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Article history: Objectives. To measure microshear bond strength (SBS) and nanoleakage (NL) of self-etch
Received 8 February 2017 universal adhesives under core buildup restorations using different curing protocols, at 24 h
Received in revised form and after 6-month water storage.
11 April 2017 Methods. Middle dentin of 55 molars was divided into: Clearfil Universal Bond [CFU],
Accepted 11 April 2017 Prime&Bond Elect [PBE], and One Coat 7 Universal [OCU]. All-Bond Universal [ABU] and
Clearfil SE Bond [CSE] were used as control. CFU, PBE and OCU were: light-cured [LC], dual-
cured [DC] and self-cured [SC]. Data were analyzed separately (two-way ANOVA), Tukey’s
Keywords: test (˛ = 0.05).
Universal adhesives Results. SBS: At 24 h OCU/LC resulted in statistically higher SBS than ABU. CSE/DC showed
Buildup composites statistically higher SBS than all DC adhesives. PBE/LC resulted in significant lower SBS
Self-cured activator than the respective DC/SC modes (p < 0.001). At 6-month, both CFU and PBE (LC/SC), resulted
Microshear bond strength in a significant decrease in SBS. SBS for OCU/DC decreased significantly (p < 0.001) com-
Nanoleakage pared to the respective LC/SC modes. NL: At 24 h, ABU showed %NL similar to CBU/LC and
OCU/LC (p > 0.05). CSE/DC resulted in significantly higher %NL than OCU/DC but significantly
lower than PBE/DC. CFU/LC/SC resulted in significantly lower %NL than CFU/DC. PBE/SC
resulted in significant lower %NL than PBE/LC and PBE/DC. OCU/LC and OCU/DC resulted in
significant lower %NL than OCU/SC (p < 0.001). At 6-month ABU, CSE, CFU/LC and CFU/SC,
resulted in a significant increase in %NL.
Significance. Self-cured activator and different curing protocols influenced SBS and NL of
self-etch universal adhesives, but this influence was material-dependent.
© 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
∗
Corresponding author at: University of Minnesota, Department of Restorative Sciences, Division of Operative Dentistry 515 SE Delaware
St, 8-450 Moos Tower, Minneapolis, MN 55455, USA. Fax: +1 612 625 7440.
E-mail address: perdi001@umn.edu (J. Perdigão).
http://dx.doi.org/10.1016/j.dental.2017.04.005
0109-5641/© 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
776 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787
d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787
1200 mW/cm2
4. Apply core buildup and light
cure for 40 s at 1200 mW/cm2
Core Flo DC (1500003885) Resin matrix: Bis-GMA, ethoxylated
Bis-GMA, TEGDMA
Filler: glass filler, fumed silica,
amorphous silica
Clearfil SE Bond—CSE Primer: 10-MDP, HEMA, 1. Apply primer with a disposable
Primer (01249A) pH = 1.9 dl-camphorquinone, hydrophilic, brush tip. Leave it in place for 20 s
aliphatic dimethacrylate, 2. Evaporate the volatile
N,N-diethanol-p-toluidine, water. ingredients with a mild oil-free air
stream
3. Dispense each one drop of bond
and activator into a well of the
dispensing dish and mix them
with the applicator brush
4. Apply the mixture and rub it for
10 s
5. After application, make the
bond film as uniform as possible
using a gentle oil-free air stream
6. Light cure for 10 s at
1200 mW/cm2
7. Apply core buildup and light
cure for 20 s at 1200 mW/cm2
