No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Two-year clinical trial of a universal adhesive in total-etch and self-etch mode in non-carious cervical
Abstract
To compare the clinical performance of Scotchbond™ Universal Adhesive used in self- and total-etch modes and two-bottle Scotchbond™ Multi-purpose Adhesive in total-etch mode for Class 5 non-carious cervical lesions (NCCLs).
37 adults were recruited with 3 or 6 NCCLs (>1.5mm deep). Teeth were isolated, and a short cervical bevel was prepared. Teeth were restored randomly with Scotchbond Universal total-etch, Scotchbond Universal self-etch or Scotchbond Multi-purpose followed with a composite resin. Restorations were evaluated at baseline, 6, 12 and 24 months for marginal adaptation, marginal discoloration, secondary caries, and sensitivity to cold using modified USPHS Criteria. Patients and evaluators were blinded. Logistic and linear regression models using a generalized estimating equation were applied to evaluate the effects of time and adhesive material on clinical assessment outcomes over the 24-month follow-up period. Kaplan-Meier method was used to compare the retention between adhesive materials.
Clinical performance of all adhesive materials deteriorated over time for marginal adaptation, and discoloration (p < .0001). Both Scotchbond Universal self-etch and Scotchbond Multi-purpose materials were more than three times as likely to contribute to less satisfying performance in marginal discoloration over time than Scotchbond Universal total-etch. The retention rates up to 24 months were 87.6%, 94.9% and 100% for Scotchbond Multi-purpose and Scotchbond Universal self-etch and total-etch respectively.
Scotchbond Universal in self- and total- etch modes performed similar to or better than Scotchbond Multipurpose respectively.
24 month evaluation of a universal adhesive indicates acceptable clinical performance, particularly in a total-etch mode.
Copyright © 2015. Published by Elsevier Ltd.
... The sample size was calculated based on a previous study 16 , in which success rate of resin composite cervical restorations using universal adhesive in total etch mode was 100% after 24 months. A two-tailed Z test was conducted to determine the difference between two independent proportions, with a 5% significance level (alpha) and 80% power. ...
... Regarding retention, no restoration loss occurred in either group during the trial, resulting in a 100% retention rate. This high retention has been similarly reported by previous trials for Single Bond Universal when using the etch-and-rinse technique 16,28,29 . The excellent retention can be attributed to the chemical bonding from the 10-MDP monomer and Vitrebond copolymer, as previously discussed. ...
... The present study found no statistically significant difference in postoperative sensitivity between the two groups, aligning with previous clinical trials 16,[29][30][31] . At baseline, two cases in the intervention group and four in the control group exhibited postoperative sensitivity, which resolved in subsequent follow-ups. ...
The aim of the current study was to evaluate the clinical performance of the novel radio-opaque universal adhesive “Scotchbond™ Universal Adhesive Plus” compared to conventional universal adhesive “Single Bond Universal” over 24 months in cervical carious lesions. Fifty participants with cervical carious lesions were randomly allocated into two groups (n = 25); either Scotchbond™ Universal Plus Adhesive (intervention) or Single Bond™ Universal Adhesive (control). Restorations were assessed at baseline, 12 and 24 months using the modified USPHS criteria. Data analysis was conducted using MedCalc software, version 22 for Windows. Intergroup comparisons at each follow-up were performed using the Chi-Square test (p ≤ 0.05). Intragroup comparisons within each intervention were conducted using Cochran’s Q test (p ≤ 0.016). After 24 months, all restorations in Scotchbond™ Universal Plus scored alpha, while in Single Bond™ Universal group, three restorations scored bravo after 24 months in marginal adaptation and discoloration. There was no statistically significant difference between both adhesives (p > 0.05) at all follow-up periods. Intragroup comparison within both adhesives has shown no statistically significant change across follow-up periods regarding all tested outcomes (p > 0.016) except for marginal adaptation within Single Bond Universal, where there was statistically significant difference (p = 0.005). Both adhesives exhibited satisfactory clinical performance in cervical restorations after 24-months. The present study emphasizes the clinical significance of using a new radio-opaque universal adhesive for restoring carious cervical lesions, providing radio-opacity, low viscosity, excellent handling, eliminating misinterpretation of MDP-based adhesive layer and generating reliable bonding performance to support long-term success in restorative dentistry.
... Another study indicated that SBU demonstrated satisfactory clinical performance even in the SE mode, but the ER mode generally yielded better results [25]. In a study with a 24-month follow-up period, it was shown that using SBU in the ER mode provided high retention rates and low postoperative sensitivity in NCCLs [26]. Conversely, a recent meta-analysis highlighted that the application strategy of universal adhesives did not significantly affect marginal discoloration in NCCL restorations. ...
... Clinical studies suggest that the ER method is recommended for enhancing the survival rates of composite restorations in NCCLs [1,25,26]. The results of our study showed clinically acceptable performance of universal adhesives in NCCLs for SE, SLE, and ER strategies, according to the FDI criteria. ...
... A 5-year study evaluating the performance of the SBU adhesive found that the ER mode yielded superior clinical outcomes compared to other strategies [1]. Furthermore, a 2-year clinical evaluation of NCCLs reported no significant differences between ER and SE modes in terms of marginal adaptation but observed a higher incidence of marginal discoloration with the SE mode [26]. The role of SLE has also been highlighted in clinical research. ...
Objective
To evaluate the 36-month clinical performance of Single Bond Universal Adhesive (SBU; 3M ESPE, Germany) in non-carious cervical lesions (NCCLs) using different modes of adhesion according to the FDI criteria. The primary outcome was the retention loss of the restorations, while the secondary outcomes included marginal staining, marginal adaptation, post-operative sensitivity and tooth vitality, recurrence of caries erosion and abfraction, and tooth integrity, all evaluated according to the FDI criteria.
Materials and methods
In this study, the SBU Adhesive was applied to 246 NCCLs of 25 patients using different modes of adhesion: Self-etch (SE), selective-enamel-etching (SLE), and etch-and-rinse (ER). All lesions were restored with the same nanohybrid resin composite. The restorations were evaluated at the 1st, the 6th, 12th, 18th, and 36th month using the FDI criteria. The differences between SE, SLE, and ER groups were tested using the Kruskal–Wallis and Mann–Whitney U tests where a value of p < 0.05 was accepted as a criterion for statistical significance.
Results
After 36-month the recall rate was 96%. The retention loss rates were 29.33% for SE, 16.66% for SLE, and 3.89% for ER modes. Interactions between time periods and adhesive modes were found to be statistically significant (p < 0.05) for all FDI criteria. ER mode performed significantly better than SE mode for marginal staining, marginal adaptation and recurrence of caries, erosion and abfraction criteria after the 36th month (p < 0.05). There was no statistically significant difference between SE and SLE mode (p > 0.05), nor between SLE and ER mode (p > 0.05).
Conclusions
After the 36-month evaluation of all adhesive modes used in the study, restorations performed with the ER adhesion mode were clinically good (2), while those performed with the SE adhesion mode and SLE adhesion mode were clinically satisfactory (3) according to the FDI criteria. The primary outcome, retention loss, was significantly lower in the ER mode compared to SE and SLE modes. For secondary outcomes, the ER mode showed better performance in marginal staining, marginal adaptation, and the recurrence of caries, erosion, and abfraction highlighting its clinical advantages for mid-term success in non-carious cervical lesions.
Clinical relevance
Restorations performed with the SE adhesion mode of universal adhesives exhibit clinically acceptable behavior after 36 months of evaluation, although with less success than those performed with the ER adhesion mode.
Clinical trial registration
Clinical trials number- NCT06227715, Clinical trials link: https://clinicaltrials.gov/study/NCT06227715
... After the full-text was examined, 9 studies were excluded: in 5 studies, a control group was not used; in 2 studies, UAs were not applied; 1 study was found to be retracted on request of the Editor in Chief; and finally, the full-text of 1 article could not be retrieved. Then, a total of 14 studies were included in the qualitative analysis [37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Of these, three articles lacked of absolute values for performing the meta-analysis, and they were excluded for the quantitative analysis [40,42,48]. ...
... Randomized clinical trials are regarded as the gold standard approach for evaluating the dental treatment and are used as a reference by experts in their choices [38,39,51,52]. Research attempts to simplify multistep dental adhesives resulted in the invention of "universal" adhesives. ...
... The UA systems evaluated in the present study have variable pH. Overall, while pre-etching enamel enhances the BS of UAs, consensus is lacking regarding the effect of pre-etching dentin [38]. ...
Universal adhesives (UAs) often exhibit comparable or even superior bond strength to traditional adhesive systems, ensuring reliable and long-lasting adhesion between the resin composite and the tooth structure. Therefore, this study aimed to assess the clinical performance of UAs compared to other adhesive systems in direct resin composite restorations through a systematic review and meta-analysis. Two reviewers executed a literature search in five electronic databases: PubMed, EMBASE, Scopus, Web of Science, and Scielo. Clinical trials comparing the clinical evaluation of resin composite restorations in Class I, Class II, or Class V cavities placed with an universal adhesive (UA) system against resin composite restorations placed with another non-UA system were included in the review. An analysis was carried out using Review Manager software version 5.3.5 (London, England, United Kingdom). Standardized effect sizes with 95% confidence intervals were calculated to allow comparisons between different interventions and different outcomes. The methodological quality of each study was assessed using the Cochrane RoB2 tool for randomized clinical trials. A total of 2331 potentially relevant studies were identified. After title and abstract examination, 14 studies remained in the systematic review. From these, a total of 11 studies were included in the meta-analysis. The retention rates of resin composite restorations after 6 months showed no significant difference between total-etch (TE, p=0.83), or self-etch (SE, p=0.78) adhesives and UAs applied in TE and SE modes (p>0.05). However, UAs applied in selective-enamel etching (SEE) mode demonstrated superior clinical performance compared to other adhesives (p=0.01), particularly TE adhesives (p=0.02). Similarly, after >12 months of follow-up, there were no significant differences in retention rates among different adhesive modes (p>0.05). Additionally, the incidence of secondary caries did not significantly differ across adhesive modes at both 6-month and >12-month evaluations (p>0.05). This systematic review and meta-analysis suggested that UAs demonstrate comparable clinical performance to TE and SE adhesive systems in direct resin composite restorations, particularly in terms of restoration retention rates and the incidence of secondary caries. UAs applied in SEE mode exhibited superior clinical outcomes compared to other adhesive systems. These findings indicate that UAs can be considered a viable alternative to traditional adhesive systems in clinical practice, offering flexibility in application while maintaining comparable long-term outcomes.
... Only after universal adhesives were launched in the market that it became possible to evaluate the same adhesive composition in both adhesive strategies (etch-and-rinse and self-etch mode) [15]. In the case of universal adhesives, although randomized clinical trials have shown that the bonding strategy used with them does not influence retention rate [16][17][18][19][20], other studies have shown that the ER approach resulted in higher retention rates and lower marginal discoloration when compared to SE strategy [21,22]. Also, there is not a consensus regarding dentine moisture (to keep the dentin moist or dry) after acid etching [23][24][25]. ...
... Also, a closer look at these previous studies showed that, despite universal adhesives having been launched in the market in 2012, the majority of clinical results in the literature are short-term follow-ups (6 to 24 months) [13,[15][16][17][18][19][20][21][22][27][28][29][30][31], and the few medium-term clinical studies evaluating universal adhesives have primarily evaluated the first universal adhesive available on the market [16,[32][33][34][35]. Therefore, it is important to have more medium-term clinical studies evaluating different universal adhesives available in the market, as recognized by a recent published review [15], to assess which adhesion strategy may optimize clinical outcomes. ...
... Actually, when universal adhesives are evaluated, the assertion that there is no consensus about which is the better adhesive strategy is based on short-term clinical studies [17][18][19][20]. When medium-term (at least 3 years of follow-up) results are evaluated, no significant difference was observed when the SE strategy, regardless of whether or not it was associated with selective enamel etching or the ER strategy (applied on dry or moist dentin), was evaluated [16,[32][33][34][35]. ...
... In the current study, all restorations were beveled with a 0.5-mm bevel. Lawson et al. (2015) and Canali et al. (2019) performed enamel beveling (19,20) because the reason for failures due to decreased retention with the ER technique might be the omission of bevel (21). However, because beveling can inhibit adhesives from demonstrating their actual performance, beveling is not performed in the majority of clinical trials. ...
... In the current study, all restorations were beveled with a 0.5-mm bevel. Lawson et al. (2015) and Canali et al. (2019) performed enamel beveling (19,20) because the reason for failures due to decreased retention with the ER technique might be the omission of bevel (21). However, because beveling can inhibit adhesives from demonstrating their actual performance, beveling is not performed in the majority of clinical trials. ...
... Perdigao et al. showed that enamel beveling, or enamel etching, had no effect on the clinical performance of the adhesive (23). Lawson et al. found better marginal adaptation for the SE mode when compared to the ER of universal adhesive with no significant differences between the three modes (19). These findings agree with the present study, in which two restorations in SE mode and only one restoration in ER mode showed marginal gaps after 12 months. ...
... Twenty-four studies were eligible for full-text evaluation; four studies were excluded after this step, and these studies are presented in Tables 2 and 3. Ultimately, 20 RCTs were included in this systematic review and meta-analysis. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Characteristics of the Included Articles All included studies were split-mouth design RCTs (published between 2013 and 2021) and included 3116 NCCL restorations of the anterior and posterior teeth of 809 patients older than 18 years. The followup periods included baseline (BL) and 12, 24, and 36 months for most studies, and only one study 19 evaluated restorations after five years (Table 3). ...
... Cochrane #1 noncarious cervical lesions:ti,ab,kw ( allocation concealment was kept hidden until the time of the restorative procedure), 7,12,23,24 performance bias (it was not reported if participants were blinded), 6,11,19,22 detection bias (it was not mentioned if raters were blinded), 11,21,22 and attrition bias (patient dropout led to >20% loss to follow-up). 2,3,22 Consequently, 45% (9) of the studies 6,7,11,12,19,[21][22][23][24] were judged to have an"uncertain risk" of bias, whereas the remaining 55% (11) were judged to have a "low risk" of bias; no study was considered to have a "high risk" of bias. ...
... Forest plots of the meta-analyses for retention at different follow-up periods (12,24, and 36 months) for the etch-and-rinse and self-etching strategies are shown in Figure 3. Significant differences were observed at ...
Objective:
To evaluate the adhesion of universal adhesive systems to the dentin of noncarious cervical lesions (NCCLs) by comparing the etch-and-rinse and self-etch strategies through a systematic review and meta-analysis.
Methods:
Systematic electronic searches were performed by two independent reviewers into the following databases: PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library until December of 2021. Only randomized clinical trials were selected, comparing etch-and-rinse and self-etch strategies and using universal adhesive systems in NCCLs. This systematic review was conducted according to the PRISMA guidelines and registered into PROSPERO.
Results:
After the removal of duplicates, 170 articles were identified. In an initial screening of titles and abstracts, 146 records did not satisfy the inclusion criteria and were, therefore, excluded. Twenty-four studies were eligible for evaluation of the full text, and four were excluded after this step. Finally, 20 randomized clinical trials were included in this systematic review and meta-analysis.
Conclusion:
This systematic review and meta-analysis revealed that applying universal adhesive systems in the etch-and-rinse strategy could lead to better medium-term (>12 to 36 months) retention of NCCL restorations than the self-etch strategy, as well as resulting in lower percentages of marginal discoloration, marginal adaptation, and secondary caries. However, the use of a self-etching strategy can lead to lower postoperative sensitivity.
... A total of 12,295 studies were retrieved from the aforementioned databases in the initial and supplementary searches. The retrieved literature was imported into EndNote X9 for management, and finally 25 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] studies were included. ...
... In the 25 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] eligible studies, 1309 restorations were treated with self-etching adhesives following resin composite restorations, whereas 1271 restorations were treated with total-etching adhesives. Literature on RCTs-associated intervention indicators was written in English. ...
... Four [12,23,29,31] and two [32,33] studies used USPHS and FDI to evaluate marginal staining on class I/II restorations after composite resin restoration, respectively. Meanwhile, nine [11,16,17,19,20,22,27,28,34] studies used USPHS; seven [14,15,18,20,27,28,35] studies used FDI to evaluate marginal staining on class V restorations. ...
