Debonding & Subhybrid-layer Failures in Self-etch Adhesives

The mechanisms behind bond degradation are still largely unknown, in particular with respect to self-etch adhesives. One-step adhesives have been especially documented with problems, such as insufficient polymerization, water-uptake and subsequent plasticization, water- and enzyme-induced nanoleakage, and/or the presence of voids due to phase-separation or osmosis. It was hypothesized that these shortcomings may weaken the adhesive layer and, as such, may jeopardize long-term bonding. In contrast to the control three-step etch & rinse adhesive, the bond strength to dentin of both one-step and two-step self-etch adhesives decreased after six-month water storage. TEM revealed not only that they exhibited filler de-bonding within the adhesive resin layer, due to hydrolysis of the filler-matrix coupling, but also that they failed predominantly directly under the hybrid layer at dentin, in spite of the presence of interfacial droplets and nanoleakage in the adhesive layer. These failures just under the hybrid layer may be attributed to insufficient encapsulation of surface smear.

Bonding effectiveness and interfacial characterization of a nano-filled resin-modified glass-ionomer

UNLABELLED Glass-ionomers (GIs) exhibit excellent clinical bonding effectiveness, but still have shortcomings such as polishability and general aesthetics. The aims of this study were (1) to determine the micro-tensile bond strength (microTBS) to enamel and dentin of a nano-filled resin-modified GI (nano-RMGI; Ketac N100, 3M-ESPE), and (2) to characterize its interfacial interaction with enamel and dentin using transmission electron microscopy (TEM). METHODS The nano-RMGI was used both with and without its primer, while a conventional RMGI restorative material (conv-RMGI; Fuji II LC, GC) and a packable conventional GI cement (conv-GI; Fuji IX GP, GC) were used as controls. After bonding to freshly extracted human third molars, microspecimens of the interfaces were machined into a cylindrical hourglass shape and tested to failure in tension. Non-demineralized TEM sections were prepared and examined from additional teeth. RESULTS The microTBS to both enamel and dentin of nano-RMGI and conv-GI were not statistically different; the microTBS of non-primed nano-RMGI was significantly lower, while that of conv-RMGI was significantly higher than that of all other groups. TEM of nano-RMGI disclosed a tight interface at enamel and dentin without surface demineralization and hybrid-layer formation. A thin filler-free zone (<1 microm) was formed at dentin. A high filler loading and effective filler distribution were also evident, with localized areas exhibiting nano-filler clustering. CONCLUSIONS The nano-RMGI bonded as effectively to enamel and dentin as conv-GI, but bonded less effectively than conv-RMGI. Its bonding mechanism should be attributed to micro-mechanical interlocking provided by the surface roughness, most likely combined with chemical interaction through its acrylic/itaconic acid copolymers.

Micro-CT based quantitative evaluation of caries excavation

OBJECTIVES To optimize a microtomographic (micro-CT) technique to quantitatively evaluate the effectiveness of contemporary caries-excavation techniques. METHODS A beam-hardening curve was obtained from an initial reconstruction of a wedge-shaped hydroxyapatite (HAp) block and fitted with a 5th order polynomial function, after which each micro-CT tooth slice was corrected accordingly. Calibration of the 8-bit gray values into mineral-density values was obtained by scanning, reconstructing and processing volume of interests (VOIs) of HAp phantoms with different mineral densities (0.25, 0.75, 3.14g/cm(3)). One carious tooth was scanned before and after caries removal with an experimental enzyme-based gel. After reconstruction, a 3D-median filter was applied to each micro-CT slice, and a connected threshold grower algorithm was used to blank-out undesired structures in each slice. Volume rendering with a look-up-table (LUT), based on mineral densities, was accomplished for the tooth before and after caries removal. Finally, the actual volume of excavated tissue was quantified. RESULTS Correction for beam hardening produced tooth slices with relatively homogeneous gray values along the whole area of enamel and dentin. Accurate mineral-density values were obtained for enamel, dentin and carious regions (2.89, 1.74 and 0.27g/cm(3), respectively). After pre-processing (3D-median filtering and connected threshold grower algorithm), acceptable segmentation of carious dentin based on gray values was accomplished (Otsu method, gray value=75 or mineral density=1.12g/cm(3)), from which quantitative volumetric parameters were calculated. SIGNIFICANCE Accurate calibration, standardization of scanning and reconstruction steps and adequate pre-processing of micro-CT slices allowed detailed volumetric calculation of caries-excavation techniques.