Adhesive (01887A) pH = 2.8 Adhesive: 10-MDP, HEMA, Bis-GMA,
hydrophobic aliphatic dimethacrylate,
dl-camphorquinone,
N,N-diethanol-p-toluidine, colloidal
silica
Clearfil DC Activator: ethanol, catalysts,
Activator—(7F0002) accelerators
Clearfil DC Core Plus A Paste: Bis-GMA, hydrophobic
(3R0147) aliphatic dimethacrylate, hydrophilic
aliphatic dimethacrylate, hydrophobic
aromatic dimethacrylate, silanated
barium glass filler, silanated colloidal
silica, colloidal silica,
dl-camphorquinone, initiators,
pigments
B Paste: triethyleneglycol
dimethacrylate, hydrophilic aliphatic
dimethacrylate, hydrophobic aromatic
dimethacrylate, silanated barium
glass filler, silanated colloidal silica,
d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787
aluminum oxide filler, accelerators
Clearfil Universal Adhesive: 10-MDP, Bis-GMA, HEMA, 1. Apply bond and rub it for 10 s 1. Dispense each one drop of bond 1. Dispense each one drop
Bond—CFU (C50002) di-camphorquinone, hydrophilic 2. Dry by blowing mild air for 5 s and activator into a well of the of bond and activator into a
pH = 2.3 aliphatic dimethacrylate, silane 3. Light-cure for 10 s at dispensing dish and mix them well of the dispensing dish
coupling agent, colloidal silica and 1200 mW/cm2 with the applicator brush and mix them with the
accelerators, ethanol, water 4. Apply core buildup and light 2. Apply the mixture and rub it for applicator brush
cure for 20 s at 1200 mW/cm2 10 s 2. Apply the mixture and
3. Dry by blowing mild air for 5 s rub it for 10 s
4. Light-cure for 10 s at 3. Dry by blowing mild air
1200 mW/cm2 for 5 s
5. Apply core buildup and light 4. Apply core buildup and
cure for 20 s at 1200 mW/cm2 wait for 20 min
5. Light cure for 20 s at
1200 mW/cm2
Clearfil DC Activator: ethanol, catalysts,
Activator—(7F0002) accelerators
Clearfil DC Core Plus A Paste: Bis-GMA, hydrophobic
(3R0147) aliphatic dimethacrylate, hydrophilic
aliphatic dimethacrylate, hydrophobic
aromatic dimethacrylate, silanated
barium glass filler, silanated colloidal
silica, colloidal silica,
dl-camphorquinone, initiators,
pigments
B Paste: triethyleneglycol
dimethacrylate, hydrophilic aliphatic
dimethacrylate, hydrophobic aromatic
dimethacrylate, silanated barium
glass filler, silanated colloidal silica,
aluminum oxide filler, accelerators
779
780
– Table 1 (Continued)
Adhesive and core Compositiona Self-etch, light cure mode (SE-LC) Self-etch, dual cure mode (SE-DC) Self-etch, self cure mode (SE-SC)
buildup (batch
number) and pHb
Prime&Bond Elect—PBE Adhesive: Mono-, di- and 1. Apply generous amount of 1. Dispense each one drop of bond 1. Dispense each one drop
(130202) pH = 2.5 trimethacrylate resins; PENTA adhesive using microbrush. and activator into a clean plastic of bond and activator into a
Diketone; organic phosphine oxide; Agitate for 20 s mixing well mix them for 2 s with clean plastic mixing well
stabilizers; cetylamine hydrofluoride; 2. Gently dry with clean, dry air a clean unused brush tip mix them for 2 s with a
d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787
acetone; water from a dental syringe for’at least 2. Apply generous amount of clean unused brush tip
5 s. Surface should’have a uniform mixed. Agitate the applied 2. Apply generous amount
