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Effect of dentin cleansers on the bonding efficacy of dentin adhesive.

The relation between the bonding efficacy of the dentin adhesive and the physical change of the dentin after treatment with various dentin cleansers was investigated. The dentin surface was cleaned with one of the seven experimental dentin cleansers, 5, 10, 20, 30 and 40% of the phosphoric acid, neutralized 0.5 M EDTA solution (pH 7.4) and 9.1% pyruvic acid containing 9.1% glycine, prior to the combining application of 35% hydroxyethylmethacrylate solution (HEMA) and a marketed dentin bonding agent. It was found that the bonding efficacy of the dentin bonding system employed in this study deteriorated with the degree of reduction of Vickers hardness on the dentin surface after the dentin cleaning.

Acid Etching, Dental↗

[Experimental study on the effect of restorative dentin formation with human dentin phosphoprotein in immature permanent teeth of minipig].

OBJECTIVE: To investigate the function of human dentin phosphoprotein(DPP) on dentine mineralization in vivo. METHODS: Pulp capping with human DPP was made in the permanent teeth of minipigs with calcium hydroxide and zinc oxide eugenol cement as controls. The minipigs were sacrificed at intervals of 14, 30, 90 days respectively after operation. RESULTS: The histopathological results revealed that pulp cells had developed into odontoblastoid cells around the major restorative dentin body after two weeks. There was complete restorative dentin bridge a month later. The bridge became thick and dense, and mainly was tubular dentin in 3 month. There were well developed odontoblasts under the bridge. In the calcium hydroxide capping group, inflammatory cytonecrosis zone was found in the surface of dental pulp and only a little calcial bodies formed in two weeks. Complete restorative dentin bridge was formed in 1 to 3 months, the speed of dentin bridge formation was not as quick as that of DPP group. CONCLUSION: DPP can induce pulp cells to develop into odontoblasts and formation of dentin bridge with little stimulation to the dental pulp. This study suggests that DPP plays an important role in the biomineralization of dentin development and restoration.

Animals↗

Dentinal composition and Knoop hardness measurements of cavity floor following carious dentin removal with Carisolv.

This study evaluated the dentinal composition and Knoop hardness measurements of the cavity floor following the removal of carious dentin by the Carisolv chemo-mechanical caries removal system, in vitro. The carious dentin of 25 extracted human teeth was removed by using Carisolv for one minute with instruments and excavation that was performed until the gel was clear. Caries removal with a sharp explorer was verified according to the color and hardness of the lesion, then, by means of DIAGNOdent. Atomic analysis of treated cavities was performed by energy dispersive x-ray spectroscopy (SEM-EDX) and the Knoop hardness number (KHN) of the cavity floor was determined. Surface characteristics were observed by the scanning electron microscope (SEM). Adjacent sound dentin was used as a control reference. No significant differences were found between the quantities of calcium content (Ca weight %), phosphorus content (P weight %) and the Ca/P weight ratio of Carisolv cavities with that of the adjacent, sound dentin (p<0.01). KHN of the Carisolv cavity floor was almost similar to that of the adjacent sound dentin. SEM analysis revealed an extremely rough or irregular surface, and there remained a minimal debris-like smear layer; most of the dentinal tubules were opened. The results indicated that Carisolv does not produce any adverse side effects on dentinal compositions of the treated cavities. The possibility of remaining residual softened dentin was also minimal in this study.

Dental Caries↗

Eighteen-month clinical evaluation of two dentin adhesives applied on dry vs moist dentin.

