The influence of bonding agents on the decision to replace composite restorations.

UNLABELLED: This in vitro study evaluated the validity of the decision to replace of a restoration based upon the radiolucent zone beneath a resin composite. MATERIALS AND METHODS: Class II cavities were prepared on the approximal surfaces of 40 molars. The teeth were divided into four groups. Clearfil SE Bond, PQ1 or Single Bond was applied in the experimental groups. No bonding agent was used in the control group. Following the restorations, digital radiographs were obtained and independently evaluated by two oral radiologists and two specialists in restorative dentistry to determine the need for replacement. The coronal portions of the teeth were then sectioned and the interfaces between the restorations and cavity walls were examined using an optical light microscope. Possible adhesive pooling and voids were examined under a light microscope. Inter-examiner reliability was evaluated with the Cohen's kappa (kappa) test. Sensitivity, specificity and negative and positive predictive values were calculated. Kruskal-Wallis, followed by the Mann-Whitney U-test, determined differences among the pooling thicknesses of the different adhesives. RESULTS: Various sensitivity and specificity degrees were obtained from the groups in which different adhesive systems were used. The PQ1 adhesive system was the best for identifying well-adapted restorations with the highest true non-replacement diagnosis (TND = 0.70). Clearfil SE Bond had the highest false positive scores. Adhesive pooling was significantly different in the experimental groups of the current study (p < 0.05). CONCLUSION: Replacement decisions for a resin composite restoration based upon digital images frequently resulted in false-positive or negative decisions.

Reversal of reduced bond strength after bleaching.

This article investigated how the shear bond strength of a luting resin to dentin was affected by antioxidant treatment and delayed bonding after bleaching with carbamide peroxide. Using a lowspeed diamond saw, 40 flat dentin surfaces were prepared from freshly extracted human molars and divided into three bleaching groups (n = 10) and a control group (n = 10). Group 1 consisted of specimens bonded immediately after bleaching. Group 2 specimens were treated with an antioxidant agent (10% sodium ascorbate), while Group 3 specimens were immersed in artificial saliva for one week after bleaching. Specimens in Group 4 were not bleached but were immersed in artificial saliva for one week before bonding. Forty ceramic blocks were prepared and luted to teeth using a dual-curing resin cement. The specimens were thermocycled and the shear bond strength tests were performed using a universal testing machine. Fracture analysis was performed using a scanning electron microscope. While the Group 1 samples demonstrated the lowest shear bond strengths (11.9 +/- 3 MPa) (p < 0.05), no significant differences were found among samples in Group 2 (26.3 +/- 7.1 MPa), Group 3 (20.7 +/- 6.5 MPa), and Group 4 (22.1 +/- 2.5 MPa) (p = 0.05).

Can the hydrogel form of sodium ascorbate be used to reverse compromised bond strength after bleaching?

PURPOSE: To assess the effect of the hydrogel form of different concentrations (2.5%, 5%, and 10%) of sodium ascorbate on the shear bond strength of composite after bleaching of the enamel with 10% carbamide peroxide gel. MATERIALS AND METHODS: Sixty flat buccal enamel surfaces obtained from 30 bovine incisors were divided into 6 treatment groups: group I, control (nonbleached); group II, no antioxidant treatment after bleaching; group III, 10% sodium ascorbate solution after bleaching; group IV, 2.5% sodium ascorbate hydrogel after bleaching; group V, 5% sodium ascorbate hydrogel after bleaching; group VI, 10% sodium ascorbate hydrogel after bleaching. The specimens were bonded with Clearfil SE Bond, then thermocycled and subjected to the shear test until failure. Fracture analysis of the bonded enamel surfaces was examined using a stereomicroscope. Statistical analysis was carried out using Kruskal-Wallis and the Mann-Whitney U-test. RESULTS: While the samples that were not treated with antioxidant after bleaching (group I) demonstrated significantly lower shear bond strengths and the 10% sodium ascorbate gel group (group VI) demonstrated significantly higher bond strengths than the control group (p < 0.05), no significant differences were found between the other groups and control group (p > 0.05). Among the antioxidant groups, only the groups treated with the 10% solution and the 10% hydrogel form of sodium ascorbate (group III and VI) revealed significantly higher bond strengths than the bleached group without antioxidant (group II) (p < 0.05). Higher scores were obtained with 10% sodium ascorbate gel (group VI) when compared with the other antioxidant-treated groups (p < 0.05). CONCLUSION: Within the limitations of this study, it can be concluded that the 10% hydrogel form of sodium ascorbate may be used in clinical procedures instead of its solution form. However, using sodium ascorbate hydrogel with concentrations lower than 10% may not be as reliable as using this agent in 10% concentration for reversing the compromised bond strength.