glossy appearance adhesive/activator mixture for 20 s of mixed. Agitate the
3. Light cure for 10 s at 3. Gently dry with clean, dry air applied adhesive/activator
1200 mW/cm2 from a dental syringe for’at least mixture for 20 s
4. Apply core buildup and light 5 s. Surface should’have a uniform 3. Gently dry with clean,
cure for 20 s at 1200 mW/cm2 glossy appearance dry air from a dental
4. Light cure for 10 s at syringe for’at least 5 s.
1200 mW/cm2 Surface should ’have a
5. Apply core buildup and light uniform glossy appearance
cure for 20 s at 1200 mW/cm2 4. Apply core buildup and
wait for 20 min
5. Light cure for 20 s at
1200 mW/cm2
Self Cure Activator (141222) Activator: UDMA, HEMA, catalyst,
photoinitiators, stabilisers, acetone,
water
FluoroCore 2+ (150608) Urethane dimethacrylate; di- &
tri-functional methacrylates; barium
boron fluoroaluminosilicate glass;
camphorquinone (CQ) photoinitiator;
photoaccelerators; silicon dioxide;
benzoyl peroxide
One Coat 7 Universal—OCU Adhesive: 10-MDP, methacrylated 1. Dispense a drop of adhesive and 1. Dispense a drop of adhesive and 1. Dispense a drop of
(G07542) pH = 2.8 polyacrylic acid, other methacrylates, rub it onto the dentin with a rub it onto the dentin with a adhesive and rub it onto the
photoinitiators, ethanol, water disposable dental brush for 20 s disposable dental brush for 20 s dentin with a disposable
2. Blow gently with oil-free 2. Blow gently with oil-free dental brush for 20 s
compressed air for 5 s compressed air for 5 s 2. Blow gently with oil-free
3. Light cure for 10 s at 3. Dispense one new drop of compressed air for 5 s
d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787
1200 mW/cm2 adhesive and one drop of activator 3. Dispense one new drop
4. Apply core buildup and light into a dispensing well and mix it of adhesive and one drop of
cure for 20 s at 1200 mW/cm2 well with a clean disposable brush activator into a dispensing
(approx. 5–10 s) well and mix it well with a
4. Apply the mixed bond using a clean disposable brush
disposable brush onto the dentin (approx. 5–10 s)
5. Gently dry for 5 s using oil-free 4. Apply the mixed bond
compressed air using a disposable brush
6. Light cure for 10 s at onto the dentin
1200 mW/cm2 5. Gently dry for 5 s using
7. Apply core buildup and light oil-free compressed air
cure for 20 s at 1200 mW/cm2 6. Apply core buildup and
wait for 20 min
7. Light cure for 20 s at
1200 mW/cm2
One Coat 7.0 Activator: ethanol, water, activator
Activator—(G46401)
ParaCore (G26422) Resin matrix: Bis-GMA, TEGDMA,
UDMA; Filler: fluoride, barium glass,
amorphous silica (68 wt%, 0.1–5 mm)
a
10-MDP = methacryloyloxydecyl dihydrogen phosphate; Bis-GMA = Bisphenol A diglycidylmethacrylate; HEMA = 2-hydroxyethyl methacrylate; PENTA = dipentaerythritol penta acrylate monophos-
phate; TEGDMA = triethyleneglycol dimethacrylate; UDMA = urethane dimethacrylate.
b
[46,47,59].
781
782 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787
Table 2 – Number of specimens according to fracture mode for all experimental groups.a
Immediate 6-month water storage
LC DC SC LC DC SC
A C M A C M A C M A C M A C M A C M
All-Bond Universal 25 0 20 17 3 25
Clearfil SE Bond 40 1 4 35 0 10
Clearfil Universal 22 1 22 27 0 18 25 2 18 19 3 23 23 3 19 20 3 22
Prime&Bond Elect 35 0 10 31 2 12 27 2 16 27 3 15 18 2 25 20 3 22
One Coat Bond 33 3 9 29 2 14 22 0 23 26 0 19 22 1 22 18 8 19
a
A = failure at the resin–dentin interface; C = cohesive (failure exclusively within dentin or core buildup) or; M = mixed (failure at the resin–dentin
interface that included cohesive failure of the neighboring substrates).
Table 3 – Mean and standard deviation of microshear bond strength (MPa) to dentin for each experimental condition.*,**
Immediate 6-month water storage
LC DC SC LC DC SC
All-Bond Universal 17.0 ± 3.5 D 15.6 ± 2.5 D,E
Clearfil SE Bond 25.9 ± 2.0 A 25.6 ± 1.1 A
Clearfil Universal 18.4 ± 1.9 C,D a,b 20.8 ± 2.6 B a 24.1 ± 2.5 A a 15.9 ± 2.9 D,E b 19.9 ± 2.3 B,C a 21.3 ± 2.4 B a
Prime&Bond Elect 15.8 ± 2.3 D,E d,e 21.3 ± 1.0 B c 22.6 ± 2.8 B c 13.9 ± 1.8 E e 21.0 ± 3.3 B c 18.9 ± 1.6 C,D c,d
One Coat Bond 20.4 ± 1.8 B,C f 20.4 ± 1.1 B,C f 23.2 ± 1.2 A,B f 20.4 ± 1.0 B,C f 16.2 ± 3.6 D,E g 23.0 ± 1.5 A,B f
∗
Different superscript letters mean statistically significant differences between groups (columns) (Tukey test, p < 0.05).
∗∗
Different lowercase letters mean statistically significant differences for each adhesive system (rows) (Tukey test, p < 0.05).