PURPOSE: To evaluate the influence of substrate moisture on the clinical behavior of two dentin adhesives after 18 months. The null hypothesis tested was that drying dentin with air upon rinsing off the acid would not influence the clinical performance of two dentin adhesives as compared to leaving the preparation visibly moist. MATERIALS AND METHODS: Thirty-five patients were enrolled in this study. One hundred twenty-eight restorations divided into 4 groups were inserted and evaluated at baseline: (1) NT/Moist - Prime & Bond NT, an acetone-based adhesive, applied on moist dentin; (2) NT/Dried - Prime & Bond NT applied on dentin dried with air for 3 to 4 s; (3) SB/Moist - Single Bond, an ethanol- and water-based adhesive, applied on moist dentin; (4) SB/Dried - Single Bond applied on dentin dried with air for 3 to 4 s. A microfilled composite resin was used for all restorations. Patients were recalled at 6 and 18 months. RESULTS: At 18 months after initial placement, 110 restorations (86% recall rate) were re-evaluated. Retention rates at 18 months were 92% for NT/Moist, 93% for NT/Dried, 100% for SB/Moist, and 89% for SB/Dried. No statistically significant differences were found among groups for retention rate. Both NT/Moist and SB/Moist resulted in a significant decrease in sensitivity to air from baseline to 18 months. When data were pooled for the variable "substrate moisture", SB resulted in an overall retention rate of 95%, while NT resulted in a retention rate of 92% (statistically similar). The marginal adaptation with SB was significantly worse at 18 months than at baseline. CONCLUSION: The moisture level of the dentin substrate in noncarious cervical lesions does not influence retention of composite restorations, but moist conditions caused less sensitivity to air. When applied as per manufacturers' instructions (moist dentin), both adhesives resulted in Class V retention rates exceeding the ADA 18-month full acceptance guidelines.

Acrylic Resins↗

Scanning electron microscopic study of dentinal surfaces treated with various dentinal bonding agents.

A three-dimensional cavity design was used to study the morphology of dentin in vitro both after dentinal pretreatment and after restoration failure (debonding). Dentinal bonding agents that require removal of the smear layer (third generation), as well as those that depend on attachment to the smear layer (second generation), were included. Results indicated cohesive failures within both the dentinal bonding agents and the smear layer in second-generation systems. Dentinal conditioners for the third-generation dentinal bonding agents and for an as-yet unclassified agent were effective in removing smear layer debris from the dentinal surface, but they varied in the degree to which they opened the dentinal tubules. Differences in morphology of the dentinal surface following debonding of the restoration were attributed to differences in chemical composition among the agents examined.

Composite Resins↗

[States of dentine surface and interface between dentine and coupling agent].

In order to research the states of dentine surface and dentine surface primed with coupling agent, we used microscope, transmission electron microscope (TEM) and solid fluorescence method. Observed under microscope, patterning of dentinal tubules and their poles was very explicit; through the view of interface between coupling agent adsorbed and human dentine powder by TEM, it was revealed that the coupling agent was adsorbed onto the dentine surface as if it "grew out" of the dentine surface; through examination of interface between the coupling agent adsorbed and dentine surface by fluorescence spectrum, which differed from that of the coupling agent or dentine surface, i.e., this fluorescence spectrum of interface changed obviously (red shift). This phenomenon indicated that there was a chemical reaction occurring between tooth surface and adsorbed coupling agent. Therefore we can conclude that the three examinations are necessary to provide the argument for establishment of chemical bonding mechanism between dentine and coupling agent.

Adhesives↗

Dentine permeability and its role in the pathobiology of dentine sensitivity.

The classical hydrodynamic theory implicated fluid movement as a transducing mechanism in the production of dental sensitivity. This theory assumes that sensitive dentine must be permeable. Various measurements of dentine permeability are discussed, including: (1) factors that influence diffusive permeation across dentine; (2) factors that influence convective fluid movement across dentine; (3) osmotic activities of solutions; (4) comparison of evaporative and convective fluid movement; (5) the interaction between outward convective fluid flux on the inward diffusive flux of molecules; and (6) the importance of pulpal blood flow in the clearance of noxious substances from dentine and pulp, a balance concept. The variables involved in achieving good penetration of desensitizing agents in the presence of outward movement of dentinal fluid are also discussed, along with the presentation of a new hypothesis which emphasizes the importance of dentine as a dynamic physiological barrier that works in harmony with neurovascular elements in the pulp in an attempt to maintain the health of the pulp-dentine complex.

Animals↗

An ultrastructural study of the application of dentine adhesives to acid-conditioned sclerotic dentine.