Objectives
This meta-analysis aimed to elucidate the effects of various acid etching patterns on the sensitivity of teeth and their clinical effectiveness following composite resin repair.
Materials and methods
PubMed, Cochrane Library, Web of Science, and Embase databases were searched for relevant studies on the postoperative sensitivity (POS) of composite resin restorations after using different bonding systems. The retrieval was from the inception of the databases to August 13, 2022, with no filter of written language. Literature screening was conducted by two independent researchers. The Cochrane risk-of-bias assessment tool was adopted for quality evaluation, and Stata 15.0 for analysis.
Results
Twenty-five randomized controlled trials were included in the present study. Following resin composite restoration, 1309 restorations were bonded by self-etching (SE) adhesives, whereas 1271 restorations were bonded by total-etching (TE) adhesives. The meta-analyses showed that there is no evidence to prove the SE and TE will affect POS at present when measured using the modified United States Public Health Service (USPHS) criteria [RR = 1.00 (95% CI: 0.96, 1.04)], the World Dental Federation (FDI) [RR = 1.06 (95% CI: 0.98, 1.15)], or the visual analog scale (VAS) [SMD = 0.02 (95% CI: −0.15, 0.20)] scales. At a certain follow-up time, TE adhesives provide better outcomes in terms of color match, marginal staining, and marginal adaptation. In other words, TE adhesives have better esthetic results.
Conclusions
The type of bonding technique (ER and SE) does not affect the risk and degree of POS in class I/II and class V restorations. Further research is required to verify whether these findings apply to different forms of composite resin restorations.
Clinical relevance
Besides the fact that TE barely increase postoperative sensitivity, it also yields superior cosmetic results.
... Researchers often use the USPHS and FDI criteria in clinical trials that evaluate restoration success. It is easy to define the characteristics of a clinically acceptable restoration using both techniques, and while the USPHS criteria are sufficient for long-term studies, the FDI criteria can give more sensitive results in short-term studies because it has more scoring options [23][24][25]. In the present study, the 4-year restoration success of the bulk-fill composite was examined using both FDI and USPHS criteria. ...
... The main focus of this study was to evaluate the clinical efficacy of the placement technique of the bulk-fill composite; therefore, the type of adhesive was standardized. Clear fill universal adhesive was used for all restorations and has been tested in several in vitro and in vivo studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The adhesive was used in self-etch mode. ...
... Bulk-fill composites have high transparency and more reactive photoinitiators that allow a higher depth of cure [19]. The higher reactiveness enables the insertion of more thicker increments (4-5 mm) with uniform polymerization and degree of conversion [21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Thanks to these factors, satisfactory mechanical properties and increased longevity of restorations are obtained [5]. ...
Objective
The purpose of this double-blind and split-mouth randomized controlled clinical trial was to evaluate the clinical success of the placement technique (bulk-filling and incremental techniques) of a bulk-fill resin composite in Class II carious lesions.
Materials and methods
Two different bulk-fill resin composites, X-tra fil (Voco) and Filtek Bulk Fill (3M ESPE), were used in the bulk-filling and incremental techniques for 20 patients. The study was carried out in 4 groups, with 20 restorations in each group. Restorations were appraised at baseline, 6-month, 2-year, and 4-year recall. World Dental Federation (FDI) and the US Public Health Service (USPHS) criteria were used in the evaluations. The Friedman, Kruskal–Wallis, and Mann–Whitney U tests were used for the statistical analysis.
Results
At the end of year 4, there was no loss of restoration in any group. According to the USPHS and FDI criteria, there was a difference in the baseline and 4-year in marginal adaptation and marginal discoloration of the restorations (P < 0.05). When Filtek-Bulk was placed as an incremental technique, there was a minor fracture in four restorations (P > 0.05). In addition, Filtek-Bulk showed a color change according to the results based on both the USPHS and FDI criteria (P < 0.05). The difference between the two placement techniques of each resin composite was not significant at the year 4 recall when all criteria were evaluated (P ˃ 0.05).
Conclusions
The 4-year clinical success of the evaluated bulk-fill composites is not dependent on the placement technique used.
Clinical relevance
This study can help clinicians choose which technique (bulk fill and incremental techniques) bulk-fill composites can be used.
Trial registration
US National Library of Medicine, www.clinicaltrials.gov, ID: NCT04565860 Registered on 10/09/2020. Clinical Evaluation of Bulk-fill resin Composites in Class II Restorations.
... De foreliggende undersøgelser har begraenset opfølgningstid, men viser lovende resultater. Én af de kliniske undersøgelser viste, at det universelle adhaesiv Scotch-bond Universal havde lige så god retention i cariesfri, cervikale laesioner efter 2 år som 3-trin etch & rinse bindingssystemet Adper Scotchbond Multi-Purpose (33). Et andet studie med en opfølgning på 3 år viste, at det anvendte adhaesiv Scotchbond Universal i etch & rinse teknikken havde lige så god retentionsevne i cariesfri, cervikale laesioner såvel på tør som fugtig dentin (34). ...
... Derudover blev såvel etch & rinse som selvaetsningsteknikken undersøgt i begge studier, og i det sidstnaevnte blev selektiv emaljeaetsning også inkluderet. Selvom der ikke blev fundet nogen signifikant forskel mellem de forskellige teknikker i op til 3 år efter behandlingen, sås mindre god kanttilslutning og øget kantmisfarvning (33,34) samt større tab af plastfylding, når det universelle adhaesiv var blevet anvendt i følge selvaetsningsteknikken fremfor ved anvendelse af etch & rinse-eller selektiv emaljeaetsningsteknik (34). ...
... Andre parametre, der bidrager positivt til retention af disse plastfyldninger er en ru overflade og anvendelse af kofferdam (35 Degraderingen af graensefladen ses på trods af tilstedevaerelsen af funktionelle monomerer, hvilket tyder på, at problematikkerne angående holdbarhed af bindingssystemerne endnu ikke er helt afklaret (24,31). Da data peger på, at selvaetsningsteknikken fungerer bedre på dentin (31), imens forudgående aetsning er signifikant bedre på emalje (23,33,34), anbefales selektiv aetsning af emalje også for de universelle adhaesiver. Det forventes, at der i naer fremtid publiceres forskningsresultater vedr. ...
... For instance, a previous meta-analysis suggested that shear bond strength of universal adhesives was improved with prior acid etching of enamel [16]. Since most of the above-mentioned studies were either conducted in relatively short follow-ups, or were of in vitro study designs, for which clinically relevant conclusion cannot be made; moreover, various pathologic conditions of substrates, such as carious or sclerotic dentin, or enamel, may result in varied clinical outcomes [2], t the purpose of this study was to determine the efficacy (≥ 12 months) of three adhesive strategies for restorations using universal adhesives: etch-andrinse, selective enamel-etching, and self-etching without selective etching, through published results of several large-scale randomized controlled trials (RCTs) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Accordingly, we performed a network meta-analysis on multi-arm [38,39] outcomes from both doubleblind and single-blind RCTs [21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] to compare esthetic, functional, and biological outcomes in terms of World Dental Federation (FDI) criteria and the United States Public Health Service (USPHS) criteria of the three adhesive strategies. ...
... Since most of the above-mentioned studies were either conducted in relatively short follow-ups, or were of in vitro study designs, for which clinically relevant conclusion cannot be made; moreover, various pathologic conditions of substrates, such as carious or sclerotic dentin, or enamel, may result in varied clinical outcomes [2], t the purpose of this study was to determine the efficacy (≥ 12 months) of three adhesive strategies for restorations using universal adhesives: etch-andrinse, selective enamel-etching, and self-etching without selective etching, through published results of several large-scale randomized controlled trials (RCTs) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Accordingly, we performed a network meta-analysis on multi-arm [38,39] outcomes from both doubleblind and single-blind RCTs [21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] to compare esthetic, functional, and biological outcomes in terms of World Dental Federation (FDI) criteria and the United States Public Health Service (USPHS) criteria of the three adhesive strategies. ...
... The treatment protocols of adhesive-involved restorations were classified as etch-and-rinse (Nr = 1110; number of NCCLs = 964), selective enamel-etching protocols (Nr = 404; number of NCCLs = 358), and self-etch protocols without selective enamel-etching (Nr = 892; number of NCCLs = 746). Most of the trials were of double-blind design, as the clinicians who evaluated the outcomes during follow-ups were blinded, and were not the clinicians who performed the restorations [21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Due to the study design of the 16 RCTs, all trials were under low risk of bias. ...
Purpose:
The efficacy of etch-and-rinse, selective enamel-etching, and self-etching protocols for universal adhesives in follow-ups of over 12 months was compared in a network meta-analysis.
Study selection:
Randomized controlled trials (RCTs) published from 1998 to 2022 that compared marginal staining, marginal adaptation, retention and fractures, post-operative sensitivity, or recurrence of caries that took place over 12-months post-restoration were selected. A network meta-analysis determined the performance of each adhesive protocol.
Results:
After screening 981 articles, 16 RCTs were subjected to data extraction. Of which, 674 patients with 2816 restorations, were included in the network meta-analysis. The pooled risk of marginal discoloration following self-etching was significantly higher than that following etch-and-rinse at over 12, 24, and 36 months, which was time-dependent. The pooled risks of unfavorable marginal adaptation and unfavorable retention and fractures following self-etching were also significantly higher than that following etch-and-rinse, with the rates of unfavorable retention and fractures in non-carious cervical lesions increasing in a time-dependent manner. The pooled risks of marginal discoloration, unfavorable marginal adaptation, retention and fractures were similar between etch-and-rinse and selective enamel-etching protocols. Post-operative hypersensitivity and recurrence of caries were not significantly different among etch-and-rinse, selective enamel-etching, and self-etching protocols.
Conclusions:
In follow-ups over 12 months, esthetic and functional outcomes of restorations completed with an etch-and-rinse adhesive protocol were superior to the ones achieved with a self-etching strategy without selective enamel-etching. Selective enamel etching is recommended for self-etching systems. Biological responses were similar for all three adhesive strategies.
... The new adhesive system known as "universal adhesives" which may be used as self-etch adhesives, total-etch adhesives, or as selective-etch adhesives are tailored to a specific clinical situation [10] . The introduction of universal adhesives has enabled clinicians the choice of total-etch, self-etch or selective-etch application from a single-bottle adhesive [11] . The composition of dentin and enamel substrates varies, necessitating the use of various bonding protocols. ...
... A majority of universal adhesives consist of acidic functional monomers, like 10-methacryloyloxydecyl dihydrogen phosphate (MDP). This monomer is made up of a polymerizable methacrylate group along with a phosphate group that can form a stable salt with the calcium in hydroxyapatite [11] . Research has shown that stability of this calcium salt has been linked with the high bond strength of MDP to enamel and dentin [17,18] . ...
Background: Non-carious cervical lesions (NCCLs) are among the most frequent pathologies that affect dental structures affecting the middle-aged and elderly population, compromising their aesthetics and function (dentinal hypersensitivity). Objectives: To determine clinical performance of a universal adhesive in total-etch and selective-etch modes in the restoration of non-carious cervical lesions in adult teeth. Materials and Methods: This randomized controlled clinical study was carried out at the Conservative Clinic of the Department of Restorative Dentistry, Lagos State University Teaching Hospital, Ikeja, Lagos State. Thirty teeth were studied for each intervention; they were randomized into two groups based on the application modes: total-etch and selective-etch. The researcher diagnosed, selected (conforming to inclusion criteria) and treated the patients, but evaluated by examiners. Scotchbond Universal was used and Filtek supreme ultra-universal composite resin was used as the final restorative material. The restorations were evaluated at baseline, 3, 6 and 12 months for marginal staining, retention, marginal adaptation, patient's view, post-operative sensitivity and recurrence of caries using FDI criteria. Patients and evaluators were blinded Data were analyzed using SPSS, IBM version 25.0. Chi-square test and Fischer's exact test were used to assess association between categorical data, while clinical outcome at different follow up interval were assessed using McNemar test. P-value was set at 0.05. Results: Restorations in total-etch and selective-etch groups were comparable in their clinical performances in marginal staining, but at 6 and 12 months in the total-etch group, there was a score 3 in marginal staining. There was a score of 3 in retention at 12 months in selective-etch. The patient's view was relatively the same throughout the study in both groups. Statistically, there was no significant difference in any of the parameters evaluated for both groups (P ≥ 0.05). Conclusion: The clinical performance of universal adhesive in both total-etch and selective-etch modes were both satisfactory in the restoration of non-carious cervical lesions throughout the evaluation period. Both techniques are suitable for the placement of resin composites in non-carious cervical lesions 'restoration.
... Several randomized clinical trials (RCT) of universal adhesives have been published within the last 11 years. While some clinical studies of non-carious cervical lesions (NCCL) reported higher retention rates for the etch-andrinse and selective enamel etch strategies compared to the self-etch strategy [3,4], other clinical studies found no difference in retention rates [5][6][7][8]. For class I and class II restorations, the retention rate for the self-etch strategy in RCT was equivalent to that of the strategies that included enamel etching with phosphoric acid [9][10][11][12]. ...
... We did not include the etch-and-rinse strategy nor the selective enamel etching strategy control groups, which may be considered a limitation of this study. However, many clinical studies with SBU have included these adhesion strategies [3,4,50], therefore the results are available in the peer-reviewed literature. In addition, we wanted to compare two generations of the same universal adhesive using an adhesive strategy that many authors consider less optimum for enamel margins than the etch-and-rinse strategy. ...
Objective
This randomized controlled trial compared the 1-year clinical efficacy of Scotchbond Universal Adhesive Plus (SBU+) with that of its predecessor Scotchbond Universal Adhesive (SBU) to restore Class I and Class II preparations using the self-etch strategy in adult patients.
Materials and methods
Fifty-one subjects participated in this study. Two posterior teeth in each subject were randomized to a restoration with SBU+ or to a restoration with SBU (control) using the self-etch strategy. Teeth were restored with Filtek Universal Restorative. Restorations were evaluated at baseline, 6 months and 1 year using the FDI criteria. The Wilcoxon signed-rank test was used to compare outcomes.
Results
No restorations were graded as “Insufficient/Unsatisfactory” or “Poor” for any of the FDI criteria at the baseline, 6-month, or 1-year visits. At 1 year the retention rate was 100% for both SBU+ and SBU. For fracture of the restorative material 42/44 SBU+ restorations (95%) and 44/44 SBU restorations (100%) were graded “Excellent/Very Good” (p > 0.05). All restorations were clinically acceptable for marginal adaptation at 1 year with no statistical differences between the two adhesive materials. There were no recurrent caries lesions at the 1-year visit.
Conclusions
The clinical efficacy of the SBU+ at 1-year was not different to that of its predecessor SBU in Class I and Class II restorations of adult patients using the self-etch strategy.
Clinical relevance
The two dental adhesives used in this clinical trial showed excellent results in posterior restorations at 1 year without using a separate phosphoric etching step.
... Estudiosos 23,26,42 afirmam que resistência de união à microtração, nanoinfiltração, grau de conversão, atividade antimicrobiana e citotoxicidade são dependentes do material, não havendo nenhuma relação com a estratégia adesiva empregada 18-20 ou o número de passos 57 . Apresentam comportamento clínico adequado, quando utilizados em todas as estratégias adesivas sugeridas pelo fabricante para retenção de restaurações em lesões cervicais não cariosas 6,18,[58][59][60] , classe I 61,62 e classe II 62 . De acordo com estudos já publicados, podem apresentar efetividade clínica melhor que dos adesivos condicionamento ácido total de três passos 14,58 . ...
... Apresentam comportamento clínico adequado, quando utilizados em todas as estratégias adesivas sugeridas pelo fabricante para retenção de restaurações em lesões cervicais não cariosas 6,18,[58][59][60] , classe I 61,62 e classe II 62 . De acordo com estudos já publicados, podem apresentar efetividade clínica melhor que dos adesivos condicionamento ácido total de três passos 14,58 . Outros ainda relatam comportamento similar aos adesivos "condicione e lave" de três 6,14 e dois passos 15,24 , assim como à do autocondicionante de dois passos 15 . ...
