Cementation of Prosthetic Restorations: From Conventional Cementation to Dental Bonding Concept

The cementation procedure of metal-free fixed partial dentures exhibits special characteristics about the porcelains and cementation agents, which turns the correct association between these materials necessary. Our purpose in this literature review was to point the main groups of cements associated to metal-free restoration and discuss about the advantages, disadvantages, and recommendations of each one. Our search was confined to the electronic databases PubMed and SciELO and to books about this matter. There are essentially 3 types of hard cement: conventional, resin, or a hybrid of the two. The metal-free restorations can be fixed with conventional or resin cements. The right choice of luting material is of vital importance to the longevity of dental restorative materials. Conventional cements are advantageous when good compressive straight, good film thickness, and water dissolution resistance are necessary. However, they need an ideal preparation, and they are not acid dissolution resistant. Conventional cements are indicated to porcelains that cannot be acid etched. Resin cements represent the choice to metal-free restoration cementation because they present better physical properties and aesthetic than conventional agents.

Use of one-bottle adhesive as an intermediate bonding layer to reduce sealant microleakage on saliva-contaminated enamel

Purpose: To evaluate the influence of three different adhesives, each used as an intermediary layer, on microleakage of sealants applied under condition of salivary contamination. Materials and Methods: Six different experimental conditions were compared, 3 with adhesives and 3 without. After prophylaxis and acid etching of enamel, salivary contamination was placed for 10 s. In Group SC the sealant was applied after saliva without bonding agent and then light-cured. In Group SCA, after saliva, the surface was air dried, and then the sealant was applied and cured. In Groups ScB, SB and PB, a bonding agent (Scotchbond Dual Cure/3M, Single Bond/3M and Prime & Bond 2.1/Dentsply, respectively) was applied after the saliva and prior to the sealant application and curing. After storage in distilled water at 37°C for 24 hrs, the teeth were submitted to 500 thermal cycles (5°C and 55°C), and silver nitrate was used as a leakage tracer. Leakage data were collected on cross sections as percentage of total enamel-sealant interface length. Representative samples were evaluated under SEM. Results: Sealants placed on contaminated enamel with no bonding agent showed extensive microleakage (94.27% in SC; 42.65% in SCA). The SEM revealed gaps as wide as 20 μm in areas where silver nitrate leakage could be visualized. In contrast, all bonding agent groups showed leakage less than 6.9%. Placement of sealant with a dentin-bonding agent on contaminated enamel significantly reduced microleakage (P< 0.0001). The use of a bonding agent as an intermediary layer between enamel and sealant significantly reduced saliva's effect on sealant microleakage.

Effect of whitening agents on dentin bonding

Background: Several studies have shown a reduction in enamel bond strengths when the bonding procedure is carried out immediately after vital bleaching with peroxides. This reduction in bond strengths has become a concern in cosmetic dentistry with the introduction of new in-office and waiting-room bleaching techniques. The aim of this in vitro study was to evaluate the effect of three bleaching regimens: 35% hydrogen peroxide (HP), 35% carbamide peroxide (CP), and 10% CP, on dentin bond strengths. Materials and Methods: One hundred and twenty fresh bovine incisors were used in this study. The labial surface of each tooth was ground flat to expose dentin and was subsequently polished with 600-grit wet silicon carbide paper. The remaining dentin thickness was monitored and kept at an average of 2 mm. The teeth were randomly assigned to four bleaching regimens (n = 30): (A) control, no bleaching treatment; (B) 35% HP for 30 minutes; (C) 35% CP for 30 minutes; and (D) 10% CP for 6 hours. For each group, half of the specimens (n = 15) were bonded with Single Bond/Z100 immediately after the bleaching treatment, whereas the other half was bonded after the specimens were stored for 1 week in artificial saliva at 37°C. The specimens were fractured in shear using an Instron machine. Results: For the groups bonded immediately after bleaching, one-way analysis of variance (ANOVA) followed by the Duncan's post hoc test revealed a statistically significant reduction in bond strengths in a range from 71% to 76%. For the groups bonded at 1 week, one-way ANOVA showed that group B (35% HP for 30 min) resulted in the highest bond strengths, whereas 10% CP resulted in the lowest bond strengths. Student's t-test showed that delayed bonding resulted in a significant increase in bond strengths for groups B (35% HP) and C (35% CP); whereas the group bleached with 10% CP (group D) remained in the same range obtained for immediate bonding. Storage in artificial saliva also affected the control group, reducing its bond strengths to 53% of the original. ©2000 BC Decker Inc.