Towards a better understanding of the adhesion mechanism of resin-modified glass-ionomers by bonding to differently prepared dentin

OBJECTIVES The purpose of this study was to evaluate the bonding effectiveness of a resin-modified glass-ionomer (RMGI) to differently prepared dentin and how this restorative material interacts with these distinct substrates. Also the potential adhesion-promoting role of a polyalkenoic-acid conditioner was assessed. METHODS Forty-eight dentin surfaces were prepared from sound human molars and randomly distributed among 6 experimental groups. Fuji II LC (GC) was applied on bur-cut (100 μm diamond), fractured and Er:YAG laser-irradiated (200mJ, 10Hz, 31.4J/cm(2)) dentin with or without the beforehand application of the aqueous polyalkenoic-acid conditioner, Cavity Conditioner (GC). After 7 days of storage in water at 37 °C, specimens were prepared for microtensile bond strength testing (μTBS), as well as for TEM characterization of the resultant RMGI-dentin interface. Statistical analysis of the μTBS results was performed using ANOVA and Tukeys test (p<0.05). RESULTS The use of conditioner resulted in a significantly higher bond strength only when dentin was prepared by diamond bur (p<0.05). Laser irradiation induced micro-cracks on the dentin surface and led to the lowest bond strength, irrespective of the use of conditioner (p<0.05). Fuji II LC was able to partially demineralise (up to 2.0μm) and infiltrate bur-cut and fractured dentin, but no evident interaction was observed at the interface between the RMGI and laser-irradiated dentin. CONCLUSIONS Laser-induced surface modifications impaired the interaction of the RMGI with dentin, thereby negatively influencing its bonding effectiveness. The use of a polyalkenoic-acid conditioner remains crucial for the RMGI to bond effectively to bur-cut dentin.

Surface roughness of etched composite resin in light of composite repair

OBJECTIVES In search for clinically effective composite repair protocols, the effect of various etching protocols on the surface roughness of composite resins with different filler composition were investigated. METHODS Of two composite resins (hybrid-filled Clearfil AP-X; nano-filled Filtek Supreme XT) specimens of 3mm thick with a diameter of 7 mm were prepared (n=24). The top surface was polished with 4000-grit SiC-abrasive paper and subjected to one of eight surface treatments: (n=3): negative control (NC), 37% phosphoric acid for 20s (37PA-20s), 3% hydrofluoric acid for 20s (3HF-20s), for 120 s (3HF-120 s), 9.6% hydrofluoric acid for 20s (9.6HF-20s), for 120 s (9.6%HF-120 s), 37PA-20s followed by 9.6%HF for 120 s (37PA-20s/9.6HF-120 s) and 9.6%HF for 120 s followed by 37PA-20s (9.6HF-120s/37PA-20s). Roughness (S(a)) was measured using a 3D noncontact optical interferometer (WYKO) and surface topography imaged by SEM. Multilevel models were used to estimate the variances within a sample and between samples in each group. Using the resulting overall variances and the means for each group, the eight groups were compared consecutively using t-tests (p<0.05). RESULTS The hybrid-filled composite resin demonstrated a significantly rougher surface than the nano-filled (p<0.05). For both composites 9.6%HF-120 s, 37PA-20s/9.6HF-120 s and 9.6%HF-120 s/37PA-20s resulted in a large increase in roughness compared to the other groups (p<0.05). For the hybrid-filled, the succeeding groups (37PA-20s, 3HF-20s, 3HF-120 s and 9.6HF-20s) resulted in a statistically significant increase in surface roughness (p<0.02). For the nano-filled only a statistically significant increase in roughness was found between 3HF-20s and 3HF-120 s (p<0.001) and between 9.6HF-20s and 9.6HF-120 s (p<0.001). SEM surface characterization revealed that the hybrid-filled composite resin was much more affected by etching than the nano-filled. SIGNIFICANCE Composite resins should not be seen as a group of materials having identical properties when it comes to repair. The effect of etching will depend on the composition of the filler particles.

Peri- and intra-implant bone response to microporous Ti coatings with surface modification.

Bone growth on and into implants exhibiting substantial surface porosity is a promising strategy in order to improve the long-term stable fixation of bone implants. However, the reliability in clinical applications remains a point of discussion. Most attention has been dedicated to the role of macroporosity, leading to the general consensus of a minimal pore size of 50-100 μm in order to allow bone ingrowth. In this in vivo study, we assessed the feasibility of early bone ingrowth into a predominantly microporous Ti coating with an average thickness of 150 μm and the hypothesis of improving the bone response through surface modification of the porous coating. Implants were placed in the cortical bone of rabbit tibiae for periods of 2 and 4 weeks and evaluated histologically and histomorphometrically using light microscopy and scanning electron microscopy. Bone with osteocytes encased in the mineralized matrix was found throughout the porous Ti coating up to the coating/substrate interface, highlighting that osseointegration of microporosities (<10 μm) was achievable. The bone trabeculae interweaved with the pore struts, establishing a large contact area which might enable an improved load transfer and stronger implant/bone interface. Furthermore, there was a clear interconnection with the surrounding cortical bone, suggesting that mechanical interlocking of the coating in the host bone in the long term is possible. When surface modifications inside the porous structure further reduced the interconnective pore size to the submicrometer level, bone ingrowth was impaired. On the other hand, application of a sol-gel-derived bioactive glass-ceramic coating without altering the pore characteristics was found to significantly improve bone regeneration around the coating, while still supporting bone ingrowth.