Objetivo: analisar, a partir da literatura publicada, os sistemas adesivos universais, conceituando sobre seu desempenho nos diferentes substratos, assim como potenciais estudos executados com eles após 10 anos no Brasil. Materiais e métodos: para esta revisão narrativa, foram pesquisados artigos na língua inglesa nas bases de dados eletrônicas PubMed/Medline, SciELO e Scopus, publicados de 2012 a 2022, período considerado por ser a última década, além dos 10 anos da chegada do sistema adesivo universal ao Brasil. Utilizaram-se os seguintes descritores: universal adhesives (adesivos universais) OR universal adhesive system (sistemas adesivos universais). Realizou-se a inclusão de estudos laboratoriais (in vitro), ensaios clínicos, revisões de literatura e sistemáticas com meta-análise. Resultados: após análise meticulosa, foram selecionados 56 estudos. Os adesivos universais são considerados mais “amigáveis” ao usuário, pois permitem ao clínico a utilização no modo condicione e lave e autocondicionante, principalmente devido à inclusão do monômero MDP ou de monômeros similares. No esmalte, o condicionamento ácido seletivo antes da aplicação do adesivo é recomendado. Permite ser utilizado com uma diversidade de substratos, a aplicação de forma ativa do adesivo melhora a resistência de união. Conclusão: os sistemas adesivos universais foram lançados para tornar os procedimentos de adesão mais simples. Entretanto, mais ensaios clínicos com maiores tempos de acompanhamento são necessários, para avaliar adequadamente a efetividade desse material. Palavras-chave: adesivos dentinários; esmalte dental; dentina.
... The technique or adhesive strategy has also developed from a more time-consuming and technique sensitive total etch system to a simpler self-etch system. The consensus of total-etch versus self-etch strategy for bonding has been widely debated over the past two decades [7][8][9]. ...
... The result of the quality assessment of RCTs of the systematic review is presented as risk of bias summary and risk of bias graph (Figs. 3, 4). As evaluated by the RoB2 tool, 7 [29-31, 33, 36, 38, 39] out of 17 included articles had a high risk of bias, 4 [9,35,37,40] studies showed some concerns and 6 [26-28, 32, 34, 41] studies had a low risk of bias. In specific, the highest risk was seen in the bias due to deviation from the [29][30][31]39] showed a high risk of bias due to missing data and measurement of outcome assessment. ...
Objective
To determine the effect of adhesive strategy (total etch or self-etch) of universal adhesives in non-carious cervical lesions.
Data source
A search was made in PubMed, Scopus, Cochrane, Web Of Science, Open Gray, Clinical Registries.
Data selection
Randomized Controlled Clinical Trials, studies on non-carious cervical lesions restored using Universal Adhesives, and studies in which universal adhesives have been used in total etch and self -etch strategies were included in this systematic review.
Data extraction
A total of 17 articles were included in the systematic review and 13 in the meta-analysis. Meta-analysis was conducted to assess the clinical performance of NCCLs in terms of retention, marginal adaptation, marginal discoloration, secondary caries and post-operative sensitivity at 18, 24, 36 month follow-up using USPHS as well as FDI criteria, separately.
Data synthesis
Overall there was no significant difference between total etch and self etch adhesive strategies for any of the five outcome measures using either the FDI or the USPHS criteria. p > 0.05, 95% CI, I ² value of 0%. A strongly suspected publication bias in the retention domain was seen at 18 month follow up under FDI criteria.
Conclusion
Most universal adhesives show acceptable clinical performance. There is no significant effect of the adhesive strategy of universal adhesives on their clinical performance according to the results of our meta-analysis.
... However, in several studies, it was reported that when etch-and-rinse strategy was used, enamel bond strength values were significantly increased (8)(9)(10). On the other hand, there are also clinical studies that reported there were no significant differences in terms of retention between application strategies on enamel (10,11). As controversial findings on bond strength of universal adhesives utilized with different strategies are included in the literature, there are no clear data on the effect of different mouth washing agents on bond strength of universal adhesives. ...
... Also, the difference between the compositions or the pH levels of the adhesive used in the current study and the previously mentioned studies may have created the conflict. On the other hand, some clinical studies reported that; there were no significant differences in terms of retention rate between etch-and-rinse and selfetch modes of universal adhesive, supporting the present study's findings (11,31). However, in these studies, universal adhesive was applied on non-carious cervical lesions that contains both enamel and dentin tissue. ...
Objective: To evaluate the effect of probiotic or chlorhexidine-based mouthwashes and coconut oil pulling therapy on microshear bond strength of a universal adhesive, used with two application modes. Method: Ninety-six enamel specimens were prepared using bovine incisors and the surfaces were grounded. Then the specimens were randomly divided into 4groups and each group were subjected to a mouth washing regimen with one of three agents-chlorhexidine mouthwash, probiotic-based mouthwash, coconut oil pulling – or stored in artificial saliva(control) for 7 days(n=24). After the procedure, all groups were divided into 2 subgroups, and a universal adhesive was applied with etch-and-rinse or self-etch mode(n=12). Composite micro-cylinders were bonded to the enamel surfaces and micro-shear-bond strength was measured after 24hours water storage. Failure modes were determined using a stereomicroscope and SEM analysis was also performed. The data were analyzed using Mann-Whitney-U and Kruskal-Wallis tests. Results: No significant differences were observed between the different mouthwash groups, regardless of application modes(p> .05). There were no significant differences in microshear-bond strength, within the same mouthwash groups, between self-etch or etch-and-rinse modes, except for oil pulling group. Etch-and-rinse group showed higher bond strength than self-etch group in specimens subjected to oil pulling(p< .05). Conclusion: Etch-and-rinse mode might be preferable on patients who practice oil pulling.
... Several in vitro studies, in which the bond durability was tested, have demonstrated remarkable effectiveness when a universal adhesive contained 10-MDP [9][10][11]. In addition, clinical trials have shown that universal adhesives attain an adequate retention rate for composite restorations placed in non-carious cervical lesions [12][13][14][15][16][17][18][19][20][21][22]. Nevertheless, when outcomes such as marginal adaptation or marginal discoloration are evaluated, the results regarding the best technique to use when applying a universal adhesive (self-etch [SE] or etch-and-rinse [ER]) are inconclusive [3,[20][21][22]. ...
... Although different clinical trials have shown that the marginal discrepancies of restorations performed with universal adhesives in the SE mode usually develop rather rapidly [12][13][14][15][16][17][18][19][20][21], particularly when FDI criteria have been used Table 7 Absolute risk (95% CI) and relative risk (95% CI) for outcome retention/fracture for different groups after 18 instead of USPHS criteria [12,13,15,19,20,44], most marginal defects are easily solved with repolishing [58]. In the present study, two clinical criteria were used to evaluate restorations (USPHS and FDI criteria). ...
Objective
The aim of this double-blind, randomized clinical trial was to evaluate the 6- and 18-month clinical performances of a new universal adhesive applied in the “no-waiting” (NW) technique to non-carious cervical lesions (NCCLs) using two evaluation criteria.
Materials and methods
One hundred and seventy-six restorations were assigned to four groups according to the adhesive system, adhesive strategy, and application mode: Prime&Bond Active (PB) applied using the etch-and-rinse (ER) and self-etch (SE) strategies with 20 s applications and Clearfil Universal Bond Quick (CQ) applied using the ER and SE strategies with the NW technique. The composite resin restorations were evaluated at baseline and after 6 and 18 months using the World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. The Friedman repeated measures analysis of variance and Wilcoxon test were used for statistical analyses (α = 0.05).
Results
No significant differences were observed among any of the groups or criteria after 6 months (p > 0.05). After 18 months, 10 restorations were lost (p > 0.05) (2 with PB-ER [95.5%; 95%CI: 92–100%], 4 with PB-SE [90.9%; 95%CI: 82–98%], 0 with CQ-ER [100%; 95%CI: 92–100%], and 4 with CQ-SE [90.9%; 82–98%]). The restorations performed with the SE strategy showed more marginal discrepancies than those performed with the ER strategy, mainly when the FDI criteria were used (p < 0.05). Those that used the PB-SE showed fewer marginal discrepancies than those that used the CQ-SE (FDI; p < 0.05). A few restorations showed marginal discrepancies after the USPHS analysis (p > 0.05).
Conclusions
The results when using the CQ-SE and -ER strategies with the NW technique were similar to those when using the PB-SE and -ER strategies in standard applications to non-carious cervical lesions after 6 and 18 months of clinical evaluation.
Clinical relevance
After 6 and 18 months, the application of Clearfil Universal Bond Quick with the “no-waiting” technique showed similar clinical performance compared to the standard application of Prime & Bond Active applied using the standard application time (20 s).
Trial registration
ClinicalTrials.gov identifier RBR-5f9gps.
... Os resultados deste trabalho podem ser atribuídos ao curto tempo de armazenamento de 24hs no corante (Lawson et al., 2015;Manfroi et al., 2020;Marchesi et al., 2014), a confecção do bisel na margem do preparo cavitário (Patanjali et al., 2019), aplicação ativa do adesivo universal (Loguercio et al., 2011;Pleffken et al., 2011) O adesivo universal foi aplicado ativamente na dentina, pois estudos anteriores relataram claramente que o uso ativo desses adesivos autocondicionantes resultam em um melhor desempenho de união (Loguercio et al., 2011;Pleffken et al., 2011). Shafiei et al. (2021) compararam a habilidade do operador durante a etapa de adesão. ...
... protocolos de aplicação do sistema adesivo universal após 24 horas de armazenamento. Porém, após 1 ano de armazenamento em saliva artificial, os resultados apontaram um aumento significativo da nanoinfiltração em todos os sistemas testados, demonstrando a necessidade de realizar um estudo a longo prazo e maior tempo de armazenamento dos espécimes.Lawson et al. (2015) compararamo desempenho clínico do adesivo Scotchbond™ Universal Adhesive (3M ESPE, St Paul, MN, EUA) nos modos AC e CT com um adesivo de condicionamento e enxágue (Scotchbond Multi-purpose, 3M ESPE, St Paul, MN, EUA) para restaurar lesões cervicais não cariosas de Classe V. Todos os materiais mostraram um aumento na descoloração margina ...
O objetivo do presente estudo foi avaliar a influência de diferentes protocolos de aplicação do sistema adesivo universal na microinfiltração marginal de restaurações classe V de resina composta. Para isso foram selecionados 30 incisivos bovinos, divididos em três grupos (n=10): Grupo CT – condicionamento total; Grupo AC – autocondicionamento e o Grupo CSE – condicionamento seletivo do esmalte. O adesivo utilizado foi um adesivo universal (Ambar Universal APS, FGM), aplicados de acordo com os grupos. Após o preparo cavitário e aplicação do sistema adesivo, foram restaurados com resina composta nanoparticulada com a técnica incremental. Após 24 horas, imersos em água destilada, todos os espécimes foram preparados e submetidos ao teste de microinfiltração durante 24 horas em uma solução de azul de metileno a 2%. Em seguida, foram seccionados no sentido vestíbulo-lingual e avaliados quanto à infiltração marginal. Os resultados assim obtidos foram submetidos à análise estatística, onde não foi observada diferença estatisticamente significante entre os grupos. Assim, de acordo com os resultados desse trabalho pode se concluir que o adesivo universal pode ser utilizado na forma autocondicionante, não tendo necessidade de fazer um condicionamento prévio com ácido fosfórico.
... Moreover, Scotchbond Universal adhesive is more hydrophobic than earlier simplified adhesives; its hydrophobicity is derived from the molecule MDP, which is inherently hydrophobic. The universal adhesive's hydrophobic nature may also help explain its favourable comparison with total-etch material in this study and a 36 similar study. Etching of enamel surfaces helps to improve the performance of restorations in terms of marginal adaptation; this was carried out on both the total-etch and selective-etch groups, which gave good clinical 32 performances in this study. ...
BACKGROUND: Problems such as microleakage and post-operative sensitivity may arise in the composite restoration of non-carious cervical lesions (NCCLs). This study assessed marginal adaptation and post-operative sensitivity in restored non-carious cervical lesions using a universal adhesive with different application techniques.MATERIALS AND METHODS: An interventional study included sixty teeth that met the selection criteria. Total-etch and selective-etch were the two application techniques used. Marginal adaptation and post-operative sensitivity were evaluated immediately post-op as a baseline, then at 3, 6, and 12 months using FDI Criteria. Data collected was analyzed using SPSS with statistical significance at p≤ 0.05.RESULTS: The majority of participants belonged to the 41-50 years age group. The NCCLs were present more in the maxillary teeth at 43(71.7%). Regarding marginal adaptation, out of the 60 restorations, seven restorations showed small marginal fractures at the 12- month period in both techniques. Restorations in the selective-etch technique group had 100% scores of 1 (no hypersensitivity) in postoperative sensitivity throughout the evaluation periods, whereas there was a score of 2 for minor hypersensitivity of restoration in the totaletch technique.CONCLUSION: The assessment of marginal adaptation and post-operative sensitivity in restored teeth with NCCLs using a universal adhesive with selective etch and total-etch techniques showed good clinical performance over a one-year evaluation.
... Depending on clinicians' preferences and clinical conditions, these multi-mode adhesives can be used with self-etch or etch-and-rinse strategies [2]. They consist of complex mixtures of hydrophobic and hydrophilic components, including functional monomers that enable chemical bonding to tooth-hard tissues [3,4]. Nevertheless, their hydrophilic nature can cause problems that decrease the stability of the resin-dentin interface due to the hydrolytic breakdown of the hybrid layer [5]. ...
Objectives
This systematic review aimed to detect whether acid etching pretreatment would enhance the bond strength of universal adhesives (UAs) to caries-affected dentin before and after aging.
Methodology
Two independent researchers reviewed materials published until August 2024 in five databases (Web of Science, PubMed, SciELO, Scopus, Science Direct, and Cochrane Library). The eligibility criteria contained in vitro studies that assessed the bond strength of UAs to caries-affected dentin using etch-and-rinse and self-etch modes, with or without aging. Statistical meta-analysis was performed using inverse variance method by the Review Manager program (p < 0.05).
Results
In total, 26 studies were included in the quantitative analysis. Studies have mostly focused on mild UAs. The application of acid etching did not impact the bond strength of ultra-mild and mild UAs (p > 0.05). Aging considerably reduced the bond strength of mild UAs in etch-and-rinse or self-etch modes (p < 0.05). Bond strength to caries-affected dentin was considerably lower than that to sound dentin in both etching modes (p < 0.05).
Conclusions
Pretreatment with phosphoric acid did not affect the bond strength of mild and ultra-mild UAs to caries-affected dentin. The aging process led to a decrease in the bond strength of mild UAs to caries-affected dentin, irrespective of the application strategy.
... Recently, manufacturers have introduced universal adhesives that can be used in both etch-&-rinse mode and self-etch mode [1]. Although self-etch approach is claimed to be user-friendly and less technique-sensitive, etch-&-rinse approach is the best choice for enamel bond and remains widely used in the clinic due to its proven clinical performance [2][3][4]. However, the dentin bond stability of etch-&-rinse approach is still suboptimal [5]. ...
Objectives
To investigate the effect of neutral 10-methacryloyloxydecyl dihydrogen phosphate salt (MDP-Na) on the dentin bond strength and remineralization potential of etch-&-rinse adhesive.
Methods
Two experimental etch-&-rinse adhesives were formulated by incorporating 0 wt% (E0) or 20 wt% (E20) neutral MDP-Na into a basic primer. A commercial adhesive, Adper Single Bond 2 (SB, 3 M ESPE), served as the control. Sixty prepared teeth were randomly allocated into three groups (n = 20) and bonded using either one of the experimental adhesives or SB. Following 24 h of water storage, the bonded specimens were sectioned into resin-dentin sticks, with four resin-dentin sticks obtained from each tooth for microtensile bond strength (MTBS) test. Half of the sticks from each group were immediately subjected to tensile loading using a microtensile tester at a crosshead speed of 1 mm/min, while the other half underwent tensile loading after 6-month incubation in artificial saliva (AS). The degree of conversion (DC) of both the control and experimental adhesives (n = 6 in each group) and the adsorption properties of MDP-Na on the dentin organic matrix (n = 5 in each group) were determined using Fourier-transform infrared spectrometry. Furthermore, the effectiveness of neutral MDP-Na in promoting the mineralization of two-dimensional collagen fibrils and the adhesive-dentin interface was explored using transmission electron microscopy and selected-area electron diffraction. Two- and one-way ANOVA was employed to assess the impact of adhesive type and water storage on dentin bond strength and the DC (α = 0.05).
