Beruflich Dokumente
Kultur Dokumente
www.intl.elsevierhealth.com/journals/jden
Department of Dental Materials and Operative Dentistry, Universidade do Oeste de Santa Catarina,
lio Vargas, 2125, Bairro Flor da Serra, CEP: 89600-000 Joacaba/SC, Brazil
Campus Joacaba, R. Getu
b
o Paulo, Sa
o Paulo, SP, Brazil
Department of Dental Materials, Universidade de Sa
Received 12 May 2004; received in revised form 18 October 2004; accepted 10 December 2004
KEYWORDS
Self-etching
adhesives;
Total-etch adhesives;
Smear layer thickness;
Microtensile test;
Ultimate microtensile
strength;
Long-term
bond
strength;
Resindentin
bond
strength;
Dentin adhesion
Summary Objectives. To evaluate the effect of smear layer thickness (SL) on early
and 6-month bond strength (BS) of self-etching adhesives to dentin and to measure
the ultimate microtensile strength (UTS) of the adhesives.
Methods. Clearfil SE Bond; Optibond Solo Plus Self-Etch Primer; Tyrian Self Priming
Etchant (TY) and as controls, Single Bond (SB) and Scotchbond Multi-Purpose Plus
(SBMP) were applied on flat superficial dentin surface with thick and thin SL
thicknesses. After adhesives application (nZ6) a resin build-up was made. After
24 h, resindentin beams (0.8 mm2) were prepared to be tested immediately and after
6-month (6M) at 0.5 mm/min. For the UTS measurement, hour-glass specimens were
prepared with the bonding resin alone or after mixing (1:1). BS values were analyzed by
three-way repeated measures ANOVA and Tukeys multiple comparison tests.
Two-way ANOVA (bonding resin and bonding resinCself-etching primer) and Tukeys
test were used for the UTS values. The bonding resins were re-evaluated separately by a
one-way ANOVA and Tukeys test, since Single Bond is a one-bottle adhesive (aZ0.05).
Results. The SL thickness was not significant (pZ0.64). BS values were reduced
after 6M, except for the SBMP. TY provided the lowest BS mean while SB and SBMP the
highest BS. The UTS of the SBMP was the highest. TY yielded the lowest UTS.
Regression analysis revealed a linear and significant relationship between the UTS of
self-etch systems and the mean BS (RZ0.95, pZ0.02).
Conclusions. The performance of a self-etching system does not seem to be
dependent on the SL thickness. The total-etch, three-step system provided the
highest BS to dentin and maintained the BS stable over 6 months. The performance of
the self-etching systems can be envisaged by their UTS.
q 2005 Elsevier Ltd. All rights reserved.
550
Introduction
Total-etch systems require a conditioning, a rinsing
and a priming step in order to allow encapsulation
of collagen fibers by the resin monomers and the
formation of the so-called hybrid layer.1 Demineralization of intertubular dentin and maintenance of interfibrillar porosity is required for
monomer penetration into dentin. Thus, wet bonding technique has been designated as essential for
the current adhesive systems in order to prevent
the known collapse of collagen fibrils in air-dried
conditions.2,3 The proper degree of moisture is
individual for each solvent-based adhesive system;4,5 however, even under ideal condition, an
actual discrepancy between the extent of the
demineralization and monomers infiltration is likely
to occur.68 The development of self-etch systems
avoided the occurrence of the above disadvantages
from total-etch systems. This bonding approach has
reintroduced the concept of employing the smear
layer as a bonding substrate, but with novel insights
and improved formulas that can etch beyond the
smear layer into the underlying dentin. Simultaneous infiltration of the demineralized dentin
matrix during acid etching is possible, as the
demineralizing component of the primer is also
the infiltrating resin.9
The hybridized complex of self-etch systems is
comprised of a surface zone of hybridized smear
layer and a subsurface zone of hybridized intertubular dentin.1012 To achieve this goal, the selfetching primer should penetrate beyond the smear
layer into the intact, mineralized dentin. Under
clinical circumstances, the thickness, coarseness,
and roughness of smear layers may vary according
to the rotary instruments used for cavity preparation.13,14 Thick smear layers might affect the
ability of self-etching systems to penetrate through
intact, mineralized dentin, since early neutralization of the adhesive by the dentin buffering
components presented in the smear layer15 might
hamper superficial demineralization of solid dentin,
which is required for collagen exposure. Studies
addressing this matter have not reached a conclusion about the performance of self-etching
systems applied to varied smear layer thickness.