Temperature analysis during bonding of brackets using LED or halogen light base units

The purpose of our investigation is to compare the intrapulpal temperature changes following blue LED system and halogen lamp irradiation at the enamel surface of permanent teeth. The fixation of brackets using composite resin is more comfortable and faster when using a photo-curable composite. Several light sources can be used: halogens, arc plasma, lasers, and recently blue LED systems. An important aspect to be observed during such a procedures is the temperature change. In this study, we have used nine human extracted permanent teeth: three central incisors, three lateral incisors, and three canines. Teeth were exposed to two light sources: blue LED system (preliminary commercial model LEC 470-II) and halogen lamp (conventional photo-cure equipment). The surface of teeth was exposed for 20, 40, and 60 sec at the buccal and lingual enamel surface with an angle of 45 degrees. Temperature values measured by a thermistor placed at pulpar chamber were read in time intervals of 1 sec. We obtained plots showing the temperature evolution as a function of time for each experiment. There is a correlation between heating quantity and exposition time of light source: with increasing exposition time, heating increases into the pulpal chamber. The halogen lamp showed higher heating than the LED system, which showed a shorter time of cooling than halogen lamp. The blue LED system seems like the indicated light source for photo-cure of composite resin during the bonding of brackets. The fixation of brackets using composite resin is more comfortable and faster when using a photo-curable composite. Blue LED equipment did not heat during its use. This could permit a shorter clinical time of operation and better performance. © Mary Ann Liebert, Inc.

Shear bond strength fatigue limit of rest seats made with dental restoratives

Purpose: This study compared the shear bond strength (SBS) to enamel of rest seats made with a glass-ionomer cement (Fuji IX GP Fast), a resin-modified glass-ionomer cement (Fuji II LC), and a composite resin (Z100 MP) under monotonic and cyclic loading. Materials and Methods: Rest seats were built up onto the lingual surfaces of 80 intact human mandibular incisors. Specimens (n=10) were stored in distilled water at 37°C for 30 days and subjected to shear forces in a universal testing machine (0.5 mm/min) until fracture. The SBS values were calculated (MPa) using the bonding area (9.62 mm2) delimited by adhesive tags. A staircase approach was used to determine the SBS fatigue limit of each material. Specimens were submitted to either 10,000 cycles (5 Hz) or until specimen fracture. A minimum of 15 specimens was tested for each material. Scanning electron microscopy was used to examine the mode of failure. Data were statistically analyzed with one-way ANOVA and Tukey HSD tests (α = 0.05). Results: Z100 MP yielded higher (p < 0.05) SBS (12.25 MPa) than Fuji IX GP Fast (7.21 MPa). No differences were found between Fuji II LC (10.29 MPa) and the other two materials (p > 0.05). Fuji II LC (6.54 MPa) and Z100 MP (6.26 MPa) had a similar SBS limit. Fuji IX GP Fast promoted the lowest (p < 0.05) SBS fatigue limit (2.33 MPa). All samples showed cohesive failure patterns. Conclusion: Fatigue testing can provide a better means of estimating the performance of rest seats made with dental restoratives.

Resin bonding to root canal dentin: Effect of the application of an experimental hydrophobic resin coating after an all-in-one adhesive

Aim: Based on the hypothesis the application of a low-viscosity hydrophobic resin coating improves the bond of all-in-one adhesive, the purpose of the study was to evaluate the bond strength of four adhesive systems to bovine root dentin using the push-out test method. Methods and Materials: The root canals of 32 bovine roots (16 mm) were prepared to a length of 12 mm using a FRC Postec Plus preparation drill. The specimens were allocated into four groups according to the adhesive system used: (Group 1) All-in-one Xeno III; (Group 2) All-in-one Xeno III+ScotchBond Multi-Purpose Plus Adhesive; (Group 3) Simplified Etch & Rinse One Step Plus; and (Group 4) Multi-Bottle Etch & Rinse All-Bond 2. A fiber-reinforced composite retention post was reproduced using an additional silicon impression and fabricated with DuoLink resin cement. The root specimens were treated with the selected adhesive systems, and the resin posts were luted in the canals with DuoLink resin cement. Each root specimen was cross sectioned into four samples (±1.8 mm in thickness), and the post sections were pushed-out to determine the bond strength to dentin. Results: Group 2 (2.9±1.2) was statistically higher than Group 1 (1.1±0.5) and Group 3 (1.1±0.5). Groups 1 and 3 showed no statistically significant difference while Group 4 (2.0±0.7) presented similar values (p>0.05) to Groups 1, 2, and 3 [(one-way analysis of variance (ANOVA)] and Tukey test, α=0.05). Conclusion: The hypothesis was accepted since the application of the additional layer of a low-viscosity bonding resin improved the bond of the all-in-one adhesive. Further studies must be conducted to evaluate the long-term bond.