Results
The addition of MDP-Na into the primer increased both the short- and long-term MTBS of the experimental adhesives (p = 0.00). No difference was noted in the DC between the control, E0 and E20 groups (p = 0.366). The MDP-Na remained absorbed on the demineralized dentin even after thorough rinsing. The intra- and extra-fibrillar mineralization of the two-dimensional collagen fibril and dentin bond hybrid layer was confirmed by transmission electron microscopy and selected-area electron diffraction when the primer was added with MDP-Na.
Conclusions
The use of neutral MDP-Na results in high-quality hybrid layer that increase the dentin bond strength of etch-&-rinse adhesive and provides the adhesive with remineralizing capability. This approach may represent a suitable bonding strategy for improving the dentin bond strength and durability of etch-&-rinse adhesive.
... Adper Scotchbond Multipurpose was chosen as the adhesive for this study, as it has a well-documented track record [30,40,41] and has also shown reliable results in thermocycling [42]. However, as only this adhesive was examined, it should be noted that the marginal quality results could be different when using other adhesives. ...
Objectives
This in vitro study examined the marginal integrity of experimental composite materials doped with bioactive glass (BG).
Materials and methods
Class-II MOD cavities were prepared and restored with one of the following composite materials: a commercial composite material as a reference (Filtek Supreme XTE), an experimental composite doped with BG 45S5 (C-20), and an experimental composite doped with a fluoride-containing BG (F-20). Six experimental groups (n = 8) were used, as each of the three composites was applied with (+) or without (-) a universal adhesive (Adper Scotchbond Multipurpose). All specimens were subjected to thermocycling (10,000 x, 5–55 °C) and then additionally stored in artificial saliva for eight weeks. Scanning electron micrographs of the mesial and the distal box were taken at three time points (initial, after thermocycling, and after eight weeks of storage in artificial saliva). The margins were classified as “continuous” and “non-continuous” and the percentage of continuous margins (PCM) was statistically analyzed (α = 0.05).
Results
In most experimental groups, thermocycling led to a significant decrease in PCM, while the additional 8-week aging had no significant effect. F-20 + performed significantly better (p = 0.005) after 8 weeks storage in artificial saliva than the reference material with adhesive, while no statistically significant differences were observed at the other two time points. C-20 + exhibited significantly better PCM than the reference material with adhesive after thermocycling (p = 0.026) and after 8 weeks (p = 0.003).
Conclusions
Overall, the experimental composites with BG showed at least as good marginal adaptation as the commercial reference, with an indication of possible re-sealing of marginal gaps.
Clinical relevance
Maintaining or improving the marginal integrity of composite restorations is important to prevent microleakage and its likely consequences such as pulp irritation and secondary caries.
... The latter was introduced to achieve all advantages of the conventional type with less complex techniques. It ensures perfect contacts, very good mechanical properties, enhanced stress response, and faster speed of introducing the material into the prepared cavity [26]. These criteria in turn decreases the number of clinical steps and the effort exerted by the dental practitioner [27]. ...
Purpose: This research aimed to investigate fracture resistance of endodontically treated maxillary premolars restored using preheated thermo-viscous and fiber-reinforced bulk fill resin composite, in vitro.
Methodology: Sixty sound human maxillary premolars were selected and divided randomly into 6 groups of ten teeth each (n = 10). Group 1; is the positive control with sound unprepared teeth (P), Group 2; is the negative control in which Mesio-occluso-distal (MOD) cavities were left unrestored (N), Group 3; includes the teeth restored by incremental packing with conventional nanohybrid composite (ChP), Group 4; includes teeth restored with short fiber reinforced bulk fill composite (EF), Group 5; includes teeth restored with preheated thermo-viscous bulk fill composite (VB), and Group 6; includes teeth restored using packable bulk fill composite (XF) Tested restorative materials were bonded with a universal adhesive in self-etch mode. Teeth were kept in distilled water for 24 h at 37 °C proceeded by thermocycling (5- 55 °C, 1200×). Teeth were then exposed to compressive load till fracture at a crosshead speed of 1 mm/min. One-way ANOVA followed by Tukey post-hoc test was implemented to compare between more than two groups in non-related samples. The significance level was established at α = 0.05 for both tests.
Results: Intact teeth significantly recorded the highest fracture resistance values among all groups. A significant difference was recorded among all the tested groups, with the EF recording the highest values, followed by the VB group then the XF group and ChP that recorded the lowest data. Negative control premolars significantly recorded the lowest fracture.
Conclusions: After thermocycling, endodontically treated maxillary premolars restored with pre-heated thermos-viscous composite did not exhibit an increase in fracture resistance. Notably, our findings indicate that short fiber-reinforced composite demonstrated significantly higher fracture resistance compared to other types of composites assessed in this study. This suggests the potential superiority of short fiber-reinforced composite in enhancing the overall structural integrity of endodontically treated teeth subjected to occlusal forces.
... Although single and double coating in SBU-er formed hybrid layers and branched adhesive tags in dentin, a double application did not prevent decay but instead induced considerable surface texture voids. This phenomenon was reported by some authors [68,69], indicating that the adhesive layer in SBU-er was partially detached from the tooth surface, exposing hollow cores with degraded collagen. SBU-se did not exhibit larger gaps to dentin after artificial aging. ...
Objectives
To evaluate the effect of an additional layer of universal adhesive on the interfacial enamel/dentin-composite gap formation in relation to application mode and aging, via spectral domain optical coherence tomography (SD-OCT) and scanning electron microscopy (SEM).
Methods
In vitro class V cavities in 114 caries-free premolars were restored by applying one or two layers of a universal adhesive (Scotchbond Universal, SBU) in self-etch (se) and etch-and-rinse (er) mode or the reference adhesive OptiBond FL (OFL-er). The restorations were imaged by SD-OCT (six groups, n = 8) and SEM (n = 3) directly after filling (t1), water storage (t2, 24 h), embedding (t3), and thermo-mechanical loading (t4, TCML). The interfacial gaps were quantified using 26 parameters and analyzed using principal component analysis and linear mixed effect models.
Results
Gap formation at enamel and dentin was significantly influenced by the adhesive, the application mode and number of layers (p < 0.001). This was due to the infl
... Otherwise, a 10-MDP monomer is a hydrolysis-resistant monomer that was first synthesized and patented by Kuraray. One study showed that this monomer has the capacity to form strong ionic bonds with calcium (18). Among the adhesives tested in the current study, SB2 contains VCP in its content, while CSE and TSB contain the 10-MDP monomer in its structure. ...
Aim: The purpose of this randomized split-mouth clinical study was to assess the effect of three adhesive systems on the 2-year clinical success of Class I composite resin restorations. Methodology: In the treatment of the Class I carious lesions of 20 participants aged 18–24 years with at least three similar carious lesions, three adhesives—Clearfil SE Bond (CSE; Kuraray, Osaka, Japan), Single Bond 2 (SB2; 3M ESPE, St. Paul, MN, USA), and Tri-S Bond (TSB; Kuraray, Osaka, Japan)—and a Filtek Z550 nanohybrid composite resin (3M ESPE, St. Paul, MN, USA) were cured. The baseline and 2-year results of the restorations were assessed according to the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. The chi-square test was used to analyze the data obtained. Results: There was no loss of restoration in any group at 2 years. No significant differences were observed in any criteria (marginal staining, fracture retention, secondary caries, and postoperative sensitivity) evaluated except marginal adaptation, in accordance with FDI and USPHS criteria (p > 0.05). At 2 years, SB2 showed the best marginal adaptation, followed by CSE and TBS. There was a statistically significant difference between SB2 and TSB (p ˂ 0.05). Conclusion: All three adhesive systems can be used successfully in the restoration of Class I carious lesions. How to cite this article: Çakır Kılınç NN, Demirbuğa S. Two-year clinical evaluation of Class I composite resin restorations using three adhesive systems: A double-blind randomized clinical trial. Int Dent Res 2023;13(2):67-74. https://doi.org/10.5577/idr.2023.vol13.no2.4 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.
... Research has indicated that self-etch mode is superior to total etch [37] or comparable to selective etch in terms of clinical performance [38]; other findings have indicated no significant effect of bonding strategy [39]. Notably, however, conflicting results are present in the literature. ...
Objectives
The purpose of this study was to evaluate the impact of dentin roughening and the type of composite resin used (either bulk-fill flowable or nanohybrid) on the restoration of non-carious cervical lesions (NCCLs) with an 18-month follow-up period.
Materials and Methods
This prospective split-mouth study included 36 patients, each with a minimum of 4 NCCLs. For each patient, 4 types of restorations were performed: unroughened dentin with nanohybrid composite, unroughened dentin with bulk-fill flowable composite, roughened dentin with nanohybrid composite, and roughened dentin with bulk-fill flowable composite. A universal bonding agent (Tetric N Bond Universal) was applied in self-etch mode for all groups. The restorations were subsequently evaluated at 6, 12, and 18 months in accordance with the criteria set by the FDI World Dental Federation. Inferential statistics were computed using the Friedman test, with the level of statistical significance established at 0.05.
Results
The 4 groups exhibited no significant differences in relation to fracture and retention, marginal staining, marginal adaptation, postoperative hypersensitivity, or the recurrence of caries at any follow-up point.
Conclusions
Within the limitations of the present study, over an 18-month follow-up period, no significant difference was present in the clinical performance of bulk-fill flowable and nanohybrid composite restorations of non-carious cervical lesions. This held true regardless of whether dentin roughening was performed.
... To date, several clinical studies have been published on universal adhesives, reporting acceptable in vivo results [6,[15][16][17][18][19][20][21][22][23][24][25][26]. SEE was the most recommended application mode for non-carious cervical lesions for better retention [27,28]. ...
The effectiveness of a universal adhesive applied in three application modes for the preparation of Class V composite restorations was evaluated both clinically and by quantitative marginal analysis (QMA) over 36 months. In 50 patients, three (n = 21) or four (n = 29) non-carious cervical lesions (NCCL) were restored with Venus® Diamond Flow (Kulzer GmbH, Hanau, Germany). The adhesive iBond® Universal (iBU, Kulzer, Germany) was used in self-etch (SE), etch-and-rinse (ER), or selective-enamel-etch mode (SEE). The etch-and-rinse adhesive OptiBondTM FL served as a control (OFL, Kerr GmbH, Herzogenrath, Germany). The restorations were clinically assessed (FDI criteria) at 14 days (BL), 6, 12, 24, and 36 months. Additionally, QMA was conducted on all restorations of 11 randomly selected patients. FDI criteria and marginal gap and perfect margin were compared between and within groups and recalls using McNemar, Wilcoxon, or Mann–Whitney U-tests (α = 0.05). Starting with 12 months, cumulative failure rates were lower in iBU-SE (0.0%, p = 0.016) and iBU-ER groups (2.1%, p = 0.07) compared to OFL (16.7%). At two years, iBU-SEE also showed fewer failures (0.0% SEE vs. 34.6% OFL, p = 0.016), as did iBU-SE compared to iBU-ER after 36 months (2.2 and 19.6%, p = 0.039). From BL, the iBU-SEE group always had the fewest marginal gaps and the highest percentage of perfect margins. From BL, iBU-SEE (0%, p = 0.008) and iBU-ER (0.2%, p = 0.027) showed significantly fewer marginal gaps compared to OFL (2.5%) and more perfect margins were found with iBU-SEE starting at 6 months (p = 0.054). The SEE and ER modes ensured the most excellent marginal quality, with differences from the control appearing earlier with QMA than clinically. In restoring NCCls, iBU showed superior clinical performance over OFL, especially in modes SE and SEE.
... After cavity preparation by laser and conventional methods, a total acid etching system with 37% phosphoric acid was used, followed by use of a Clearfil Universal Bond Quick etching primer on the enamel surface. Cavity preparation by laser was followed by acid etching to reduce microleakage at the enamel-composite interface [15][16][17][18][19]. The reason for selecting only one type of adhesive system was to solely obtain a comparison of the cavity preparation techniques [20]. ...
The most frequently used and universally accepted technique for removing caries is mechanical ablation of decayed tissues by rotating drills. New minimally invasive strategies, such as the use of lasers to perform highly controlled tissue ablation, have been introduced in dental practice. The aim of this study was to assess and compare treatment with a 2940 nm erbium/yttrium–aluminum–garnet (Er:YAG) laser versus a conventional rotary treatment during cavity preparation in children with regard to restoration integrity. In a randomized, controlled, blinded trial using a split-mouth design, 40 (9–12-year-old) children with 80 carious primary molars were included. The cavity in one quadrant was randomized to be treated conventionally using a bur, while the cavity in the other quadrant was prepared using an Er:YAG laser. At the one-year follow-up, clinical examinations were conducted to assess the integrity of the restorations according to the Ryge criteria. The data were analyzed using SPSS version 22 (IBM Inc., Chicago, IL, USA). The average age of the participants was 9.4 ± 1.29 years. Males accounted for 51.4% of the participants. The Ryge criteria showed clinical success of restorations, and there was no discernible difference between the conventional and laser intervention techniques. Over one year, no statistically significant differences in the clinical integrity based on the Ryge criteria were found following class I cavity preparation in primary teeth with either procedure.
... o tipo de substrato dentinário (Bakry e Abbassy 2021;Lawson et al. 2015); a composição química do adesivo(Maciel Pires et al. 2022;Kanniappan et al. 2022); os componentes minerais da smear layer que podem neutralizar o ácido do adesivo, afetando assim a desmineralização da superfície dentinária(Kanniappan et al. 2022); a capacidade dos monômeros funcionais e/ou ácidos do adesivo de interagir com a smear layer e a dentina mineralizada subjacente (Maciel Pires et al. 2022); e uma infiltração eficaz dos monômeros resinosos, que está relacionada à alta hidrofilicidade do seu solvente e dos monômeros funcionais (normalmente do MDP e PENTA) (Maciel Pires et al. 2022). Além disso, é necessário fornecer tempo adequado para os procedimentos de adesão (Thanatvarakorn et al. 2016). ...
Atualmente, a disponibilidade de uma ampla variedade de adesivos universais torna difícil aos clínicos escolher o sistema correto para diferentes situações de adesão ao substrato dentinário. Este trabalho apresenta uma revisão sistemática que avaliou a qualidade da camada híbrida criada pelas diferentes estratégias de aplicação de sistemas adesivos universais, no modo autocondicionante e no modo de condicionamento e lavagem, com o objetivo de investigar se as diferenças observadas na camada híbrida são significativas para a prática clínica. Assim, dois revisores realizaram uma pesquisa bibliográfica até dezembro de 2022 na base de dados eletrônicos PubMed (MedLine). Apenas estudos in vitro que avaliaram a qualidade da camada híbrida por meio de microscopia confocal de varredura a laser e que relataram o efeito do uso dos adesivos universais na qualidade da camada híbrida da dentina foram incluídos. Verificou-se que o modo de aplicação dos adesivos universais influencia na qualidade da camada híbrida. Os adesivos aplicados no modo condicionamento e lavagem apresentam a camada híbrida mais espessa e com maiores prolongamentos nos túbulos dentinários. Entretanto, adesivos universais autocondicionantes demonstram uma maior longevidade devido à sua interface resina-dentina ser mais resistente ao envelhecimento associado ao fato de que estudos demonstram que uma abordagem de condicionamento prévio à aplicação do sistema adesivo não melhora a resistência de união. A partir desses resultados podemos concluir que a abordagem autocondicionante consiste na opção mais vantajosa para aplicação em dentina, uma vez que proporciona maior longevidade, menor possibilidade de nanoinfiltração e degradação da camada híbrida com o envelhecimento.
... Although self-etching adhesive systems do not require moisture to bond, water is included in their composition to ionize the hydrophilic acid monomers, which are responsible for the mineral ions available to the chemical bond with the dental substrate [8][9][10] . Approximately ten years ago, multi-mode adhesives were designed under the all-in-one concept, providing greater versatility than existing adhesives and enabling the clinician to decide which adhesive strategy to use 1,9,[11][12][13][14] .These universal adhesives tend to minimize dentin sensitivity because deep demineralization is not necessary. Some studies, however, have shown that in enamel, the selective etching technique improves bonding performance 6,8,9,15,16 . ...