Some studies reported low resindentin bond
strengths over thick dentin smear layers,1618
while others reported no influence of smear layer
thickness on resindentin bond strengths.11,13
To the authors knowledge, there is no information as to whether the thicknesses of smear
layers incorporated in the hybridized complex
affect the long-term resindentin bond strength.
A. Reis et al.
Other important issue that has been disregarded in
most studies and may play a role on the adhesive
performance is the ultimate strength of the
adhesive systems employed. Therefore, the objective of this study was to determine the effects of
varied dentin smear layer thicknesses on the early
and six-month bond strength of three two-step selfetching systems possessing different levels of
acidity, and to measure the ultimate microtensile
strength of the bonding resin and the self-etching
primer. The null hypothesis to be tested was:
(1) there will be no influence of smear layer
thicknesses on early and 6-month bond strengths
to dentin; (2) the bond strengths over thick and thin
smear layer covered dentin will not be dependent
on the acidity of self-etch systems and; (3) the
ultimate strength of the adhesives will not be
different among each other.
Figure 1
551
Experimental design.
Restorative procedure
A single operator applied on superficial dentin all
the adhesive systems, according to Table 1. The
bonding procedure was performed under controlled
temperature and humidity (24 8C and 50% relative
humidity). Special care was taken to ensure that the
dentin surfaces were adequately covered by monomers after evaporation of the solvents. In the event
that matte dentin was encountered, additional
coats of adhesives were applied to produce shiny
surfaces prior to light-activation of the adhesives. A
VIP light-curing unit with a light intensity of
600 mW/cm2 (Bisco, Schaumburg, IL, USA) was
used throughout the restorative procedure. Following the adhesive application, resin composite buildups (Z 250, 3M ESPE, St Paul, MN, USA) were
constructed in 1 mm increments, and light-cured
for 30 s each.
552
Table 1
Adhesive systems
Composition
Application mode
Batch number
Clearfil SE BondSE
(Kuraray)
00176A001185A
1. Alkyl dimethacrylate resins, Barium aluminoborosilicate glass, fumed silica (silicon dioxide), sodium hexafluorosilicate and ethyl alcohol
2. Alkyl dimethacrylate resins (2528%), ethyl alcohol,
water, stabilizers and activators
205187203D20
1. Self-etching2-acrylamido-2-methyl propanesulfonic
acid (215%); Bis-GMA; Ethanol (2550%)
2. Adhesive-Bis-GMA, BPDM, HEMA, Glass Frit initiator and
acetone (4070%)
200002694
200004295
2GM
A. Reis et al.
30087543
553
Statistical analysis
A bond strength index (BS) was calculated for each
hemi-tooth used per group as described by Reis
et al.5 The BS index is a weighted mean assuming
the relative contribution of the possible mode of
failures. The cohesive strength of the resin composite and the cohesive strength of dentin are
considered as the average value of all the specimens (from a single tooth) that failed in that
manner. The prematurely debonded specimens
were included in the BS index. The average value
attributed to specimens that failed prematurely
during preparation is arbitrary, and corresponds to
approximately half of the minimum bond strength
value that could be measured in this study
(ca. 10.4 MPa).
The microtensile BS indexes were subjected to
a three-way repeated measures analysis of variance and a post hoc test (Tukeys test at
aZ0.05) for pair-wise comparisons. The period
of evaluation (immediate or 6 months) was the
repeated factor. An additional random factor was
added to the statistical model as correction for
the two samples (hemi-tooth) gathered from the
same tooth.20
The UTS of the adhesive systems was subjected
to a two-way analysis of variance (factors: bonding
resin and bonding resinCself-etching primer).
Tukeys test was used for pair-wise comparisons
(aZ0.05) among averages. As Single Bond is a onebottle adhesive, the ultimate strength of the
bonding resins were evaluated separately by a
one-way ANOVA (aZ0.05) and Tukeys test for
pair-wise comparisons (aZ0.05).
554
A. Reis et al.
Table 2 Percentage of specimens (%) according to the fracture patterna or premature debonding (D) for each
experimental condition.
Adhesive systems
Time
Immediate
Fracture pattern
A/M
Clearfil SE Bond
Optibond Solo Self-Etch PrimerC
Optibond Solo Plus
Tyrian SPECOne Step Plus
Scotchbond Multi Purpose Plus
Single-Bond
85.3
87.1
11
9.2
0
0
86
89.7
89.9
0
7.7
7.2
0
0
0
6 months
PD
A/M
PD
3.7
3.7
73.7
56.3
4.3
7.8
4.4
15.1
17.6
20.8
14
2.6
2.5
72.6
74
94.5
0
7.1
0
1.6
7.7
0
25.8
11.2
5.5
The correlation between the UTS of the selfetching primers and their mean BS were
analyzed by simple linear regression analysis.