Table 4 – Mean and standard deviation of nanoleakage (NL) in dentin for each experimental condition.*,**
Immediate 6-month water storage
LC DC SC LC DC SC
All-Bond Universal 7.9 ± 2.0 A,B 36.5 ± 4.7 E,F
Clearfil SE Bond 15.3 ± 2.1C 30.3 ± 5.5 E
Clearfil Universal 3.0 ± 3.7 A a 13.0 ± 3.4C b 4.0 ± 7.9 A,B a 18.9 ± 3.4 D b 16.2 ± 3.3C,D b 19.8 ± 4.4 D,E b
Prime & Bond Elect 47.6 ± 10.9 F d 40.8 ± 7.5 F d 26.3 ± 2.8 E c 52.2 ± 8.8 F d 47.4 ± 6.3 F d 32.9 ± 7.2 E c
One Coat Bond 0.9 ± 1.8 A f 5.6 ± 4.3 A,B f,g 18.2 ± 3.5 D h 1.4 ± 1.0 A f 10.2 ± 2.3 B,C g 18.5 ± 1.5 D h
∗
Different superscript letters mean statistically significant differences between groups (columns) (Tukey test, p < 0.05).
∗∗
Different lower case letters mean statistically significant differences for each adhesive system (rows) (Tukey test, p < 0.05).
Fig. 2 – Representative SEM micrographs of the resin-dentin interfaces of different experimental groups in the immediate
time. Higher percentage of silver penetration was obtained for Prime&Bond Elect adhesive groups (F, G and H), mainly in the
hybrid layer (white pointers). (Ce = core buildup; De = dentin; HL = hybrid layer).
Fig. 3 – Representative SEM micrographs of the resin-dentin interfaces of different experimental groups after 6-month water
storage. Higher percentage of silver penetration was shown for Prime&Bond Elect adhesive groups (F, G and H), mainly in
the hybrid layer (white pointers), as well as, for the control groups (Ce = core buildup; De = dentin; HL = hybrid layer).
ites/cements [14–17]. However, the previous literature is based permeable [43,44]. The inclusion of 10-MDP makes universal
on older simplified self-etch adhesive systems. More recently, adhesives more hydrophobic than their predecessors, as this
different manufacturers have developed simplified adhesives monomer is quite hydrophobic due to its long carbonyl chain
to be more hydrophobic (i.e., less hydrophilic) and less water [45].
d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787 785
A recent paper evaluated the role of the hydrophilicity of of acidic adhesive systems deactivate the aromatic tertiary
adhesives on the compatibility between simplified SE adhe- amine initiator, inhibiting the polymerization reaction of resin
sives and a DC resin cement that was light cured or chemically composites that are initiated via peroxide-amine binary redox
cured [46]. The authors evaluated a self-etch adhesive with catalysts [14]. The addition of the self-curing activator may
different degrees of hydrophilicity (10–30% of hydroxyl-etil have reversed this reaction for both adhesives PBE and CFU in
methacrylate—HEMA), but with the same pH. In comparison DC and SC mode, resulting in higher mean uSBS.
two simplified commercial SE adhesives, ABU and Optibond Additionally the %NL obtained with PBE, when polymer-
All-in-One (Kerr) were also evaluated. The results showed that ized in all curing modes, were significantly higher than the
there was no incompatibility between the adhesive and the LC %NL of other adhesives tested, in line with the data pre-
or SC resin cement for more hydrophobic adhesives, as well viously reported by Luque-Martinez et al. [50]. Nanoleakage
as for the universal adhesive evaluated (ABU). However, for reveals the location of defects at the resin-dentin interface
more hydrophilic adhesives, there were significant drops in that may serve as pathways for degradation of resin-dentin
mean bond strengths (80–93%) when the adhesive was asso- bonds over time. Silver nitrate ions occupy nanometer-sized
ciated with a SC resin cement [46]. We hypothesize that the spaces around unprotected collagen fibrils, where resin failed
unexpected similar mean bond strengths obtained with dif- to infiltrate or where residual water/solvent were not dis-
ferent curing modes of both OCU and CFU in our study may placed by the adhesive resin [56]. As acetone present in the
be a consequence of their reduced hydrophilicity, in line with PBE composition evaporates faster than ethanol present in
the findings of Chen and Suh for ABU [46]. all others adhesives tested, the application of only one coat
Unfortunately, the exact composition of each universal of PBE may have been insufficient to promote a complete
adhesive is proprietary information. However, the SDS of OCU resin infiltration inside the hybrid layer The higher amount
indicates that the amount of HEMA varies between 5–10%. of solvent in PBE (less than 50%) when compared to CFU (less