Unlabelled:
The objective of this study was to evaluate the microtensile bond strength (μTBS) to dentin of two universal adhesive systems: Single Bond Universal (SBU) and Ambar Universal (AU), used in different adhesion strategies.
Materials and method:
Thirty-six human teeth were prepared (n=6) and treated following different adhesive strategies: G1: SBU-etch-and-rinse, applied on dry dentin; G2: SBUetch- and-rinse, applied on moist dentin; G3: SBU-self-etching; G4: AU-etch-and-rinse, applied on dry dentin; G5: AU-etch-and-rinse, applied on moist dentin; G6: AU-self-etching. The specimens were submitted to μTBS test, failure analysis, and scanning electron microscopy (SEM). Data were analyzed with ANOVA and Tukey's tests (p<0.05).
Results:
Microtensile bond strength was significantly lower in G1 than G2 and G3. AU adhesive performed worse than the SBU system, except in G5. Cohesive and mixed failures predominated in G1 and G2, while adhesive failures predominated in G3 and G5.
Conclusions:
Universal adhesives are an interesting innovation, but there are still doubts about their performance, mainly regarding the different protocols provided by the manufacturers. The conventional adhesive strategy on moist dentin demonstrated higher μTBS for both adhesives. The use of the selfetching strategy with the SBU showed promising results.
... According to a systematic review, the mean retention rate of cervical restorations after 36 months was 90.8% [29]. Other studies reported mean retention rates of 90% after 24 months [30] and between 89 and 100% after 36 months [18]. The finds of this study showed similar survival rates as the literature. ...
Objective
To compare 2 different resin composites and 2 adhesive systems used in a new restorative protocol (partial restoration) to treat non-carious cervical lesions associated with gingival recession type 1 (RT1).
Material and methods
Eighty combined defects (CDs) were treated with a partial restoration and periodontal plastic surgery for root coverage. The CDs were randomly assigned to one of the following groups: NP + TE (n = 20), nanofilled composite and 2-step total-etch adhesive system; NP + UA (n = 20), nanofilled composite and universal adhesive system; MH + TE (n = 20), microhybrid composite and 2-step total-etch adhesive; MH + UA (n = 20), microhybrid composite and universal adhesive. Restorations were assessed using the United States Public Health Service (USPHS) criteria at 1 week (baseline) and 6, 12, and 24 months. Survival rate, periodontal parameters, dentin hypersensitivity (DH), and aesthetics were also evaluated.
Results
After 24 months, only the MH + TE group did not lose any restoration, with no significant differences between groups. For surface roughness parameter, MH presented 83.3% of the restorations scoring Bravo, whereas NP presented 48.5% of the restorations scoring Bravo. All groups presented restorations with marginal discoloration. All periodontal parameters behaved similarly, regardless of the restorative material. All groups presented significant reductions of dentin hypersensitivity and improved aesthetic perceptions (p < 0.05).
Conclusion
Both resin composites and adhesives tested can be combined for partial restorations to treat CDs.
Clinical relevance
This new restorative-surgical protocol to treat CDs presents satisfactory outcomes. The partial restorations can be successfully executed with both combinations of adhesives and resin composites evaluated in this investigation.
TRN
ClinicalTrial.gov: NCT03215615; registration date July 12, 2017.
... In the present study, only moderate Class Ⅱ cavities were included because of the observed low failure rate of Class Ⅰ restorations. A recent study found that the success rate for Class Ⅱ in primary teeth was 68% at 18 months [38] . Based on the American Dental Association criteria, some studies reported that the failure rates due to retention and microleakage must be less than 10% at 18 months [39] . ...
The current study aims to investigate a suitable adhesive for primary tooth enamel. Shear bond strength (SBS) of primary teeth and the length of resin protrusion were analyzed using one-way ANOVA with Bonferroni multiple comparison tests after etching with 35% H 3PO 4. SBS and marginal microleakage tests were conducted with Single Bond Universal (SBU)/Single Bond 2 (SB2) adhesives with or without pre-etching using a nonparametric Kruskal-Wallis test. Clinical investigations were performed to validate the adhesive for primary teeth restoration using Chi-square tests. Results showed that the SBS and length of resin protrusion increased significantly with the etching time. Teeth in the SBU with 35% H 3PO 4 pre-etching groups had higher bond strength and lower marginal microleakage than those in the SB2 groups. Mixed fractures were more common in the 35% H 3PO 4 etched 30 s + SB2/SBU groups. Clinical investigations showed significant differences between the two groups in cumulative retention rates at the 6-, 12- and 18-month follow-up evaluations, as well as in marginal adaptation, discoloration, and secondary caries at the 12- and 18-month follow-up assessments. Together, pre-etching primary teeth enamel for 30 s before SBU treatment improved clinical composite resin restoration, which can provide a suitable approach for restoration of primary teeth.
... Esta apresentou um sucesso de 82% contra 100% de sucesso para as cavidades restauradas com a FZ. Dois aspectos são importantes para determinar o sucesso do tratamento restaurador das LCNCs, sendo eles a adaptação das margens e o grau de manchamento marginal 5,30,31 . A forma de contorno da LCNC não favorece macrorretenção do material restaurador, assim sendo, os sistemas adesivos são cruciais para garantir esta união da restauração ao dente 26 . ...
O presente estudo propôs-se a avaliar o desempenho da resina FiltekTM Bulk Fill - 3M- -ESPE (FBF) versus a Filtek Z350 XT - 3M (FZ) em restaurações de lesões cervicais não cariosas (LCNC) por meio de um ensaio clínico. O estudo trata-se de um ensaio clínico randomizado, boca dividida e duplo cego, em que foram selecionados 40 pacientes, totalizando 80 dentes. Os grupos foram divididos quanto ao tratamento restaurador em FBF e FZ. Avaliaram-se os critérios de sensibilidade pós-operatória (SPO), retenção, manchamento e integridade marginal (IM) por 1 e 6 meses por um examinador cego, alheio ao operador. Os dados foram tabulados no programa Microsoft Excel® 2013 e foram analisados pelo programa Bioestat 5.3, utilizando o teste de McNemar para medidas repetidas, e o teste Exato de Fisher para o mesmo período (p<0,05). Em relação à IM, a resina FZ apresentou resultados melhores (p=0,05). No critério de manchamento e retenção, não foram apresentadas diferenças estatísticas significativas (p=1,00). Na avaliação de SPO, não houve diferença estatística quando se comparou a FZ em diferentes períodos (p=0,63), bem como a FBF (p=0,37). Portanto, a resina FZ apresentou melhores resultados no critério de integridade marginal, no entanto, nos demais critérios não houve diferença significativamente estatística.
... [6][7][8][9] Universal adhesives contain acidic functional monomers such as MDP (methacryloxidecyl dihydrogen phosphate). 10 MDP has polymerizable methacrylate groups, phosphate groups capable of chemical bonding with calcium in hydroxyapatite. It is an acidifying monomer due to the dihydrogen phosphate groups it contains. ...
Effect of Self-cured Universal Adhesive System on Shear Bond Strengths of Conventional and Bulk-fill Composites
Ihsan HUBBEZOGLU1, Serra KUTLU2, Ayşegül KARAARSLAN3
1 Sivas Cumhuriyet University, Faculty of Dentistry, Department of Restorative Dentistry, Sivas, Turkey
2 Niğde Oral and Dental Center, Niğde, Turkey
3 Sivas Oral and Dental Center, Sivas, Turkey
Aim: The aim of this study was to investigate the effect of self-cured universal adhesive system on shear bond strengths of two conventional and two bulk-fill composites to dentin.
Material-method: In this study, four groups were formed: two conventional condensable composites[G-aenial posterior(GC), Palfique Estelite Paste(Tokuyama)], and two bulk-fill composites[Estelite Bulk Fill Flow(Tokuyama), Beautifil Bulk Restorative(Shofu)]. Each group was divided into two subgroups; G-premio bond (control group) ve self-cured Universal Bond (Tokuyama). 32 human third molar human teeth were prepared to expose dentin surfaces. After the preparation, the teeth were randomly divided into 4 main groups and 2 subgroups (n = 8), composites were applied to the surfaces with the help of cylindrical silicone transparent mold with a diameter of 4 mm and a height of 4 mm.
Results: In this study, when both adhesive systems are evaluated; the highest shear bond strength value was Palfique Estelite Paste, while the lowest shear bond strength value was Beautifil Bulk Restorative. While the difference between Palfique Estelite Paste and Estelite bulk-fill flow, Beautifil Bulk Restorative was found to be statistically significant (p<0.05), the difference with G-aenial posterior was not significant (p>0.05). The difference between G-aenial posterior and Beautifil Bulk Restorative was found to be statistically significant (p<0.05). When adhesive systems are compared; G-premio bond was found to be higher in all composite groups compared to self-cured Universal Bond, but the difference between them was statistically insignificant (p>0.05).
Conclusion: While conventional composites exhibited high shear bond strengths, bulk-fill composites showed values close to these values. The self-cured adhesive system we used showed near values of shear bond strength to the light-polymerized adhesive system. In terms of bond strength self-cured adhesive systems can be recommended for use in areas where light can be difficult to reach in clinical applications. It is advisable to use self-cured adhesive systems for use in areas where light can be difficult to access in clinical applications.
Keywords: shear bond strength, bulk-fill composites, self-cured adhesive systems
ÖZET
Geleneksel ve Bulk-fill Kompozitlerin Makaslama Bağlanma Dayanımlarına Işıksız Adeziv Sistemin Etkisi
Amaç: Çalışmamızın amacı, iki geleneksel ve iki bulk-fill kompozitlerin dentine makaslama bağlanma dayanımlarına ışıksız adeziv sistemin etkisinin incelenmesidir.
Materyal-metod: Çalışmamızda iki geleneksel kondanse edilebilen kompozit [G-aenial posterior(GC), Palfique Estelite Paste(Tokuyama)], kütlesel yerleştirilebilen iki bulk-fill kompozit [Estelite Bulk Fill Flow(Tokuyama), Beautifil Bulk Restorative(Shofu)] olarak 4 grup oluşturuldu. Her grup iki alt gruba ayrıldı; G-premio bond (Kontrol grubu) ve ışıksız Universal Bond (Tokuyama). 32 adet insan üçüncü molar insan dişi dentin yüzeyleri açığa çıkacak şekilde prepare edildi. Preparasyonun ardından dişler rastgele 4 ana, 2 alt gruba ayrıldı(n=8), yüzeylere 4 mm çapında ve 4 mm yüksekliğindeki silindirik silikon şeffaf kalıp yardımıyla kompozitler uygulandı. Tüm grupların makaslama bağlanma değerleri universal test cihazında ölçüldü, kuvvet birimi ise “newton” (=N) olarak kalibre edildi.
Bulgular: Çalışmamızda her iki adeziv sistem kullanıldığında da, en yüksek makaslama bağlanma dayanım değerini Estelite Paste gösterirken, en düşük makaslama bağlanma dayanım değerini Beautifil Bulk Restorative göstermiştir. Estelite pasteile; Bulk-fill flow ve Beautifil Bulk Restorative arasındaki fark istatistiksel olarak anlamlı bulunurken (P<0,05), G-aenial posterior ile arasındaki fark anlamsız bulunmuştur(P>0,05). G-aenial posterior ile Beautifil Bulk Restorative arasındaki fark istatistiksel olarak önemli bulunmuştur(P<0,05). Adeziv sistemler kıyaslandığında; tüm kompozit gruplarında G-premio bond, Işıksız Universal Bonda göre daha yüksek bağlanma sağlarken, aralarındaki fark istatistiksel olarak anlamsız bulunmuştur (P>0,05).
Sonuçlar: Geleneksel kompozitler, yüksek makaslama bağlanma dayanımları sergilerken, bulkfill kompozitler bu değerlere yakın değerler göstermiştir. Kullandığımız ışıksız adeziv sistem, ışıkla polimerize edilen adeziv sisteme yakın bağlanma değerleri sergilemiştir. Işıksız adeziv sistemler, klinik kullanımlarda ışığın zor olabileceği bölgelerde bağlanma dayanımı açısından kullanılması önerilebilir.
Anahtar kelimeler: makaslama bağlanma dayanımı, bulkfill kompozitler, ışıksız adezivler
... The bonding mechanism of universal adhesives used in ER strategy would be mainly micromechanical as calcium depletion would hamper its interaction with MDP and polyalkenoic acid copolymer [5]. However, in medium-and long-term clinical trials performed on NCCLs, the application of Scotchbond Universal Adhesive in ER or selective enamel etching approach provides more predictable retention [16][17][18][19], although more long-term studies are warranted. ...
Objectives:
To evaluate the effect of the application of an additional hydrophobic bonding resin on the clinical performance of a universal adhesive applied in etch-and-rinse (ER) or self-etch adhesive (SE) strategy in non-carious cervical lesions (NCCLs) after 5 years.
Materials and methods:
Scotchbond Universal Adhesive (3M Oral Care) was applied in 134 NCCLs of 39 subjects using different adhesion approaches: 3-step ER (3-ER), 2-step ER (2-ER), 2-step SE (2-SE), and 1-step SE (1-SE). Enamel and dentin were acid etched prior to application of the universal adhesive for the 3-ER and 2-ER groups. An extra layer of a hydrophobic bonding resin was applied for groups 3-ER and 2-SE. All lesions were restored with Filtek Supreme XTE resin composite (3M Oral Care). Restorations were evaluated at baseline and at 5 years using the modified USPHS criteria. Mann-Whitney U and Wilcoxon tests were performed, and the survival rates (retention/fracture) were analyzed using Kaplan-Meier and log-rank tests (p < 0.05).
Results:
The recall rate was 66.7% at 5 years. The cumulative survival rate was 96.9% for 3-ER, 96.8% for 2-ER, 71.4% for 2-SE, and 81.3% for 1-SE strategies. The log-rank test was statistically significant (p = 0.006). Retention rates were 100% for both ER groups, 75% for 2-SE and 81.3% for 1-SE. At 5 years, 2- and 1-SE approaches showed similar retention rates, but lower than those for 3- and 2-ER. A significant decrease in retention rate was detected for 2-SE (p = 0.007) and 1-SE (p = 0.014) groups between baseline and 5 years. All groups, except 2-ER, showed an increase in marginal discoloration. For this parameter, significant differences were detected between 2-ER and 1-SE (p = 0.004).
Conclusions:
The addition of a hydrophobic bonding resin to the recommended application sequence of Scotchbond Universal Adhesive did not improve its clinical performance in NCCLs after 5 years. Higher retention rates were measured when this adhesive was applied in ER mode.
Trial registration:
This manuscript is a 5-year follow-up of a randomized clinical trial that started in 2012 when there was no strong recommendation for registration in clinicaltrials.gov. The results after 36 months of clinical service were previously published in this journal.
... In the present study, the same results were observed, given that, five lost restorations were in premolar (two maxillary and three mandibular) and two in maxillary incisors in agreement with Heymann's results [35]. This seems to be the reason that explains why, in many studies in which clinical follow-up of adhesive restorations in NCCL was performed, both anterior and posterior teeth were included [36][37][38][39][40][41]. ...
The objective of this double-blind, randomized controlled clinical trial was to evaluate the clinical performance of two methacrylate-based flowable composite and ormocer-based flowable composite in non-carious cervical lesions (NCCLs) of adult patients. 183 restorations were performed on NCCLs using the Futurabond U adhesive system, applied in the selective enamel etching mode in all cavities. After the adhesive application, the cavities were restored with one out of the three evaluated flowable composites (n = 61
per group): ormocer-based flowable composite (Admira Fusion Flow, ORM), low viscosity methacrylate-based composite (GrandioSO Flow, LV) and high viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV). After 12 months of clinical performance, these restorations were evaluated according to FDI and USPHS criteria in the following items: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity and caries recurrence. Results: eight restorations were lost/fractured after 12 months of clinical evaluation (1 in the ORM and 7 in the HV group). The retention rates for 12- months (95% confidence interval) were 98.4% (91.3%-99.7%) for the ORM group, 100% (94.5%-100%) for the LV group and 88.5% (78.1%-94.3%) for the HV group, with no statistical difference identified between any pair of groups (p > 0.05). Five restorations
presented small marginal adaptation defects at the 12-months evaluation recall, and all of them were considered clinically acceptable. Conclusion: The clinical performance of the universal adhesive associated to ormocer-based or methacrylate-based flowable composite were found to be promising after 12-month of clinical evaluation.