OBJECTIVE: This in vitro study examined the ultrastructure of resin-infiltrated sclerotic dentine following the application of a self-etching primer, with or without the adjunctive use of phosphoric acid pre-conditioning. MATERIALS AND METHODS: Non-carious, natural cervical sclerotic lesions were hand-cleaned with a slurry of pumice and chlorhexidine and bonded without further cavity preparation. One group was bonded using Clearfil Liner Bond 2V (Kuraray Co. Ltd, Osaka, Japan) alone. Specimens from the other group were pre-conditioned with K-etchant (40% phosphoric acid gel, Kuraray) prior to the application of the same self-etching primer. Artificially prepared wedge-shaped lesions were also made in sound bicuspids, bonded using the two methods, and used as controls for the two groups. For SEM examination, each specimen was cryofractured into two halves through a pre-formed slit made on the lingual surface, after the respective conditioning treatment. Different locations within the lesions were examined after rinsing of the phosphoric acid/self-etching primer and specimen dehydration. For TEM investigation, specimens were bonded with the adhesive. Both demineralised and undemineralised ultrathin sections were prepared from the occlusal, gingival and deepest part of the wedge-shaped bonded lesions following specimen fixation, dehydration and resin embedding. RESULTS: A hypermineralised surface layer was present on the surface of etched sclerotic dentine. This layer was thicker in the deepest part of the natural lesions, where bacterial colonisation of the lesion surface was also apparent. Both treatment protocols were unable to effectively dissolve sclerotic casts that occluded the dentinal tubules. Depending upon the thickness of the surface layers at different locations in the natural lesion, self-etching primer treatment alone resulted in reduction of the thickness of the authentic hybrid layer (i.e. hybridised intertubular dentine). This was also true of phosphoric acid pre-conditioning along the deepest part of the natural lesions. Within this region, intertubular dentine completely devoid of an authentic hybrid layer could be seen in both treatment groups. Resin tags were also sparsely observed in such regions. CONCLUSIONS: Adhesive strategies that rely mostly on micromechanical retention alone may be compromised by the sporadic absence of the hybrid layer and resin tags in sclerotic dentine. Based on the ultrastructural features presented, it is further speculated that adaptive strategies such as removal of the surface layers and extended etching time may not be completely effective in improving bonding efficacy in highly sclerotic dentine. Interdisciplinary research should be continued to develop alternative procedures for bonding resins equally well to sound and sclerotic dentine.

Acid Etching, Dental↗

Effect of dentinal pretreatments on coronal dentin primary carious lesions: a field emission SEM study.

The aim of the study was the morphological analysis of coronal dentin caries and the modifications induced by different pretreatments with phosphoric acid or sodium hypochlorite. Carious dentin specimens were obtained from human molars affected by carious lesions. Specimens were divided in four groups and submitted to: (1) untreated; (2) 35% phosphoric acid for 15 s; (3) 35% phosphoric acid for 15 s and 5% sodium hypochlorite for 2 min; (4) sodium hypochlorite for 5 min. Specimens were observed under high-resolution SEM. Different areas were identified within the carious lesion: a deeper, inner region revealing closed highly mineralized tubules, and a more superficial outer layer showing an increasing demineralization rate toward the surface of the lesion. Phosphoric acid followed by NaOCl treatment removed all collagen fibrils from greatly altered carious outer-dentin layer. The 5-min treatment with sodium hypochlorite affected both inner and outer dentin, removing all collagen fibrils and increasing the porosities of deeper intertubular hypermineralized dentin. FEISEM analysis confirmed that only inner carious dentin after phosphoric acid treatment may be considered a suitable substrate for dentinal bonding system. On the contrary, the outer dentin is an unstable substrate for any type of bonding systems and must be avoided/removed from any surface before conditioner application.

Acid Etching, Dental↗

An in vitro investigation of microtensile bond strengths of two dentine adhesives to caries-affected dentine.