For CFU, this amount varies between 10–35%, while for PBE than 20%) and OCU (between 35–40%) may also have con-
this amount is lower than 20%. Future studies need to evalu- tributed to this deficient infiltration. Additionally, PBE may
ate this variable for several commercial universal adhesives. be too hydrophilic, as it does not contain 10-MDP, as previ-
It worth mentioning that we selected ABU as the LC control, ously mentioned. This monomer is quite hydrophobic due
mainly because ABU is considered a less hydrophilic univer- to its long carbonyl chain [45]. For PBE, the increase in bond
sal adhesive, containing 10-MDP in its composition [15]. Also, strengths and decrease of %NL from LC to SC may be related
according to the respective manufacturer’s instructions, ABU to the extended time that the adhesive was allowed to inter-
does not require a separate self-cured activator with SC or act with hydroxyapatite in the SC mode (20 min), which may
DC resin composite materials, due to its fairly high pH of 3.2, have increased its pH from hydroxyapatite buffering [57]. This
compared to other universal adhesives [25,46,47]. same phenomenon may occur with CFU in terms of decreas-
OCU showed higher mean bond strengths compared to ABU ing bond strengths. On the other hand, this was not observed
at 24 h. The lower amount of HEMA may have been responsible for OCU. According to Hume [57], such reaction would be
for the higher bond strengths of OCU in LC more compared to less relevant for adhesives with higher pH. The pH of OCU
other adhesives in the same curing mode (ABU and PBE). As is 2.8 [Böhner R.—personal communication], which is slightly
HEMA has been shown to inhibit interfacial nano-layering of less acidic than the pH of CFU (pH = 2.3) and PBE (pH = 2.5)
the molecule 10-MDP with calcium in hydroxyapatite [48], the [47].
chemical bonding ability of OCU may have been stronger than This same extended buffering reaction may have been
that of other adhesives with a higher HEMA concentration. responsible for decreased bond strengths for both PBE and
HEMA promotes water uptake and hydrolysis at the adhesive CFU after 6-month water storage, as PBE and CFU showed
interface, affecting the durability of the bond [12,49]. lower mean bond strengths in SC mode when compared with
For PBE/LC mode, previous studies have reported lower the 24 h results. Although the higher buffering capacity of
dentin bond strengths compared to other universal adhesives dentin and the high reactivity of H+ insure that little H+ dif-
[33,50,51]. PBE contains acetone as solvent, which has been fuses through dentin [58], Carvalho et al. [59] observed the
known to prevent direct access of air to the surface of the occurrence of a porous zone of mineralized dentin in the
resin monomer [52], forming a deficient air-inhibited layer. corresponding undemineralized sections of self-etch adhe-
Due to the rapid evaporation of acetone, acetone-based resin sives and the authors hypothesized that this occur due to
monomers do not form a uniform layer on the dentin surface the accumulation of acidic but non-polymerizable hydrolytic
and may not plug dentinal tubules [53]. The high technique- adhesive components in some acidic one-step adhesives.
sensitivity of LC acetone-based adhesives may be responsible These non-polymerizable acidic monomers may continue
for poor long-term results [54,55]. Additionally, PBE is more to etch the underlying dentin after the formation of the
hydrophilic as it does not contain 10-MDP. These factors might hybrid layer being responsible for continuous demineraliza-
be responsible for the lower adhesion capability of PBE in LC tion of the surrounding dentin, mainly when stored in water
mode. [60].
The relatively lower mean uSBS of both PBE/LC and CFU/LC In summary, the first null hypothesis was rejected, as the
compared to their respective DC and SC modes (although mean SBS and %NL of universal adhesives varied according
not significant for CFU in the immediate time) may be a to the curing protocol used. The second null hypothesis was
result of the low pH of both adhesives (pH = 2.5 for PBE, rejected, as mean SBS and %NL of some universal adhesives
pH = 2.3 for CFU). As mentioned in the Introduction, resid- varied after 6 m water storage.
ual acidic monomers in the underlying oxygen inhibited layer
786 d e n t a l m a t e r i a l s 3 3 ( 2 0 1 7 ) 775–787
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