... A polyalkenoic acid copolymer is also present in the composition of this adhesive system, which has functional carboxylic groups capable of chemically interacting with hydroxyapatite [30,31]. High retention rates with the use of this adhesive system have been previously demonstrated by other clinical trials [31,32]. Therefore, the presence of these components may have improved the retention rate. ...
Objectives:
The aim of this investigation was to evaluate the effectiveness of collagen cross-linking agents (CCLAs) used in combination with the adhesive technique in restorative procedures.
Materials and methods:
In this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An electronic search was performed using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and DOSS, up to October 2020. The gray literature was also researched. Only randomized clinical trials were selected.
Results:
The selection process yielded 3 studies from the 838 retrieved. The addition of CCLAs in the retention of restorations increased the number of events. The postoperative sensitivity scores and marginal adaptation scores showed no significant difference between the CCLA and control groups, and the marginal pigmentation scores showed a significant increase in the CCLA group. There were no caries events in any group throughout the evaluation period.
Conclusions:
This systematic review showed that there is no clinical efficacy to justify the use of CCLAs in the protocols performed.
This systematic review aims to compare the postoperative sensitivity of self-etching and total-etching adhesives systems in restorations of non-carious cervical lesions by analyzing randomized clinical studies. Following PRISMA recommendations, six recognized databases (Cochrane Library, EMBASE, LILACS, Pubmed, Scopus, Web of Science) and the grey literature were used to search for articles in October 2024. Only randomized clinical trials, carried out on humans, of any duration and year of publication, which compared and evaluated postoperative sensitivity in restorations of non-carious cervical lesions (NCCL) using self-etching and total-etching adhesives were included. Uncontrolled clinical trials, editorial letters, pilot studies, case reports, and case series were excluded. The quality of the articles was analyzed using the Risk of Bias Tool for Randomized Trials (RoB 2.0). The results of data extraction from the selected articles were tabulated in spreadsheets to examine the outcomes assessed. Self-etching adhesive systems showed variable performance compared to total-etching adhesives in reducing postoperative dentin sensitivity. The ten studies included in the systematic review had some risk of bias, revealing the need to pay attention to the criteria for conducting randomized clinical trials. When compared, the control and test groups did not show a significant reduction in postoperative sensitivity in NCCLs, and there was great variability in the effects of the studies.
Objective This randomized controlled trial compared the 1-year clinical efficacy of Scotchbond Universal Adhesive Plus (SBU+) with that of its predecessor Scotchbond Universal Adhesive (SBU) to restore Class I and Class II preparations using the self-etch strategy in adult patients. Materials and methods - Fifty-one subjects participated in this study. Two posterior teeth in each subject were randomized to a restoration with SBU+ or to a restoration with SBU (control) using the self-etch strategy. Teeth were restored with Filtek Universal Restorative. Restorations were evaluated at baseline, 6 months and 1 year using the FDI criteria. The Wilcoxon signed-rank test was used to compare outcomes. Results - No restorations were graded as “Insufficient/Unsatisfactory” or “Poor” for any of the FDI criteria at the baseline, 6-month, or 1-year visits. At 1 year the retention rate was 100% for both SBU+ and SBU. For fracture of the restorative material 42/44 SBU+ restorations (95%) and 44/44 SBU restorations (100%) were graded “Excellent/Very Good” (p>0.05). All restorations were clinically acceptable for marginal adaptation at 1 year with no statistical differences between the two adhesive materials. There were no recurrent caries lesions at the 1-year visit. Conclusions - The clinical efficacy of the SBU+ at 1-year was not different to that of its predecessor SBU in Class I and Class II restorations of adult patients using the self-etch strategy. Clinical relevance– The two dental adhesives used in this clinical trial showed excellent results in posterior restorations at 1 year without using a separate phosphoric etching step.
Purpose
This systematic review aimed to answer the PICO question: do adhesive protocols used for non-carious cervical lesions (NCCLs) using a universal adhesive system influence marginal degradation, marginal staining, and retention of these restorations? The self-etching adhesive strategy and selective enamel etching were compared with the etch-and-rinse strategy as a control.
Materials and Methods
The study searched various databases, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, Embase, and grey literature, to find randomized clinical trials (RCTs) comparing self-etching (SE) or selective enamel etching (SEE) to the etch and rinse (ER) strategy. The risk of methodological bias was assessed using the Cochrane RoB 2 tool. Data were dichotomized and analyzed using RevMan v 5.3, adopting the Mantel-Haenszel method. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results
Twenty RCTs were included in the meta-analysis. Results showed that using universal adhesives with the SE strategy resulted in clinical signs of marginal degradation at 12 months, 24 months, and 36 months of follow-up, and marginal staining at 24 months. The adhesive strategy did not interfere with the retention of restorative material used for NCCLs over 36 months, as assessed based on both the United States Public Health Service (USPHS) and World Dental Federation (FDI) criteria.
Conclusion
With moderate certainty of evidence, after 24 months of follow-up, the SE strategy results in the detection of clinical signs of marginal degradation and staining. The adhesive strategy adopted did not influence the retention rate of the restorations over 36 months of follow-up.
The central aim of adhesive dentistry is to improve the compatibility between current adhesives and a range of substrates by employing diverse application techniques. Therefore, the overarching objective of this review is to offer a comprehensive analysis of dentin bonding systems, starting with an introduction to adhesion and a detailed overview of enamel and dentin structures, their histology, and the impact of dentin structure on resin–dentin bonding. It covers the mechanisms of resin–dentin bonding, including resin adhesive application, bonding mechanisms, and factors influencing efficacy. Further, this review explores the composition of resin adhesive systems, including acidic components, cross-linking monomers, solvents, and other critical elements. It also examines various adhesive strategies—etch-and-rinse, self-etch, and universal adhesives—highlighting their applications and advantages. The review extends to clinical applications of dental adhesion, including direct restorations, indirect restorations, and immediate dentin sealing (IDS), demonstrating the practical implications of adhesive systems in enhancing restoration longevity and performance. In conclusion, despite significant advancements, no gold-standard method for optimal adhesion exists. Each adhesive system has distinct strengths and limitations. The review emphasizes the importance of evaluating methods for achieving durable adhesion and staying current with technological advancements in adhesive systems. Summary: This review provides a thorough analysis of dentin bonding systems, delving into the structures and bonding mechanisms of both enamel and dentin. By exploring various adhesive systems and their components, it highlights the ongoing challenges in achieving optimal resin–dentin adhesion. The review also addresses the clinical applications of dental adhesion, including direct restorations, indirect restorations, and immediate dentin sealing (IDS), illustrating how different adhesive techniques impact clinical outcomes. It underscores the necessity for continuous innovation and assessment of adhesive systems to enhance long-term bonding effectiveness in clinical practice.
Objective
To assess the clinical performance of two composite materials with two universal adhesives and a two‐step self‐etch adhesive on class II restorations for 18 months.
Materials and Methods
Two hundred and fifty‐two class II cavities were bonded with G‐Premio Bond, Single Bond Universal, and Clearfil SE Bond 2. A nanohybrid composite (Filtek Z550 Universal) or a microhybrid composite (G‐aenial Posterior) was used to fill the bonded cavities. World Dental Federation criteria were used to evaluate the restorations at 1 week, 6, and 18 months. Statistical analysis was performed using Friedman and Fisher's exact tests ( α = 0.05).
Results
Retention loss and fracture were not observed in any restorations during the 18 months. The adhesives used showed no significant differences for all criteria examined ( p > 0.05) regardless of composite material. After an 18‐month follow‐up, seven G‐aenial Posterior and three Filtek Z550 Universal restorations presented slight marginal discrepancies, with no significant differences ( p = 0.246). At 1 week, Filtek Z550 Universal (9.5%) led to significantly higher postoperative sensitivity compared with G‐aenial Posterior (0.8%) ( p = 0.001).
Conclusions
Universal adhesives showed similar clinical performance to Clearfil SE Bond 2. The restorations with Filtek Z550 Universal had a relatively higher risk of postoperative sensitivity.
Clinical Significance
Universal adhesives were clinically successful for 18 months. At 1 week, the type of composite material used significantly affected the occurrence of postoperative sensitivity.
Objectives
To investigate the effect of neutral 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-Na salt on the dentin bond strength and remineralization potential of etch-&-rinse adhesive.
Methods
Two experimental etch-&-rinse adhesives were prepared by integrating varying weight percentages (0wt%, 20wt%) of neutral MDP-Na into a base primer. A commercial etch-&-rinse adhesive Adper Single Bond 2 (SB, 3M ESPE) was used as control. Following this, microtensile bond strength (MTBS) was evaluated after subjecting the samples to 24 h of water storage or a 6-month incubation in artificial saliva. Fourier-transformed infrared spectrometry was used for assessment of the degree of conversion of the experimental adhesives and the adsorption properties of MDP-Na on the dentin organic matrix. Furthermore, the efficacy of neutral MDP-Na in facilitating the remineralization of two-dimensional collagen fibrils and the adhesive–dentin interface was investigated using transmission electron microscopy and selected-area electron diffraction.
Results
The addition of MDP-Na into the primer increased both the short- and long-term MTBS of the experimental adhesives (p = 0.000). No difference was noted in the degree of conversion between the control, 0 wt% and 20 wt% MDP-Na-containing groups (p = 0.336). The intra- and extra-fibrillar remineralization of the two-dimensional collagen fibril and dentin bond hybrid layer was confirmed by transmission electron microscopy and selected-area electron diffraction when the primer was added with MDP-Na.
Conclusions
The use of neutral MDP-Na results in high-quality hybrid layer that increase the dentin bond strength of etch-&-rinse adhesive and provides the adhesive with remineralizing capability. This approach may represent a suitable bonding strategy for improving the dentin bond strength and durability of etch-&-rinse adhesive.
AIM. To conduct a systematic review to evaluate the differences between the clinical performance of restorations made with total-etch and self-etch techniques.
MATERIALS AND METHODS. A literature search was conducted in the Pubmed, Google Scholar and Cyberleninka databases. The research was done according to the PICO strategy. Articles from the last 10 years (2013–2023) were included in the review.
RESULTS. After screening 1005 articles, 52 studies were subjected to data extraction. There were no statistically significant differences in any study regarding recurrence of caries. In 9 of 14 articles, retention was higher with the total-etch technique. Total-etch groups showed better marginal adaptation in 11 of 19 studies. 11 of 17 studies recorded the least marginal staining using the total-etch technique. None of the studies found statistically significant results for the presence of post-operative sensitivity at the end of the follow-up period. However, three studies reported statistically significant evidence of post-operative sensitivity at baseline, and after 12 months (1/2 follow-up) in the total-etch groups only.
CONCLUSIONS. Both methods show effective and clinically acceptable restoration performance.
Objective
This study aimed to evaluate the effects of different surface treatments on the repair bond strength between a fiber‐reinforced dentin composite and a posterior composite.
Methods
Forty fiber‐reinforced dentin composite resin blocks (4 mm × 4 mm × 4 mm) were separated into eight groups ( n = 5) according to the surface preparation methods: (G1) negative control group, (G2) adhesive application, (G3) 50% dimethylsulfoxide (DMSO) application, (G4) 50% DMSO + adhesive application, (G5) 37% phosphoric acid etch + adhesive application, (G6) air abrasion + adhesive application, (G7) 37% phosphoric acid etch + 50% DMSO application + adhesive application, and (G8) air abrasion +50% DMSO application + adhesive application group. The composite surfaces were repaired in two layers with a posterior composite. Composite sticks were subjected to a micro tensile bond strength (μTBS) test. Fractured surfaces were evaluated using a stereomicroscope (×25). Short fiber‐reinforced composite samples' surfaces were investigated by scanning electron microscope (SEM). Shapiro Wilk, one‐way ANOVA, and Tukey HSD tests were used for statistical evaluation.
Results
The highest average (μTBS) values were observed in G8, whereas the lowest mean μTBS values were evident in the G1 group. Statistically significant μTBS values were found in all adhesive‐applied groups when compared with the negative control group. Notably, the application of 50% DMSO without adhesive did not lead to a statistically significant increase in μTBS values. SEM images demonstrated that acid etching partially eliminated residues on the composite surface, while air abrasion had a detrimental effect on the integrity of fiber structures.
Conclusion
In the repair of fiber‐reinforced dentin composite with a posterior composite, adhesive application is an effective approach. The treatment of 50% DMSO without adhesive did not confer a statistically significant advantage, and the supplemental use of acid etch or air abrasion did not show an additional benefit compared to adhesive‐only repairs.
Clinical Significance
Adhesive application emerges as a potent and effective strategy for the repair of bur‐roughened fiber‐reinforced dentin composites. With its limitations, the study highlights the efficacy of adhesive‐only repairs without the necessity for additional surface treatments.
This study aimed to (1) comparatively analyze properties of Sr‐ and Mg‐substituted hydroxyapatite (HAP)‐based dental inserts; (2) evaluate insert bonding to restorative materials, and (3) evaluate the effect of doped HAP inserts on fracture resistance (FR) of human molars with large occlusal restorations. By ion‐doping with Sr or Mg, 3 insert types were obtained and characterized using XRD, SEM, Vickers hardness and fracture toughness. Shear bond strength (SBS) was determined between acid etched or unetched inserts and following materials: Maxcem cement (Kerr); Filtek Z250 (3M) bonded with Single Bond Universal (SBU; 3M) or Clearfil Universal (Cf; Kuraray). Modified Class I cavities were prepared in 16 intact molars and restored using insert + composite or composite only (control) (n = 8/group). FR of restored molars was determined by static load until fracture upon thermal cycling. Fracture toughness was similar between Sr/Mg‐doped inserts (0.94–1.04 MPam−1/2 p = .429). Mg‐doped inserts showed greater hardness (range 4.78–5.15 GPa) than Sr6 inserts (3.74 ± 0.31 GPa; p < .05). SBS for SBU and Cf adhesives (range 7.19–15.93 MPa) was higher than for Maxcem (range 3.07–5.95 MPa) (p < .05). There was no significant difference in FR between molars restored with insert‐containing and control restorations (3.00 ± 0.30 kN and 3.22 ± 0.42 kN, respectively; p > .05). HAP‐based inserts doped with Mg/Sr had different composition and mechanical properties. Adhesive bonding to inserts resulted in greater bond strength than cementation, which may be improved by insert acid‐etching. Ion‐doped HAP inserts did not affect FR of restored molars. In conclusion, HAP‐based dental inserts may potentially replace dentin in large cavities, without affecting fracture resistance of restored teeth.
The effectiveness of a universal adhesive applied in different application modes for the preparation of Class V composite restorations was evaluated both clinically and by quantitative marginal analysis (QMA). In each of the 22 patients, four non-carious cervical lesions (NCCL) were restored with Filtek™ Supreme XTE (3M). The adhesive Scotchbond™ Universal (SBU, 3M) was applied in self-etch (SE), selective-enamel-etch (SEE) or etch-and-rinse (ER) modes. The etch-and-rinse adhesive OptiBond™ FL (OFL, Kerr) served as a control. The restorations were clinically evaluated (FDI criteria) after 14 days (BL), 6, 12, 24, and 36 months. Additionally, QMA was conducted on all restorations of 11 randomly selected patients. The FDI criteria and marginal gap were statistically compared between the groups at each recall as well as for the time periods between recalls. The cumulative failure rate was non-significantly higher in the OFL group when compared to all of the SBU groups. Marginal adaptation in the OFL and SBU-SE/ER groups was significantly decreased (BL-36 m, p: 0.004) in comparison to the SBU-SEE group (BL-36 m, p: 0.063). More marginal gaps were found in the OFL group than in the SBU-SEE (BL to 36 m, p: 0.063–0.003) and SBU-ER (24/36 m, p: 0.066/0.005) groups as well as in the SBU-SE group when compared to the SBU-SEE (12–36 m, pi ≤ 0.016) and SBU-ER (24/36 m, p: 0.055/0.001) groups. SBU-SEE performed most effectively. The clinical evaluation and QMA corresponded, yet QMA detected group differences earliest after 6 months and is thus a valuable extension to clinical evaluations.