In vitro lingual bracket evaluation of indirect bonding with plasma arc, LED and halogen light

Authors - Magno AFF, Martins RP, Vaz LG, Martins LP Objectives - Evaluate the shear bond strength (SBS) and the adhesive remnant index (ARI) of indirect bonded lingual brackets using xenon plasma arc light, light-emitting diode (LED) and conventional quartz-tungsten-halogen light. Material and Methods - Lingual brackets were bonded indirectly to 60 premolars divided to three groups according to the curing light used: Group 1, plasma arc for 6 s; Group 2, LED for 10 s; and Group 3, halogen light for 40 s. After bonding, the specimens were subjected to a shear force until debonding. The debonding pattern was assessed and classified according to the ARI scores. The mean shear bond strengths were accessed by anova followed by the Student-Newman-Keuls test for multiple comparisons. ARI scores were assessed using the chi-square test. Results - The three groups showed significant differences (p < 0.001), with the averages of group 1 < group 2 < group 3. Groups showed no differences regarding ARI scores. Conclusion - Bonding lingual brackets indirectly with plasma arc, during 60% of the time used for the LED, produced lower SBS than obtained with the latter. Using LED during 25% of the time of the halogen light produced lower SBS than obtained with the latter. These differences did not influence the debonding pattern and are clinically acceptable according to the literature. © 2010 John Wiley & Sons A/S.

Evaluating the bonding of two adhesive systems to enamel submitted to whitening dentifrices.

The aim of this study was to evaluate by micro-shear bond strength test, the bond strength of composite resin restoration to enamel submitted to whitening dentifrices. Forty bovine teeth were embedded in polystyrene resin and polished. The specimens were randomly divided into eight groups (n=5), according to the dentifrice (carbamide peroxide, hydrogen peroxide and conventional dentifrice) and the adhesive system (Prime & Bond 2.1 and Adper Single Bond 2). Dentifrice was applied for 15 minutes a day, for 21 days. Thirty minutes after the last exposure to dentifrice, the samples were submitted to a bonding procedure with the respective adhesive system. After that, four buttons of resin were bonded in each sample using transparent cylindrical molds. After 24 hours, the teeth were submitted to the micro-shear bond strength test and subsequent analysis of the fracture mode. Data were submitted to analysis of variance and Fisher's PLSD test (alpha = 0.05). The micro-shear bond strength showed no difference between adhesives systems but a significant reduction was found between the control and carbamide groups (p = 0.0145) and the control and hydrogen groups (p = 0.0370). The evaluation of the failures modes showed that adhesive failures were predominant. Cohesive failures were predominant in group IV The use of dentifrice with peroxides can decrease bonding strength in enamel.

Influence of CVD diamond tips and Er:YAG laser irradiation on bonding of different adhesive systems to dentin