The strength of the association between these
two variables (UTS vs. BS) was estimated with the
Pearson productmoment correlation statistics
(aZ0.05).
Results
The mean cross-sectional area ranged from 0.78 to
0.89 mm2 and no difference among the treatment
groups was detected (pO0.05).
The average strength of all specimens that failed
cohesively in dentin was 38.5 MPa (38.5G9.1,
nZ16). The average strength of all specimens
that failed cohesively in resin was 50.0 MPa
(50.0G8.3, nZ13). The percentage of sticks that
had a premature failure during specimen preparation as well as the frequency of each fracture
pattern in each group is shown in Table 2. The
means and standard deviations of the BS indexes are
shown in Table 3.
Three-way repeated measures ANOVA did not
detect statistical significant effects for the
interactions (p!0.05). The main categorical variable smear layer thickness was not statistically
significant (pZ0.64). A significant effect of
the storage time on bond strengths was detected
(pZ0.0001). Reductions in BS were observed after
the 6-month storage, except for the SBMP (Table 3).
Regarding the main categorical factor adhesive,
significant differences were detected (pZ0.001).
The lowest BS mean was observed for Tyrian SPEC
One Step Plus which was statistically different from
all the others (Table 3). The highest BS was found
for the SBMP.
The means and standard deviations of the UTS
are shown in Table 4. As detected by two-way
ANOVA, the UTS of the bonding resins whether
associated or not with their self-etching primer
were different (pZ0.001). The highest UTS of the
bonding resin were found for the SBMP, while the
lowest was One Step Plus and Single Bond. Similar
trends were observed when the bonding resin was
mixed with the primer solution, i.e. the SBMP
adhesive had the best performance while Tyrian
SPECOne Step Plus had the worst. For the same
adhesive system, there was a trend towards a
reduction in the UTS when the bonding resin was
mixed with self-etch primer. However, this
Table 3 Means, standard deviations (MPa) and statistical significance of bond strength indexes at each
experimental condition.
Adhesive systems
Clearfil SE bond
Optibond Solo Self-Etch PrimerC
Optibond Solo Plus
Tyrian SPECOne Step Plus
Scotchbond Multi Purpose Plus
Single-Bond
Time
Immediate
6 months
40.6G4.7 (53) a
36.2G4.0 (55) a,b
26.6G4.1(42) b,c
24.6G2.4(41) b,c
24.1G3.7(42) b,c
42.6G5.5(66) a
41.5G2.6(72) a
18.6G2.8(28) c
45.2G4.3(60) a
28.0G2.6(65) b,c
Same symbols indicate similar means (pO0.05). Values in parentheses are the number of specimens tested.
555
Table 4 Means, standard deviations (MPa) and statistical significance of the ultimate bond strength for each
adhesive system.
Bonding resin
(*)
(**)
Bonding resinC
primer
(*)
Scotchbond Multi
Purpose Plus
Adhesive
Clearfil SE Bond
Optibond Solo Plus
Adhesive
One Step Plus
38.4G4.2 a
Scotchbond Multi
Purpose Plus
32.9G2.3 a,b
26.5G3.7 b
15.5G3.3 c,d
b
m
Clearfil SE Bond
Optibond Solo
27.3G2.6 b
12.7G2.1 d
m, f
Tyrian SPECOne
Step Plus
5.1G0.8 e
Single-Bond
8.7G0.9 d
10.1G1.2
(*) Comparison between the bonding resins and the bonding resins plus primer, excluding Single-Bond. Means with the same letters
are statistically similar (pO0.05). (**) Comparison between the bonding resins. Means with the same symbols are statistically similar
(p!0.05).
Discussion
In the last decade, bonding to smear-covered
dentin was not successful because early
556
the dentin surface condition. The results of the
present investigation agree with these studies,
demonstrating that the smear layer thickness has
no influence on the early bond strength values.
Thus, the first null hypothesis was accepted.