Modern restorative dentistry would not be possible without the ability to bond to tooth structure. The development of dental adhesives has a lengthy gestation, from the beginnings around 1950, to the latest generation: modern universal adhesives, which were introduced during the 2010s. The foundation for these developments was a deeper understanding of the mechanisms of adhesion to the tooth structure, and to restoration materials. Typically, the performance of an adhesive does not depend on the use of a single ingredient, but on an overall balanced and optimised formulation that contains various components with different roles, such as functional adhesive monomers.While a wealth of literature exists on adhesives that have a long and successful clinical history ('gold standards'), some universal adhesives have also accumulated a lot of scientific evidence while offering benefits like ease of use, low technique sensitivity and versatility.To achieve reliable results with a modern adhesive, several tips should be kept in mind regardless of the product, which result in a homogeneous adhesive layer, proper cure and ultimately high bond strength. Although high performance is already achieved with the adhesives currently available, this is still an exciting area of ongoing research.
SUMMARY The purpose of this study was to use shear bond strength (SBS) and shear fatigue limit (SFL) testing to determine the effect of phosphoric acid pre-etching of enamel and dentin prior to application of self-etch adhesives for bonding resin composite to these substrates. Three self-etch adhesives-1) G- ænial Bond (GC Corporation, Tokyo, Japan); 2) OptiBond XTR (Kerr Corp, Orange, CA, USA); and 3) Scotchbond Universal (3M ESPE Dental Products, St Paul, MN, USA)-were used to bond Z100 Restorative resin composite to enamel and dentin surfaces. A stainless-steel metal ring with an inner diameter of 2.4 mm was used to bond the resin composite to flat-ground (4000 grit) tooth surfaces for determination of both SBS and SFL. Fifteen specimens each were used to determine initial SBS to human enamel/dentin, with and without pre-etching with a 35% phosphoric acid (Ultra-Etch, Ultradent Products Inc, South Jordan, UT, USA) for 15 seconds prior to the application of the adhesives. A staircase method of fatigue testing (25 specimens for each test) was then used to determine the SFL of resin composite bonded to enamel/dentin using a frequency of 10 Hz for 50,000 cycles or until failure occurred. A two-way analysis of variance and Tukey post hoc test were used for analysis of SBS data, and a modified t-test with Bonferroni correction was used for the SFL data. Scanning electron microscopy was used the examine the area of the bonded restorative/tooth interface. For all three adhesive systems, phosphoric acid pre-etching of enamel demonstrated significantly higher (p<0.05) SBS and SFL with pre-etching than it did without pre-etching. The SBS and SFL of dentin bonds decreased with phosphoric acid pre-etching. The SBS and SFL of bonds using phosphoric acid prior to application of self-etching adhesives clearly demonstrated different tendencies between enamel and dentin. The effect of using phosphoric acid, prior to the application of the self-etching adhesives, on SBS and SFL was dependent on the adhesive material and tooth substrate and should be carefully considered in clinical situations.
The purpose of this study was to evaluate the five-year clinical performance of a two-step self-etch adhesive in non-carious cervical sclerotic lesions with or without selective acid-etching of enamel margins. A total of 104 cervical restorations in 22 patients (46-64 years) were bonded following either self-etch approach (AdheSE non-etch) or a similar application, including selective acid-etching of enamel margins (AdheSE etch), and were restored with resin composite. The restorations were evaluated at baseline and after one, two, three and five-years (84 restorations in 19 patients) according to the USPHS criteria. Data were analyzed using McNemar's test. Cumulative retention rates for the non-etch and etch groups were 82.6% and 86.1% respectively. No significant differences were detected in the retention rates, marginal adaptations at dentin side and secondary caries between the groups. After five-years, the clinical performance of the two-step self-etch adhesive with or without selective acid-etching of enamel margins, was acceptable.
Purpose:
To evaluate the 18-month clinical performance of a multimode adhesive (Scotchbond Universal Adhesive, SU, 3M ESPE, St Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria.
Materials and methods:
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 composite resin, Filtek Supreme Ultra (3M ESPE), was placed incrementally. The restorations were evaluated at baseline, and at 18 months, using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed using Friedman repeated-measures analysis of variance by rank and McNemar test for significance in each pair (α=0.05).
Results:
Five restorations (SE: 3; Set: 1; and ERm: 1) were lost after 18 months (p>0.05 for either criteria). Marginal staining occurred in four and 10% of the restorations evaluated (p>0.05), respectively, for USPHS and FDI criteria. Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38%, 40%, 36%, and 44% for groups ERm, ERd, Set, and SE, respectively, when the FDI criteria were applied (p>0.05). However, when semiquantitative scores (or SQUACE) for marginal adaptation were used, SE resulted in a significantly greater number of restorations, with more than 30% of the total length of the interface showing marginal discrepancy (28%) in comparison with the other groups (8%, 6%, and 8%, respectively, for ERm, ERd, and Set).
Conclusions:
The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy. The only differences between strategies were found for the parameter marginal adaptation, for which the FDI criteria were more sensitive than the USPHS criteria.
Multimode adhesives, which can be used as etch-and-rinse or as self-etch adhesives, have been recently introduced without clinical data to back their use.
To evaluate the 6-month clinical performance of Scotchbond Universal Adhesive (SU; 3M ESPE, St. Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria.
Thirty-nine patients participated in this study. Two hundred restorations were assigned to four groups: SU-TEm: etch-and-rinse + moist dentin; SU-TEd: etch-and-rinse + dry dentin; SU-SEet: selective enamel etching; and SU-SE: self-etch. The composite resin Filtek Supreme Ultra (3M ESPE) was placed incrementally. The restorations were evaluated at baseline and after 6 months using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed with Friedman repeated measures analysis of variance by rank and McNemar test for significance in each pair (α = 0.05).
Only four restorations (SU-SE: 3 and SU-TEm: 1) were lost after 6 months (p > 0.05 for either criteria). Marginal discoloration occurred in one restoration in the SU-SE group (p > 0.05 for either criteria). Only 2/200 restorations were scored as bravo for marginal adaptation using the USPHS criteria (one for SU-SE and one for SU-SEet, p > 0.05). However, when using the FDI criteria, the percentage of bravo scores for marginal adaptation at 6 months were 32%, 36%, 42%, and 46% for groups SU-TEm, SU-TEd, SU-SEet, and SU-SE, respectively (p > 0.05).
The clinical behavior of the multimode adhesive does not depend on the bonding strategy at 6 months. The FDI evaluation criteria are more sensitive than the USPHS criteria.
At 6 months, the clinical behavior of the new multimode adhesive Scotchbond Universal was found to be reliable when used in noncarious cervical lesions and may not depend on the bonding strategy employed.
To evaluate the laboratory dentin and enamel microtensile bond strengths (microTBS) and interfacial ultra-morphology of a new multi-purpose dental adhesive applied under different bonding strategies.
microTBS - 36 extracted caries-free human molars were assigned to six groups: Group CSE - Clearfil SE Bond, a 2-step self-etch adhesive (self-etch control); Group SBU-SE - Scotchbond Universal Adhesive (SBU), applied as a one-step self-etch adhesive; Group OSLm - OptiBond SOLO Plus (OSL), a 2-step etch-and-rinse adhesive applied on moist dentin (etch-and-rinse control); Group OSLd - OSL applied on air-dried dentin; Group SBU-ERm - SBU applied as a 2-step etch-and-rinse adhesive on moist dentin; Group SBU-ERd - SBU applied as a 2-step etch-and-rinse adhesive on air-dried dentin. Build-ups were constructed with Filtek Z250 and cured in three increments of 2 mm each. Specimens were sectioned with a slow-speed diamond saw under water in X and Y directions to obtain bonded beams that were tested to failure in tension at a crosshead speed of 1 mm/minute. Statistical analyses were computed using one-way ANOVA followed by post-hoc tests at P< 0.05. Ultra-morphologic evaluation - dentin-resin interfaces were prepared for each of the six groups, processed, and observed under a FESEM.
microTBS - OSLm resulted in significantly higher mean microTBS (63.0 MPa) than the other five groups. All SBU groups ranked in the same statistical subset regardless of the dentin treatment. The lowest mean microTBS were obtained with CSE (47.2 MPa) and OSLd (50.2 MPa), which were ranked in the same statistical subset. Ultramorphologic evaluation - The two self-etch adhesives resulted in a similar ultra-morphology. Dried dentin did not preclude the formation of a hybrid layer with SBU-ERd, as opposed to OSLd.
The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience.
To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience.
To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
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, 3 M ESPE); (2) Bonding strategy – self-etch (SE) or etch-and-rinse (ER); and (3) Adhesive solvent evaporation time – 5 s, 15 s, and 25 s. Two extra groups were prepared with ABU because the respective manufacturer recommends a solvent evaporation time of 10 s. After restorations were constructed, specimens were stored in water (37 °C/24 h). Resin–dentin beams (0.8 mm2) were tested at 0.5 mm/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 Tukey's 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 5 s to 25 s 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 25 s 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.
Purpose:
To compare microtensile bond strength (μTBS) and interfacial morphology of a new one-step multimode adhesive with a two-step self-etching adhesive and two etch-and-rinse adhesives systems on enamel.
Materials and methods:
Thirty human third molars were sectioned to obtain two enamel fragments. For μTBS, 48 enamel surfaces were ground using 600-grit SiC paper and randomly assigned into 6 groups (n = 8): nonetched Scotchbond Universal [SBU]; etched SBU [SBU-et]; non-etched Clearfil SE Bond [CSE]; etched CSE [CSE-et]; Scotchbond Multi-PURPOSE [SBMP]; Excite [EX]. The etched specimens were conditioned with 37% phosphoric acid for 30 s, each adhesive system was applied according to manufacturers' instructions, and composite resin blocks (Filtek Supreme Plus, 3M ESPE) were incrementally built up. Specimens were sectioned into beams with a cross-sectional area of 0.8-mm2 and tested under tension (1 mm/min). The data were analyzed with oneway ANOVA and Fisher's PLSD (α = 0.05). For interface analysis, two samples from each group were embedded in epoxy resin, polished, and then observed using scanning electron microscopy (SEM).
Results:
The μTBS values (in MPa) and the standard deviations were: SBU = 27.4 (8.5); SBU-et = 33.6 (9.3); CSE = 28.5 (8.3); CSE-et = 34.2 (9.0); SBMP = 30.4 (11.0); EX = 23.3 (8.2). CSE-et and SBU-et presented the highest bond strength values, followed by SBMP, CSE, and SBU which did not differ significantly from each other. EX showed the statistically significantly lowest bond strength values. SEM images of interfaces from etched samples showed long adhesive-resin tags penetrating into demineralized enamel.
Conclusions:
Preliminary etching of enamel significantly increased bond strength for the new one-step multimode adhesive SBU and two-step self-etching adhesive CSE.
The aim of this study was to compare the microtensile bond strength (μTBS) and resin penetration into dentin of three universal adhesives (UAs) applied in two different etching modes (i.e. self-etch or etch-and-rinse). The effect of thermocycling on the μTBS was also evaluated.
The occlusal third of sound human molars was removed and the exposed surfaces were treated with three UAs (Futurabond Universal, Scotchbond Universal Adhesive and All-Bond Universal) in self-etch or etch-and-rinse mode. Two one-step self-etch adhesives (Futurabond DC and Futurabond M) were applied on additional teeth as reference. After composite build up, the specimens were stored for 24hours in distilled water at 37° C or thermocycled for 5000 cycles. Composite/dentin beams were prepared (1mm(2)) and μTBS test was performed. Data was analyzed using three-way ANOVA and Tukey's test (α=0.05). One additional tooth was prepared for each group for evaluation of infiltration ability into dentin by dyeing the adhesives with a fluorochrome (Rhodamine B). After longitudinal sectioning, the generated interfaces were examined under confocal light scanning microscopy.
The addition of an etching step did not significantly affect the μTBS of none of the UAs, when compared to their self-etch application mode. All pre-etched specimens showed considerably longer resin tags and thicker hybrid layers. Thermocycling had no significant effect on the μTBS of the UAs.
Application of an etching step prior to UAs improves their dentin penetration, but does not affect their bond strength to dentin after 24h or after thermocycling for 5000 cycles. Clinical Significance: Similar bond strength values were observed for the UAs regardless of application mode, which makes them reliable for working under different clinical conditions.
The purpose of this prospective, controlled, randomized study was to evaluate the 3-year clinical performance of a two-step self-etch adhesive (AdheSE, Ivoclar Vivadent; Schaan, Liechtenstein) in non-carious cervical sclerotic lesions with or without selective acid-etching of the enamel margins.
Twenty-two patients (mean age 51.5) having at least two pairs of non-carious cervical sclerotic erosion⁄attrition⁄abfraction lesions with incisal or occlusal margins in the enamel and gingival margins in the dentin were included in the study. The two-step self-etch adhesive was applied following either the self-etch approach (AdheSE non-etch, n = 52) or a similar application approach, including prior selective acid-etching of the enamel margins (AdheSE etch, n = 52). Composite resin Point 4 (Kerr Corp; Orange, CA, USA) was used as the restorative material for all 104 restorations. The restorations were evaluated at baseline and after 1, 2, and 3 years, according to the modified USPHS criteria. Data were analyzed using McNemar's test (p < 0.05).
The retention rates for AdheSE non-etch were 100 %, 98 %, and 91.5 %; whereas, 100 %, 100 %, and 97.9 % retention rates were recorded for AdheSE etch after 1, 2, and 3 years, respectively. No significant differences were detected between the retention rates, marginal adaptation at the dentin side, secondary caries, and postoperative sensitivity (p > 0.05). A significantly higher number of restorations in AdheSE non-etch group showed clinically acceptable slight marginal discoloration (p = 0.0001) and clinically acceptable small marginal defects at the enamel side (p = 0.008) than in the AdheSE etch group.
After 3 years, the two-step self-etch adhesive exhibited acceptable clinical performance with or without selective enamel etching in non-carious cervical sclerotic lesions.
Selective acid-etching of the enamel margins enhanced the performance of the two-step self-etch adhesive in terms of marginal discoloration and marginal adaptation at the enamel side.
Sales of self-etch adhesive systems have grown considerably over the last 10 to 12 years. One of the most important factors contributing to this growth is the perception that self-etch adhesives cause less postoperative sensitivity than etch-and-rinse adhesives. Certainly, there is much anecdotal evidence supporting this perception. But what does the science say? This Critical Appraisal presents evidence from several clinical trials of postoperative sensitivity in posterior composite restorations.
Objectives:
To evaluate the dentine microtensile bond strength (μTBS), nanoleakage (NL), degree of conversion (DC) within the hybrid layer for etch-and-rinse and self-etch strategies of universal simplified adhesive systems.
Methods:
forty caries free extracted third molars were divided into 8 groups for μTBS (n=5), according to the adhesive and etching strategy: Clearfil SE Bond [CSE] and Adper Single Bond 2 [SB], as controls; Peak Universal Adhesive System, self-etch [PkSe] and etch-and-rinse [PkEr]; Scotchbond Universal Adhesive, self-etch [ScSe] and etch-and-rinse [ScEr]; All Bond Universal, self-etch [AlSe] and etch-and-rinse [AlEr]. After restorations were constructed, specimens were stored in water (37°C/24h) and then resin-dentine sticks were prepared (0.8mm(2)). The sticks were tested under tension at 0.5mm/min. Some sticks from each tooth group were used for DC determination by micro-Raman spectroscopy or nanoleakage evaluation (NL). The pH for each solution was evaluated using a pH metre. Data were analyzed with one-way ANOVA and Tukey's test (α=0.05).
Results:
For μTBS, only PkSe and PkEr were similar to the respective control groups (p>0.05). AlSe showed the lowest μTBS mean (p<0.05). For NL, ScEr, ScSe, AlSe, and AlEr showed the lowest NL similar to control groups (p<0.05). For DC, only ScSe showed lower DC than the other materials (p<0.05).
Conclusions:
Performance of universal adhesives was shown to be material-dependent. The results indicate that this new category of universal adhesives used on dentine as either etch-and-rinse or self-etch strategies were inferior as regards at least one of the properties evaluated (μTBS, NL and DC) in comparison with the control adhesives (CSE for self-etch and SB for etch-and-rinse).