Aim: The aim of this study was to compare the microtensile bond strength of three adhesive systems, using different methods of dentin preparation. Materials and methods: A hundred and eight bovine teeth were used. The dentin from buccal face was exposed and prepared with three different methods, divided in 3 groups: Group 1 (DT)- diamond tip on a high-speed handpiece; Group 2 (CVD)-CVD tip on a ultrasonic handpiece; Group 3 (LA)-Er: YAG laser. The teeth were divided into 3 subgroups, according adhesive systems used: Subgroup 1-Adper Single Bond Plus/3M ESPE (SB) total-etch adhesive; Subgroup 2-Adper Scotchbond SE/3M ESPE (AS) selfetching adhesive; Subgroup 3-Clearfil SE Bond/Kuraray (CS) selfetching adhesive. Blocks of composite (Filtek Z250-3M ESPE) 4 mm high were built up and specimens were stored in deionized water for 24 hours at 37°C. Serial mesiodistal and buccolingual cuts were made and stick-like specimens were obtained, with transversal section of 1.0 mm2. The samples were submitted to microtensile test at 1 mm/min and load of 10 kg in a universal testing machine. Data (MPa) were subjected to ANOVA and Tukey's tests (p < 0.05). Results and conclusion: Surface treatment with Diamond or CVD tips associated with Clearfil SE Bond adhesive produced significantly lower bond strength values compared to other groups. Surface treatment with Er: YAG laser associated with Single Bond Plus or Clearfil SE Bond adhesives and surface treatment with CVD tip associated with Adper Scotchbond SE adhesive produced significantly lower bond strength values compared to surface treatment with diamond or CVD tips associated with Single Bond Plus or Adper Scotchbond SE adhesives. Clinical significance: Interactions between laser and the CVD tip technologies and the different adhesive systems can produce a satisfactory bonding strength result, so that these associations may be beneficial and enhance the clinical outcomes.

Comparative study on direct and indirect bracket bonding techniques regarding time length and bracket detachment

OBJECTIVE: The aim of this study was to assess the time spent for direct (DBB - direct bracket bonding) and indirect (IBB - indirect bracket bonding) bracket bonding techniques. The time length of laboratorial (IBB) and clinical steps (DBB and IBB) as well as the prevalence of loose bracket after a 24-week follow-up were evaluated. METHODS: Seventeen patients (7 men and 10 women) with a mean age of 21 years, requiring orthodontic treatment were selected for this study. A total of 304 brackets were used (151 DBB and 153 IBB). The same bracket type and bonding material were used in both groups. Data were submitted to statistical analysis by Wilcoxon non-parametric test at 5% level of significance. RESULTS: Considering the total time length, the IBB technique was more time-consuming than the DBB (p < 0.001). However, considering only the clinical phase, the IBB took less time than the DBB (p < 0.001). There was no significant difference (p = 0.910) for the time spent during laboratorial positioning of the brackets and clinical session for IBB in comparison to the clinical procedure for DBB. Additionally, no difference was found as for the prevalence of loose bracket between both groups. CONCLUSION: the IBB can be suggested as a valid clinical procedure since the clinical session was faster and the total time spent for laboratorial positioning of the brackets and clinical procedure was similar to that of DBB. In addition, both approaches resulted in similar frequency of loose bracket.

A Microleakage Study Of Gutta-percha/ah Plus And Resilon/real Self-etch Systems After Different Irrigation Protocols.

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin. The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-etch systems. One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+eDTA; NaOCl+H3PO4; NaOCl+eDTA+chlorhexidine (CHX); NaOCl+H3PO4+CHX; CHX+eDTA; CHX+ H3PO4; CHX+eDTA+CHX and CHX+H3PO4+CHX. Gutta-percha/AH Plus or Resilon/Real Seal Se were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests. No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by eDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage. A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE.

In vitro evaluation of an alternative method to bond molar tubes

Despite the advances in bonding materials, many clinicians today still prefer to place bands on molar teeth. Molar bonding procedures need improvement to be widely accepted clinically. OBJECTIVE: The purpose of this study was to evaluate the shear bond strength when an additional adhesive layer was applied on the occlusal tooth/tube interface to provide reinforcement to molar tubes. MATERIAL AND METHODS: Sixty third molars were selected and allocated to the 3 groups: group 1 received a conventional direct bond followed by the application of an additional layer of adhesive on the occlusal tooth/tube interface, group 2 received a conventional direct bond, and group 3 received a conventional direct bond and an additional cure time of 10 s. The specimens were debonded in a universal testing machine. The results were analyzed statistically by ANOVA and Tukey's test (α=0.05). RESULTS: Group 1 had a significantly higher (p<0.05) shear bond strength compared to groups 2 and 3. No difference was detected between groups 2 and 3 (p>0.05). CONCLUSIONS: The present in vitro findings indicate that the application of an additional layer of adhesive on the tooth/tube interface increased the shear bond strength of the bonded molar tubes.