These observations suggest that either the
buffering capacity of the smear layer is weak, or
the smear layer does not prevent the primer from
penetrating into the underlying mineralized dentin
matrix.11,12 The smear layer is, in fact, a disaggregated substrate full of easily penetrable subunits with interconnecting channels. 23 This
morphology enhances diffusion and allows acidic
monomers to reach the basal portion of the smear
layer easily, irrespective of their aggressiveness
potential. As the smear layer is a very porous
substrate, the acidic monomers diffuse freely until
they reach the mineralized substrate underneath.
This is somewhat true, that Tay et al.11,12 demonstrated that the authentic hybrid layer thickness
produced by a mild self-etch system did not vary
even in the absence or presence of varied smear
layer thicknesses.
Irrespective of the smear layer thickness, the
self-etching systems showed different bond
strength performances and thus the second null
hypothesis was rejected. As already demonstrated
by other authors, it seems that the depth of
penetration of self-etch adhesives into subsurface
dentin varies according to the acidity of the selfetch system.24 Thin authentic hybrid layers are
formed with a mild self-etch adhesive, as Clearfil SE
Bond (approximately 0.5 mm thick) whereas a
moderate and an aggressive self-etch system
usually forms thicker hybrid layers, in the range of
1.22.2 and 2.55.0 mm, respectively.
Conversely, a close analysis of bond strengths of
self-etch systems with different levels of acidity
indicates that the aggressive ones, as Tyrian SPE
(Table 3), usually present low bond strength
values.2527 In fact, previous literature reports
have demonstrated that there is no correlation
between bond strengths and hybrid layer thickness,28,29 and thus it seems that the ability to
create thick hybrid layers cannot be considered as
an additional advantage for improved retention.
These observations suggest that other factors are
involved in the performance of a self-etch system.
For instance, Pashley et al.30 showed, using a
modeling approach, that the theoretical strength
of the resindentin bond strength should be proportional to the strength of the adhesive used to
infiltrate demineralized dentin. The present study
has found a strong correlation between the resin
dentin bond strengths and the mechanical
properties of cured resin for the self-etch systems,
A. Reis et al.
and thus the third null hypothesis was rejected.
This finding is in agreement with other laboratory
investigation,31 and they confirm the observations
of the theoretical modeling approach. This means
that by knowing the ultimate strength of a self-etch
system, one may envisage their bonding
performance.
Another important aspect is the amount of the
solvents included in the self-priming solution.
Water is present in all the self-etch systems
employed because it is an essential component to
enable ionization of the acidic monomers and
demineralization of dental hard tissues. As Tyrian
SPE is very acidic, it is likely that its solvent content
may be higher than the others self-etch systems, in
order to promote complete ionization of the acidic
monomers. Consequently, the thickness of the
adhesive layer, after solvent evaporation, can be
very thin and an incomplete polymerization due to
oxygen inhibition may occur.32,33 This partially
explains why aggressive self-etch primers demonstrated higher resindentin bond strengths when
several coats of the primer were applied.33 The
lower the remaining solvent content, the higher the
mechanical properties of the polymer formed,
which is a relevant property for the integrity of
adhesive interfaces.34,35 This seems to be particularly important for some adhesive systems. For
instance, it was not possible to obtain One-Step
specimens without increasing the air-stream period
to allow solvent evaporation and increasing the
light-curing time. Even under improved conditions
the ultimate strength of One-Step systems was
lower than for the other systems (Table 4). The high
amount of solvents in its composition (unpublished
data) may prevent the attainment of an adequate
degree of conversion, which is in turn responsible
for the low mechanical properties of this system
and possibly of the low resindentin bond
strengths.35 This situation got even worse when
the bonding resin One-Step was mixed with the selfpriming Tyrian SPE, which was probably due to an
increase in the amount of solvent within the mass of
the bonding resin. Besides that, the addition of
acidic monomers to polymerisable resins causes
reduction of their ultimate tensile strength. In a
clinical situation, it is possible that the application
of acidic primers or adhesives to dentin will render
acidity buffered, and may improve the degree of
conversion of the polymer after contact with
dentin. By preparing the specimens in a compound
mold, while solvents may evaporate, the acidic
monomers are not buffered, and that may compromise their polymerization.
Recently, Carrilho et al.36 have reported the
ultimate microtensile strength of some adhesives
557
558
evaluating total-etch, three-step adhesives over
time encourage future studies on this matter.
Acknowledgements
The authors are grateful to the Dental School of
UNOESC, Joac
aba (SC). This study was partially
supported by CAPES and CNPq Grants
(551049/2002-2; 350085/2003-0; 302552/2003-0
and 474225-2003-8).
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