Rating scales were developed for several factors that were considered relevant to the problem of clinically evaluating dental
restorative materials. Examiners were trained to use the rating scales, and their performance was evaluated in field trials.
Data analysis of examiner performance was used to revise the written criteria, and to train the examiners in making consistent
judgments of dental restorations. Criteria were adopted when field testing indicated that examiners were able to duplicate
their own judgments and judgments of other examiners at a predetermined level of acceptability. Further experience with the
rating scales in actual clinical studies led to the consolidation of anterior and posterior criteria, which had been developed
separately, and to the deletion of certain rating scales which failed to yield useful information. The rating scales which
were finally adopted are for color match, cavo-survace marginal discoloration, anatomic form, marginal adaptation, and caries.
According to the 'Adhesion-Decalcification' concept, specific functional monomers within dental adhesives can ionically interact with hydroxyapatite (HAp). Such ionic bonding has been demonstrated for 10-methacryloyloxydecyl dihydrogen phosphate (MDP) to manifest in the form of self-assembled 'nano-layering'. However, it remained to be explored if such nano-layering also occurs on tooth tissue when commercial MDP-containing adhesives (Clearfil SE Bond, Kuraray; Scotchbond Universal, 3M ESPE) were applied following common clinical application protocols. We therefore characterized adhesive-dentin interfaces chemically, using x-ray diffraction (XRD) and energy-dispersive x-ray spectroscopy (EDS), and ultrastructurally, using (scanning) transmission electron microscopy (TEM/STEM). Both adhesives revealed nano-layering at the adhesive interface, not only within the hybrid layer but also, particularly for Clearfil SE Bond (Kuraray), extending into the adhesive layer. Since such self-assembled nano-layering of two 10-MDP molecules, joined by stable MDP-Ca salt formation, must make the adhesive interface more resistant to biodegradation, it may well explain the documented favorable clinical longevity of bonds produced by 10-MDP-based adhesives.
Functional monomers in adhesive systems can improve bonding by enhancing wetting and demineralization, and by chemical bonding to calcium. This study tested the hypothesis that small changes in the chemical structure of functional monomers may improve their bonding effectiveness. Three experimental phosphonate monomers (HAEPA, EAEPA, and MAEPA), with slightly different chemical structures, and 10-MDP (control) were evaluated. Adhesive performance was determined in terms of microtensile bond strength of 4 cements that differed only for the functional monomer. Based on the Adhesion-Decalcification concept, the chemical bonding potential was assessed by atomic absorption spectrophotometry of the dissolution rate of the calcium salt of the functional monomers. High bond strength of the adhesive cement corresponded to low dissolution rate of the calcium salt of the respective functional monomer. The latter is according to the Adhesion-Decalcification concept, suggestive of a high chemical bonding capacity. We conclude that the adhesive performance of an adhesive material depends on the chemical structure of the functional monomer.
The aim of this study was to determine the clinical performance of a two-step self-etch adhesive with and without additional enamel etching technique to advanced non-carious cervical sclerotic lesions.
Twenty-two patients (mean age = 51.5) having at least two pairs of non-carious cervical erosion/attrition/abfraction lesions with incisal or occlusal margins in enamel and gingival margins in dentine/cementum were included in the study. The two-step self-etch adhesive (AdheSE; Ivoclar-Vivadent) was either applied following the self-etch approach on both enamel and dentine (AdheSE non-etch), or a similar application including additional acid-etching of the enamel cavity margins with 37% phosphoric acid (AdheSE etch). Resin composite Point 4 was used for all 104 restorations. Restorations were evaluated at baseline and at one year according to the modified United States Public Health Service (USPHS) criteria. Data were analysed by using McNemar's test (p <0.05).
There were no significant differences in the marginal adaptation both at the cervical and enamel margins between AdheSE non-etch and AdheSE etch groups (p >0.05). At one year, marginal discolouration was evident in the AdheSE non-etch group but it was not statistically significant from the AdheSE etch group (p = 0.12). Postoperative sensitivity was 5% at baseline and reduced to 2% at one year.
At one year, the two-step self-etch adhesive with and without additional enamel etching technique showed excellent clinical results to advanced non-carious cervical sclerotic lesions.
The purpose of this study was to evaluate the resin-dentin interfacial morphology and shear bond strength of several new and experimental dentin bonding systems classified as single-bottle/total etch, multi-step/total etch, and self-etching. Class 1 and 5 cavities were prepared from freshly extracted permanent molars and restored with composite resin. Each bonded sample was cross sectioned and one-half was completely demineralized and deproteinized, while the other half was polished along the cut surface to permit measurement of the thickness of resin-infiltrated dentin layer (RIDL) within intertubular dentin (iRIDL) and around the peritubular walls (pRIDL) of resin tags by SEM. Shear bond strength was measured for all the systems 2 minutes after photocuring. SEM showed iRIDL and resin tags of different morphology depending on material and dentin location. The iRIDL was thinner in superficial dentin and thicker in deep dentin. Peritubular RIDL (pRIDL) was thinner than intertubular RIDL. Bond strength measurements varied from 12 to 21 MPa, depending on the materials used. Self-etching primer systems exhibited the highest bond strength, although one of the one-step/total etch systems also yielded very high values. The contribution of pRIDL to adhesion onto superficial dentin is limited by the small number of tubules. Single-component bonding agents produced SEM morphology and bond strengths similar to those of multi-step systems. Self-etching systems, despite their limited RIDL thickness, produced the highest immediate bond strengths. Bond strength did not correlate well with the thickness and morphology of RIDL.
Correlated response data are common in biomedical studies. Regression analysis based on the generalized estimating equations (GEE) is an increasingly important method for such data. However, there seem to be few model-selection criteria available in GEE. The well-known Akaike Information Criterion (AIC) cannot be directly applied since AIC is based on maximum likelihood estimation while GEE is nonlikelihood based. We propose a modification to AIC, where the likelihood is replaced by the quasi-likelihood and a proper adjustment is made for the penalty term. Its performance is investigated through simulation studies. For illustration, the method is applied to a real data set.
To investigate the effect of phosphoric acid etching prior to the application of self-etching primer on the adhesion of resin composite to tooth substrates.
Bovine teeth were randomly divided in four groups of 20 samples each. Tooth surface conditions were as follows: Group 1: enamel ground with 600-grit SiC paper; Group 2: ground enamel was etched with 35% phosphoric acid gel for 15 seconds, water-rinsed and completely dried; Group 3: ground dentin; Group 4: dentin etched using the same method as Group 2. The samples in each group were divided in two subgroups of 10 each. UniFil Bond (UB) and Clearfil SE Bond (SE) were applied as adhesive systems with self-etching primers, and a layer of resin composite (AP-X) was placed and light-cured for 40 seconds. The tensile bond strengths (TBS) were measured and the resin-tooth interfaces were observed with scanning electron microscopy.
The mean TBS values were 11.2 MPa (Group 1-UB), 14.3 MPa (Group 1-SE), 16.3 MPa (Group 2-UB), 20.5 MPa (Group 2-SE), 13.4 MPa (Group 3-UB), 16.7 MPa (Group 3-SE), 9.3 MPa (Group 4-UB) and 12.6 MPa (Group 4-SE). Two-way ANOVA and Scheffe's F test showed that the enamel etching significantly increased the TBS values but dentin etching significantly decreased the TBS values.
This study tested the hypotheses that micro-tensile bond strengths of all currently available single-step adhesives to dentine are adversely affected by delayed activation of a light-cured composite, and that such a phenomenon only occurs in the presence of water from the substrate side of the bonded interface.
In experiment I, a control three-step adhesive (All-Bond 2, Bisco) and six single-step adhesives (One-Up Bond F, Tokuyama; Etch&Prime 3.0, Degussa; Xeno CF Bond, Sankin; AQ Bond, Sun Medical; Reactmer Bond, Shofu and Prompt L-Pop, 3M ESPE) were bonded to sound, hydrated dentine. A microfilled composite was placed over the cured adhesive and was either light-activated immediately, or after leaving the composite in the dark for 20 min. In experiment II, three single-step adhesives (Etch&Prime 3.0, Xeno CF Bond and AQ Bond) were similarly bonded to completely dehydrated dentine using the same delayed light-activation protocol. In experiment III, a piece of processed composite was used as the bonding substrate for the same three single-step adhesives. The microfilled composite was applied to the cured adhesives using the same immediate and delayed light-activation protocols. Bonded specimens were sectioned for micro-tensile bond strength evaluation. Fractographic analysis of the specimens was performed using SEM. Stained, undemineralised sections of unstressed, bonded specimens were also examined by TEM.
When bonded to hydrated dentine, delayed light-activation had no effect on the control three-step adhesive, but significantly lowered the bond strengths of all the single-step adhesives (p < 0.05). This adverse effect of delayed light-activation was not observed in the three single-step adhesives that were bonded to either dehydrated dentine or processed composite. Morphological manifestations of delayed light-activation of composite in the hydrated dentine bonding substrate were exclusively located along the composite-adhesive interface, and were present as large voids, resin globules and honeycomb structures that formed partitions around a myriad of small blisters along the fractured interfaces.
These features resembled the 'overwet phenomenon' that was previously reported along the dentine-adhesive interfaces of some acetone-based three-step adhesives. The cured adhesive layer in single-step adhesives may act as semi-permeable membranes that allow water diffusion from the bonded hydrated dentine to the intermixed zone between the adhesive and the uncured composite. Osmotic blistering of water droplets along the surface of the cured adhesive layer and emulsion polymerisation of immiscible resin components probably account for the compromised bond strength in single-step adhesives after delayed activation of light-cured composites.
Previously, we introduced a methodology to determine the chemical bonding potential of polyalkenoic acids to mineralized tissues through quantification of the degree of ionic bond formation between the carboxyl groups of a polyalkenoic acid with calcium of hydroxyapatite. In a continuation of that study, we now investigated in how far the chemical bonding potential to synthetic hydroxyapatite is influenced by the molecular structure of the polyalkenoic acid and if this also may affect the self-adhesiveness to enamel and dentin. X-ray photoelectron spectroscopy and inductively coupled plasma atomic emission spectrometry were used to quantitatively analyze the chemical bonding efficacy of a polyalkenoic acid consisting of acrylic acid units (PAA) to synthetic hydroxyapatite (HAp) in comparison to the chemical bonding potential of the previously investigated synthesized polyalkenoic acid (s-PA) co-polymer consisting of 90w/w% acrylic and 10w/w% maleic acid units. In addition, the analysis was carried out for enamel and dentin samples. PAA revealed a significantly lower bonding effectiveness with only half of its carboxyl groups bonded to HAp versus about two-third of the carboxyl groups of s-PA. The difference in bonding potential was confirmed by the considerably lower adhesiveness of PAA to enamel and dentin as compared to that of s-PA The present findings indicate that the molecular structure of the polyalkenoic acid significantly influences the chemical bonding efficacy to Hap-based substrates.
The purpose of this randomized controlled clinical trial was to test the hypothesis that a two-step self-etch approach is equally effective to restore cervical class-V lesions as a self-etch approach with beforehand selective etching of enamel using phosphoric acid.
Twenty-nine patients received two or four restorations randomly following two experimental protocols ('paired-tooth' study design): (1) A 'mild' self-etch adhesive (Clearfil SE, Kuraray) was applied following a self-etch approach on both enamel and dentin (C-SE non-etch); (2) Similar application of Clearfil SE, but including beforehand selective acid-etching of the enamel cavity margins with 40% phosphoric acid (C-SE etch). Clearfil AP-X (Kuraray) was used as restorative composite for all 100 restorations. The clinical effectiveness was recorded in terms of retention, marginal integrity and clinical micro-leakage after 2 years of clinical service.
No restoration losses were recorded. Clinical micro-leakage was slight and only rarely observed. No significant differences were found between both groups for the diverse parameters evaluated except for the number of small incisal marginal defects, which was significantly higher in the C-SE non-etch group (McNemar: p = 0.0391).
The clinical effectiveness of the mild two-step self-etch adhesive Clearfil SE was excellent after 2 years of clinical service. Although in general no difference in clinical performance was recorded when Clearfil SE was applied following either of the experimental protocols, more marginal defects at the enamel side were noticed when enamel was not beforehand etched with phosphoric acid. However, these defects were small and of clinically negligible relevance.
The self-etch approach provides dentists with a generation of user-friendly and less technique-sensitive adhesives. Nevertheless, some concern has been raised regarding their bonding effectiveness to enamel, in particular when so-called 'mild' self-etch adhesives are employed.
The purpose of this study was to test the hypothesis that the two-step self-etch adhesive Clearfil SE Bond (C-SE; Kuraray, Osaka, Japan) bonds equally effective to enamel/dentin either with or without prior etching with phosphoric acid.
Bur-cut enamel/dentin surfaces prepared from human molars were partially split in two halves by cutting a shallow groove. One half was first etched with 40% phosphoric acid (K-etchant), while protecting the other half by holding a razor blade in the groove. Next, C-SE was applied strictly following the manufacturer's instructions, after which the surface was built up using Z100 (3M Espe). After 24-h water storage, micro-specimens were prepared with the interface circularly constricted using a Micro-Specimen Former, prior to micro-tensile bond strength (MPa) measurement. In addition, interfaces of C-SE with enamel/dentin prepared with and without beforehand acid etching were examined by Feg-SEM and TEM.
Beforehand etching significantly increased the bonding effectiveness of C-SE to enamel. A clearly more micro-retentive surface was revealed by TEM and Feg-SEM when enamel was etched. Phosphoric-acid etching prior to C-SE application on dentin significantly decreased the muTBS to dentin. TEM provided indications of a low-quality hybrid layer after beforehand phosphoric-acid etching.
Using C-SE, additional etching with phosphoric acid to improve bonding effectiveness should be limited to enamel.
Objectives:
The purpose of this paper was to review current literature on the clinical effectiveness of contemporary adhesives when used to restore cervical non-carious class-V lesions. Restoration retention in function of time was recorded in order to find out if adhesives with a simplified application procedure are as clinically effective as conventional three-step adhesives.
Data sources:
Literature published from January 1998 up to May 2004 was reviewed for university-centred clinical trials that tested the clinical effectiveness of adhesives in non-carious class-V lesions. Restoration-retention rates per adhesive reported in peer-reviewed papers as well as IADR-AADR abstracts and ConsEuro abstracts were included and depicted as a function of time in graphs for each of the five adhesive classes (three- and two-step etch-and-rinse adhesives, two- and one-step self-etch adhesives, and glass-ionomers). The guidelines for dentin and enamel adhesive materials advanced by the American Dental Association were used as a reference. Per class, the annual failure rate (%) was calculated. Kruskal-Wallis analysis and Dwass-Steel-Chritchlow-Fligner pairwise comparisons were used to determine statistical differences between the annual failure percentages of the five adhesive categories.
Results:
Comparison of retention of class-V adhesive restorations as a measure to determine clinical bonding effectiveness of adhesives revealed that glass-ionomers most effectively and durably bond to tooth tissue. Three-step etch-and-rinse adhesives and two-step self-etch adhesives showed a clinically reliable and predictably good clinical performance. The clinical effectiveness of two-step etch-and-rinse adhesives was less favourable, while an inefficient clinical performance was noted for the one-step self-etch adhesives.
Significance:
Although there is a tendency towards adhesives with simplified application procedures, simplification so far appears to induce loss of effectiveness. Clinical performance can be correlated with, and predicted by, appropriate types of laboratory study.
Principles of Adhesion Dentistry
- B Su
Su, B. Principles of Adhesion Dentistry. AEGIS Publications; India: 2013.
Adhesive performance of a multimode adhesive system: 1-Year in vitro study
- G Marchesi
- A Frassetto
- A Mazzoni
- F Apolonio
- M Diolosa
- M Cadenaro
- Di Lenarda
- R Pashley
- D H Tay
- F Breschi
Marchesi G, Frassetto A, Mazzoni A, Apolonio F, Diolosa M, Cadenaro M, Di Lenarda R, Pashley
DH, Tay F, Breschi L. Adhesive performance of a multimode adhesive system: 1-Year in vitro
study. J Dent. 2014; 42:603-612. [PubMed: 24373855]