Reversal of compromised bonding in bleached enamel using antioxidant gel.

Many studies have shown a considerable reduction in the enamel bond strength of resin composite restorations when the bonding procedure is carried out immediately after bleaching. These studies claim that a certain waiting period is needed prior to performing the restoration in order to attain the original bond strength values. This study determined the most effective time duration for the application of sodium ascorbate prepared in gel form. The labial surfaces of 70 bovine incisors were polished with 600-grit silicon carbide paper on a water-irrigated metallurgical polishing wheel. The specimens were randomly divided into seven groups: 1) bleaching (10% Rembrandt Xtra-Comfort +) immersed in artificial saliva for seven days, 2) bonded immediately after bleaching, 3) bleaching + 10% sodium ascorbate (SA) gel for 10 minutes, 4) bleaching + 10% SA gel for 60 minutes, 5) bleaching + 10% SA gel for 120 minutes, 6) bleaching + 10% SA gel for 240 minutes and 7) bleaching + 10% SA gel for 480 minutes. After preparation, a standard-shaped resin composite was applied to all specimens. The teeth were stored in distilled water at 37 degrees C for 24 hours and a universal testing machine determined their shear bond strength. The data were evaluated using ANOVA and Tukey tests. Antioxidant gel proved to be effective for increasing the shear bond strength of the resin composite to enamel. For maximum effectiveness, antioxidant gel should be applied to enamel for at least 60 minutes. As the application period of the antioxidant increased, the bond strength of the composite on enamel tissue also increased. The increase noticed in Groups 5, 6 and 7 was statistically significant (p<0.05). Application of the antioxidant gel by the patient shortens the time spent in the clinic.

Effect of antioxidant treatment on bond strength of a luting resin to bleached enamel.

PURPOSE: The aim of this study was to comparatively investigate the effect of antioxidant treatment and delayed bonding after bleaching with carbamide peroxide on the shear bond strength (SBS) of a luting resin to enamel. MATERIALS AND METHODS: Forty flat enamel surfaces were prepared from freshly extracted human molars using a low speed diamond saw, then divided into three bleaching groups (n=10/group) and a control group (n=10). Group 1 consisted of specimens bonded immediately after bleaching. Group 2 specimens were treated with an antioxidant agent, 10% sodium ascorbate, while Group 3 specimens were immersed in artificial saliva for 1 week after bleaching. Specimens in Group 4 were not bleached, but immersed in artificial saliva for 1 week before bonding. Forty ceramic blocks (Empress 2, Ivoclar) were prepared and luted to teeth using a dual-curing resin cement (Variolink II, Ivoclar). The specimens were thermocycled and the SBS tests were performed using a universal testing machine (crosshead speed: 0.5mm/min). Fracture analysis of the bonded surfaces was done using a scanning electron microscope. Statistical analysis was carried out by Kruskall-Wallis and Mann-Whitney U-tests. RESULTS: While the samples that were immediately bonded after bleaching (Group I) demonstrated significantly lower shear bond strengths and 10% sodium ascorbate group (Group II) demonstrated significantly higher bond strengths than control group samples (p<0.05), no significant differences were found among delayed bonded group and control group (p>0.05). CONCLUSION: Using sodium ascorbate with a concentration of 10% may be reliable for reversing the compromised bond strength.

Effect of an antioxidizing agent on the shear bond strength of brackets bonded to bleached human enamel.