OBJECTIVES: To compare the micro-tensile bond strengths of two different adhesive systems (ABF (Clearfil Protect Bond), Kuraray Medical Inc., Tokyo, Japan) and Prime & Bond NT (PBNT, Dentsply, Konstanz, Germany) bonded to caries-affected dentine retained after chemo-mechanical caries removal using Carisolv gel, with that retained after excavation using conventional hand instrumentation. METHOD: Twenty, adult, human extracted carious teeth were used in this split tooth study with bur-cut cavities in sound dentine acting as controls. After clinical caries excavation, the occlusal cavities in each experimental group were restored with either bonding system plus composite. Matchstick-shaped samples through the bond interfaces were sectioned and microtensile bond strengths recorded. Scanning electron microscopy (SEM) was used to ascertain the mode of failure at the restoration-dentine interface. RESULTS: Statistical analysis of the bond strength data showed that for the ABF group, there was no difference in bond strengths between the controls and Carisolv group but these values were significantly higher than those for the hand-excavated samples. PBNT samples showed no significant differences in any of the three test groups, with wider ranging data sets. SEM analysis indicated a variety of failures at the interface including cohesive failures within the caries-affected dentine itself. CONCLUSIONS: From the data generated by this study it could be concluded that microtensile bond strengths of PBNT/composite restorations to caries-affected dentine in clinical cavities were statistically comparable to those to sound dentine. In the ABF/composite restored group (self-etched), the use of conventional hand excavation appeared to weaken the bond strength to the remaining caries-affected dentine. However, the use of Carisolv gel excavation did not compromise bond strengths to caries-affected dentine in either group tested.

Adhesiveness↗

Investigation into the nature of dentin resin tags: a scanning electron microscopic morphological analysis of demineralized bonded dentin.

STATEMENT OF PROBLEM: While the formation of the dentin/adhesive hybrid layer has been generally established, the infiltration and flow of the adhesive resin inside the acid treated dentinal tubules remains controversial. PURPOSE: The aim of the present study was to investigate and review the current interpretation of resin tags by means of scanning electron microscopic (SEM) observation. MATERIAL AND METHODS: Eight noncarious, human third molars were cut transversally and then longitudinally to obtain 8 middle-to-deep dentinal surfaces. The dentin was etched with 37% phosphoric acid (H 3 PO 4 ) gel for 10 seconds and then rinsed with water for 20 seconds. The dentin was kept moist by removing the excess water with a damp cotton pellet. The conditioned dentin was treated with a dentin bonding agent (Single Bond) and was light-polymerized for 20 seconds. A 0.2- to 0.5-mm layer of flowable composite (Tetric Flow) was then applied to the bonded dentin followed by 2 layers (2 mm each) of composite (Z 250). Each composite was light-polymerized for 40 seconds. Subsequently, the specimens were cut lengthwise into 2 halves and randomly divided into 4 groups (n=4), according to the surface preparation modality of the sectioned surface: Group EA: ethylenediamine tetraacetic acid, Group PA3: H 3 PO 4, Group PA120: H 3 PO 4 + NaOCl, and Group CA: HCl + NaOCl. Two additional teeth (Group N) were cut lengthwise into 2 halves and served as the control. The sectioned surfaces were treated with HCl and NaOCl. All specimens were processed for SEM observation. RESULTS: Specimens from Groups EA, PA3, PA120, CA, and N showed filamentous structures that were tens of microns long. Some filaments presented split-ends with hollow structures and very thin walls. Others made sharp hairpin turns indicating they were soft and compliant. CONCLUSIONS: Conventional SEM techniques, which are currently used to detect resin tags, actually identified filamentous organic structures, supposedly glycosaminoglycans, which were resistant to conventional specimen preparation techniques. The organic component showed a strong resemblance to the lamina limitans contained within the dentinal tubules. Over-reliance on SEM morphology has led to much confusion about the depth of penetration of resin tags.

Acid Etching, Dental↗

The effect of dentine location and tubule orientation on the bond strengths between resin and dentine.

This study determined the influence of dentine structure on the micro-tensile bond strengths between resin and dentine of two different dentine adhesive systems (Single Bond, 3M Dental Products, St Paul, MN; MF-102 (experimental self-etching primer), GC Corporation, Tokyo, Japan). The study was separated into two main parts: bond strength measurement and investigation of the bonding interface. Twenty-two human premolars were used for the bond strength measurement. Each tooth was cut vertically, separating the tooth into mesio-distal halves. One half of the tooth was used to bond to a surface perpendicular to the dentinal tubules and other half to bond to a surface parallel to the tubules. For each half, six locations of dentine were bonded. Each material was used in accordance to the manufacturer's directions. Cylindrical hourglass-shaped specimens of 1.2 mm diameter at the bonded interface were manufactured. The bonds were stressed in tension at a crosshead speed of 1 mm/min. Mean bond strengths were compared using LSD, one-way ANOVA, and Student's t-test. The fractured surfaces were examined under a scanning electron microscope, and the frequency of fracture modes was compared using the Kruskal-Wallis and Mann-Whitney U tests. For the investigation of the bonded interface, four teeth were prepared by the same procedure used for the bond test specimens. The bonded interfaces were observed after an acid-base treatment or fracturing across the bonded interface, prior to investigation with a field-emission scanning electron microscope. For Single Bond, the bond strengths for mid-root dentine were significantly lower than for other locations (p < 0.05). For MF-102, there was no significant difference for all locations (p > 0.05). MF-102 bonded well to all locations of dentine while Single Bond showed a porous zone at the base of the hybrid layer. The bonds were not influenced by tubule orientation. The results indicate that the bond for Single Bond may be affected by its ability to penetrate demineralised dentine in different locations of a tooth. The self-etching primer of MF-102 produces a good bond and is independent of the position on the tooth.