Influence of intrapulpal pressure simulation on the bond strength of adhesive systems to dentin

The purpose of this study was to evaluate the influence of intrapulpal pressure simulation on the bonding effectiveness of etch & rinse and self-etch adhesives to dentin. Eighty sound human molars were distributed into eight groups, according to the permeability level of each sample, measured by an apparatus to assess hydraulic conductance (Lp). Thus, a similar mean permeability was achieved in each group. Three etch & rinse adhesives (Prime & Bond NT - PB, Single Bond -SB, and Excite - EX) and one self-etch system (Clearfil SE Bond - SE) were employed, varying the presence or absence of an intrapulpal pressure (IPP) simulation of 15 cmH2O. After adhesive and restorative procedures were carried out, the samples were stored in distilled water for 24 hours at 37°C, and taken for tensile bond strength (TBS) testing. Fracture analysis was performed using a light microscope at 40 X magnification. The data, obtained in MPa, were then submitted to the Kruskal-Wallis test ( a = 0.05). The results revealed that the TBS of SB and EX was significantly reduced under IPP simulation, differing from the TBS of PB and SE. Moreover, SE obtained the highest bond strength values in the presence of IPP. It could be concluded that IPP simulation can influence the bond strength of certain adhesive systems to dentin and should be considered when in vitro studies are conducted.

Effectiveness of sealing active proximal caries lesions with an adhesive system: 1-year clinical evaluation

The objective of this study was to evaluate the effectiveness of a therapeutic sealant to arrest non-cavitated proximal carious lesion progression. The study population comprised 44 adolescents who had bitewing radiographs taken for caries diagnosis. Non-cavitated lesions extending up to half of dentin thickness were included in the sample. In the experimental group (n = 33), the proximal caries-lesion surfaces were sealed with an adhesive (OptiBond Solo, Kerr) after tooth separation. The control group (n = 11) received no treatment, except for oral hygiene instructions including use of dental floss. Follow-up radiographs were taken after one year and were analyzed in comparison with baseline radiographs. In a blind study setting, visual readings were performed by two examiners, blinded to whether the examined radiograph was baseline or follow-up, and whether it concerned a test or control lesion. The efficacy of sealing treatment was evaluated by the McNemar test (0.05). About 22% of the sealed lesions showed reduction, 61% showed no change and 16% showed progression. For the control lesions, the corresponding values were 27%, 36% and 36% respectively. The number of lesions that showed reduction and no changes were merged and therefore 83.3% of the sealed lesions and 63.6% of the control lesions were considered clinically successful. No statistical significance was detected (p > 0.05). In the course of 1 year, sealing proximal caries lesions was not shown to be superior to lesion monitoring.

Clinical performance of cervical restorations: a meta-analysis.

OBJECTIVES: To carry out a meta-analysis in order to assess the influencing factors on retention loss and marginal discoloration of cervical restorations made of composites and glass ionomer (derivates). METHODS: The literature was searched for prospective clinical studies on cervical restorations with an observation period of at least 18 months. RESULTS: Fifty clinical studies involving 40 adhesive systems matched the inclusion criteria. On average, 10% of the cervical fillings were lost and 24% exhibited marginal discoloration after 3 years. The variability ranged from 0% to 50% for retention loss and from 0% to 74% for marginal discoloration. Hardly any secondary caries was detected. When linear mixed models with a study and experiment effect were used, the analysis revealed that the adhesive/restorative class had the most significant influence, with 2-step self-etching adhesive systems performing best and 1-step self-etching adhesive systems performing worst; 3-step etch-and-rinse systems, glass ionomers/resin-modified glass ionomers, 2-step etch-and-rinse systems and polyacid-modified resin composites were ranked in between. Restorations placed in teeth whose dentin/enamel had been prepared/roughened showed a statistically significant higher retention rate than those placed in teeth with unprepared dentin (p<0.05). Beveling of the enamel and the type of isolation used (rubberdam/cotton rolls) had no significant influence. SIGNIFICANCE: The clinical performance of cervical restorations is significantly influenced by the type of adhesive system used and/or the adhesive class to which the system belonged and whether the dentin/enamel is prepared or not. 2-Step self-etching- and 3-step etch&rinse systems shall be chosen over 1-step self-etching systems and glass ionomer derivates. The dentin (and enamel) surface shall be roughened before placement of the restoration.