INTRODUCTION: The purpose of this study was to investigate the effect of antioxidant treatment and delayed bonding on the shear bond strength of metal brackets bonded with composite resin to human enamel after bleaching with carbamide peroxide (CP). METHODS: Eighty recently extracted premolars were divided into an experimental group (n = 60), which was bleached with 10% CP, and a control group (n = 20), which was not bleached. The experimental group was further divided into 3 groups. Specimens in group 1 (n = 20) were bonded immediately after bleaching; specimens in group 2 (n = 20) were bleached, then treated with 10% sodium ascorbate, an antioxidant agent, and then bonded; group 3 specimens (n = 20) were bleached, then immersed in artificial saliva and held for 1 week before bonding. The specimens were debonded, and the enamel surfaces and bracket bases were examined with a stereomicroscope. The adhesive remnant index was used to assess the amount of resin left on the enamel surfaces after debonding. The shear bond strength data were subjected to 1-way analysis of variance. Multiple comparisons were performed with the Bonferroni test. The level of significance was established at P < .05 for all statistical tests. RESULTS: Shear bond strength of brackets bonded immediately after bleaching with 10% CP was significantly lower than that of brackets bonded to unbleached enamel (P < .05). No statistically significant differences in shear bond strength were noted when the antioxidant-treated and delayed bonding groups were compared with the control group (P > .05). CONCLUSIONS: Bleaching with 10% CP immediately before bonding reduces the bond strength of composite resin to enamel. Treating the bleached enamel surface with 10% sodium ascorbate or waiting 1 week reverses the reduction.

Effect of antioxidant on coronal seal of dentin following sodium-hypochlorite and hydrogen-peroxide irrigation.

PURPOSE: To reduce the microleakage of a self-etching priming dentin adhesive with the use of antioxidant or bur finishing after sodium-hypochlorite or hydrogen-peroxide irrigation. METHODS: 70 single-root canals were enlarged and seven different treatment protocols were applied throughout the root canal treatment: The roots in Groups 1, 2, and 3 were irrigated with sodium-hypochlorite. Group 1 was used as the negative control with only sodium-hypochlorite irrigation whereas in Group 2, sodium-ascorbate was applied as an additional irrigation agent following sodium-hypochlorite. Irrigation procedure in Group 3 was same as in Group 1, however, after the roots in this group were obturated, cavities were cleaned off with a carbide bur (bur-finishing) to remove the effect of sodium-hypochlorite. Hydrogen-peroxide irrigation was used in Groups 4, 5 and 6; the procedural steps were similar to those of Groups 1, 2 and 3: hydrogen-peroxide in Group 4, sodium-ascorbate application in Group 5, and bur-finishing in Group 6. Group 7 was the positive control with saline irrigation alone. All roots were obturated with Diaket sealer and gutta-percha cones using cold lateral condensation technique immediately after irrigation. A self-etching priming adhesive plus resin composite was applied after the endodontic treatment. The microleakage of dentin margins was determined using dye-penetration technique with clearing process. RESULTS: The Kruskal-Wallis followed by Mann-Whitney test showed that both sodium-hypochlorite and hydrogen-peroxide deteriorated the marginal seal of the dentin adhesive (P < 0.05), however, following both irrigation solutions the use of sodium-ascorbate reduced the microleakage (P < 0.05). Additionally, when sodium-ascorbate or bur-finishing was applied to remove the deterioration caused by sodium-hypochlorite or hydrogen-peroxide, the microleakage scores obtained were not different from that of the positive control (P > 0.05).

Reversal of dentin bonding to bleached teeth.

Many studies have shown a considerable reduction in enamel bond strength of resin composite restorations when the bonding procedure is carried out immediately after bleaching. These studies claim that a certain waiting period is needed prior to restoration to reach the original bond strength values prior to bleaching. This study determined the effect of anti-oxidant applications on the bond strength values of resin composites to bleached dentin. Ninety human teeth extracted for orthodontic purposes were used in this study. The labial surface of each tooth was ground and flattened until dentin appeared. The polished surfaces were subjected to nine different treatments: 1) bleaching with gel (35% Rembrandt Virtuoso); 2) bleaching with gel + 10% sodium ascorbate (SA); 3) bleaching with gel + 10% butylhydroxyanisole (BHA); 4) bleaching with sol (35% hydrogen peroxide); 5) bleaching with sol + 10% sodium ascorbate; 6) bleaching with sol + 10% BHA; 7) bleaching with gel + immersed in artificial saliva for seven days; 8) bleaching with sol + immersed in artificial saliva for seven days; 9) no treatment. After bonding application, the resin composite in standard dimensions was applied to all specimens. The teeth were stored in distilled water at 37 degrees C for 24 hours and a universal testing machine determined their resistance to shear bond strength. The data was evaluated using ANOVA and Duncan tests. Bond strength in the bleached dentin group significantly decreased compared to the control group. On the other hand, the antioxidant treatment had a reversal effect on the bond strength to dentin. After the bleaching treatment, the 10% sodium ascorbate application was effective in reversing bond strength. In the samples where antioxidant was applied after the bleaching process, bonding strength in dentin tissue was at the same level as those teeth kept in artificial saliva for seven days.