Analysis of Variance↗

Dentine hypersensitivity: the effects of brushing toothpaste on etched and unetched dentine in vitro.

Although many people have exposed dentine, only a percentage exhibit symptoms of dentine hypersensitivity. This has been ascribed to opening and closing of the dentinal tubules by for example, smear layer changes or tubular occlusion. The aims of this study were to examine the surface morphological changes of etched and unetched dentine in vitro, attributed to the effects of toothbrushing with and without toothpastes designed for the alleviation of dentine hypersensitivity. A total of 96 etched and 96 unetched human dentine specimens were brushed with various toothpastes and water for 1, 2, 5 or 10-min periods in a toothbrushing machine and subsequently examined under scanning electron microscopy for surface changes. Analyses of brushed etched specimens demonstrated that time and treatment were significant variables (P < 0.05) for tubule occlusion. Further, the interaction between time and treatment was significant (P < 0.05). The artificial silica based paste was significantly better for all time intervals at occluding the dentine tubules. All toothpastes investigated caused dynamic changes to the smear layer of the unetched dentine, opening tubules. However, the artificial silica based paste resulted in occluded rather than patent tubules. All of the pastes evaluated had the capacity to remove the smear layer but some could then occlude tubules through the contained abrasives.

Acid Etching, Dental↗

Dentine hypersensitivity--the effect of toothbrushing and dietary compounds on dentine in vitro: an SEM study.

Dentine hypersensitivity occurs when dentinal tubules are open on the dentine surface and patent to a vital pulp. There has been limited interest in the aetiology of dentine hypersensitivity. In particular, little is known about agents that remove the dentine smear layer to expose tubules. Toothbrushing certainly may expose dentine, but whether a toothbrush per se has the effect of opening tubules has not been established. The aim of this study in vitro was to determine whether a toothbrush could remove or create a smear layer. In addition, the combined effects of toothbrushing with dietary fluids on dentine was assessed. Toothbrushing was observed, by scanning electron microscopy, both to remove and to recreate a smear layer on dentine specimens. However, the processes took a considerable time, and under conditions of normal toothbrushing it is unlikely that the latter plays a direct aetiological role in opening tubules. Indeed, together with toothpaste it is more likely that brushing has a therapeutic action by mechanically forming a smear layer. Conversely, and importantly, toothbrushing in the presence of dietary acids enhanced smear layer removal. This finding raises the question of whether the dental profession should be advising that teeth be brushed before meals rather than after, as is often the case.

Acid Etching, Dental↗

Treatment of dentinal hypersensitivity using a dentine bonding system.

AIMS AND OBJECTIVES: Many agents have been used in treatment of dentinal hypersensitivity in the past, but dentine bonding systems have recently been suggested as being effective. This study examined the effectiveness of a dentine bonding system in the treatment of dentinal hypersensitivity in dental practice conditions. METHODS: Dentists in two dental practices agreed to carry out the project. One practice was in the UK, the other in India. A total of 34 patients who were diagnosed to have dentinal hypersensitivity were treated using the dentine bonding system. Patients were requested to record their perception of their pain on a 100mm linear scale, pre-treatment, one day and one week post-treatment. RESULTS: All patients experienced relief of pain, both 1 day and 1 week after treatment. Profile plots of the patients' perceived pain scores for the two practices separately indicated that there was a general trend across both practices for these to fall quite sharply one day after treatment and then generally level out one week post-treatment. There was evidence indicating a possible difference in pain perception in the two communities from which the patients were drawn. CONCLUSION: The dentine bonding system evaluated was successful in reducing the pain of dentinal hypersensitivity, at least in the short term.

Analysis of Variance↗

Effect of dentinal fluid composition on dentin demineralization in vitro.

Dentin demineralization is reduced by perfusion with water. We hypothesized that a simulated dentinal fluid (SDF) that contains albumin, in addition to electrolytes, would be more effective in reducing dentin demineralization than water alone, and this effect would increase with increasing flow rate of SDF. Perfusion rate in tooth segments that carried buccal cervical dentin windows was measured in a fluid transport set-up. These windows were then demineralized under perfusion with water, or SDF at 1.47 kPa for 31 days. We analyzed integrated mineral loss and lesion depth with the use of transverse microradiography (TMR), which revealed that 38% more mineral dissolved from dentin lesions perfused with water than from those perfused with SDF. The former were also 18% deeper. Flow rate of dentinal fluid showed no correlation with demineralization. We concluded that composition of dentinal fluid is an important determinant of the rate of lesion formation and progression in dentin.

Albumins↗

Transmission and control of dentinal pain: resin impregnation for the desensitization of dentin.

With the exception of direct electrical stimulation, it seems that all procedures known to produce dentinal pain may mechanically distort the structure of pain-sensitive nerves in the pulp and predentinal area and that this effect is mediated by a hydrodynamic link. Nature may contribute to insensitive dentin by: production of irregular, atubular dentin at the pulpal wall; obliteration of dentinal tubules by sclerosis; and mineralization of a superficial layer, pellicle or plaque, at the exposed surface. Few clinical methods are capable of accelerating these mechanisms. A technique of resin impregnation for the desensitization of exposed dentin has been presented. After proper pretreatment, that includes drying the dentin surface, resin tags can be obtained in the outer part of the dentinal tubules and may immediately and permanently relieve dentinal pain. This technique seems to be a good alternative to other methods, especially for patients with occlusal or incisal exposures caused by abrasion, grinding, or fracture, in which other methods cannot provide immediate and long-lasting desensitization.

Acid Etching, Dental↗

Field-emission scanning electron microscopy of resin-dentin interface morphology of seven dentin adhesive systems.

PURPOSE: The purpose of this study was to evaluate the resin-dentin interface morphology of 7 resin-based dentin adhesive systems (Solid Bond, EBS-Multi, PermaQuik, One Coat Bond, Gluma One Bond, Prime & Bond NT/NRC, and Clearfil Liner Bond 2V). MATERIALS AND METHODS: Fourteen dentin disks 1.0 mm thick were obtained from superficial occlusal dentin of extracted human third molars, and finished with wet 600-grit silicon carbide paper. Two dentin disks were bonded using each of the adhesives above according to the manufacturers' instructions, and a thin layer of flowable resin composite was applied. The specimens were kept in tap water for 24 h at 37 degrees C, and then assigned to one of two observational techniques: a fracture technique and an acid-base technique. Fracture technique: shallow grooves were cut, fixed in 10% buffered formalin, and dehydrated in an ascending ethanol series up to 100%, critical-point dried, and fractured along the prepared grooves. Acid-base technique: the specimens were embedded in epoxy resin, sectioned through the center, polished with diamond paste down to 0.25-micron particle size, and treated with 10% orthophosphoric acid for 10 s and 5% sodium hypochlorite for 5 min. All the specimens were mounted on aluminum stubs, gold sputter coated, and observed using field-emission scanning electron microscopy (FE-SEM). RESULTS: All the dentin adhesive systems showed hybrid layer formation, but the thickness varied depending on the bonding system used. The self-etching priming systems (Prime & Bond NT/NRC and Clearfil Liner Bond 2V) showed the thinnest hybrid layer at 1 to 2 microns, whereas the "single-bottle" system (Gluma One Bond) exhibited the thickest hybrid layer at 8 to 16 microns. CONCLUSION: The ultramorphological structures of dentin bonding systems are determined by the composition of each system. Characterization of the interface of the adhesive system using the fracture technique provides additional information regarding the pattern of resin infiltration in some dentin bonding systems.

Adhesives↗