The Current State of Adhesive Dentistry - A Guide For Clinical Practice

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Volume 34, Special Issue 9
NOVEMBER/DECEMBER 2013
PROCEEDINGS FROM THE

5TH INTERNATIONAL
CONGRESS ON
ADHESIVE DENTISTRY
JUNE 14-15, 2013 | PHILADELPHIA, PENNSYLVANIA
CE Course | 2CEUs
The Current State of Adhesive Dentistry:

A Guide for Clinical Practice
Scientific Abstracts
Bonding to Tooth Structures
Bonding to Dental Materials
Dental Materials
Clinical Studies
Published by AEGIS Publications, LLC 2013

Compendium of Continuing Education in Dentistry and
Proceedings from the 5th International Congress on Adhesive
Proceedings from
Dentistry are published by AEGIS Publications, LLC.
Copyright 2013 by AEGIS Publications, LLC. All rights re-
the 5th International served under United States, International and Pan-American
Copyright Conventions. No part of this publication may be
Congress on reproduced, stored in a retrieval system or transmitted in

any form or by any means without prior written permission
Adhesive Dentistry from the publisher.
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The views and opinions expressed in the articles appearing in

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sarily reflect the views or opinions of the editors, the editorial
board, or the publisher. As a matter of policy, the editors, the
editorial board, the publisher, and the university affiliate do
not endorse any products, medical techniques, or diagnoses,
and publication of any material in this journal should not be
construed as such an endorsement.
WARNING: Reading an article in the Compendium of

Continuing Education in Dentistry and Proceedings from the
5th International Congress on Adhesive Dentistry does not nec-
essarily qualify you to integrate new techniques or procedures
2 CE Course into your practice. AEGIS Publications, LLC, expects its readers
to rely on their judgment regarding their clinical expertise and
The Current State of Adhesive recommends further education when necessary before trying
to implement any new procedure.
Dentistry: A Guide for Clinical Practice Printed in the U.S.A.
Francis K. Mante, DMD, PhD; Fusun Ozer, DDS, PhD; Ricardo
Walter, DDS, MSc; Alan M. Atlas, DMD; Najeed Saleh, DMD; PUBLISHER
AEGIS Publications, LLC
Didier Dietschi, DMD, PhD; and Markus B. Blatz, DMD, PhD
EDITOR
Catherine Paulhamus
10 Scientific Award Winning Abstracts PRODUCTION/DESIGN

Eileen Keough
12 Bonding to Tooth Structures

PRODUCTION MANAGER
Maureen Bruecks
SENIOR MANAGER, SPECIAL PROJECTS

28 Bonding to Dental Materials C. Justin Romano
jromano@aegiscomm.com
38 Dental Materials CEO

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47 Clinical Studies
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EXECUTIVE VICE PRESIDENT

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ONLINE EXCLUSIVE VICE PRESIDENT, PUBLICATIONS
View the Digital Edition to read these exclusive product profiles. Melissa J. Warner
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November 2013 Volume 34 Special Issue 9
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COVER TOOT H: MICHAEL BE R GLE R , M DT
The 5th International Congress
on Adhesive Dentistry
W
hether you believe in it or not, minimally training coursesfeatured over 30 of the most eminent leaders
invasive dentistry is now the center of and researchers in adhesive dentistry from around the world,
research and development in all areas sharing their latest, cutting-edge science and state-of-the-art
of modern oral healthcare, with dental clinics. Day 1 of the scientific program addressed the history,
adhesion and resin bonding as the biggest game changers in current state, and future of dental adhesion, with day 2 focusing
restorative dentistry. This new age of adhesive dentistry is limit- on adhesive restorative materials and treatment options. The
ing the need for retentive and invasive tooth preparations while program included a scientific corporate forum, where industry
providing highly esthetic and long-term functional restorations. leaders discussed their latest innovations and developments.
My own clinical focus has always been on treatment options The poster presentations were another clear highlight of the
that rely heavily on mechanical retention: fixed and removable congress. Research abstracts were selected based on their
prosthodontics. However, the more I learned about the intrica- scientific and clinical merit by the Scientific Advisory Board
cies of tooth bonding while researching the resin bond to for poster presentation at the IAD, and Scientific Awards were
modern ceramics, the more fascinated I became with the end- presented to the three most outstanding among them.
less possibilities and benefits of modern adhesive dentistry. This special issue of Compendium of Continuing Education
Most important, I learned that these concepts are not just in Dentistry features the Proceedings of the 5th IAD. First,
temporary fashions; they are validated by an overwhelming members of the Executive Board summarize the Current
amount of scientific evidence. State of Adhesive Dentistry in a continuing education ar-
Besides direct restorations with composites and other materi- ticle, followed by the research abstracts presented at the
als, some modern treatment optionssuch as laminate veneers, congress. These abstracts serve as invaluable indicators for
tooth-colored inlays/onlays, silicate ceramic crowns, and resin- current scientific knowledge and research trends, providing
bonded fixed-partial dentureswould not even be possible a unique opportunity for clinicians and fellow researchers to
without proper resin bonding. Today, we bond orthodontic get a glimpse of the state of the science in adhesive dentistry.
brackets to teeth, endodontic posts into root canals, crowns to Adhesive dentistry is no longer merely a treatment option;
implant abutments, composite and ceramic veneering materials it is an ethical imperative. Like dental implants and CAD/CAM
to metal and ceramic frameworks, and so on. Even our crown technology, it is here to stayfor the benefit of our patients. On
preparations have become significantly less invasive through behalf of the IAD Executive committee, our speakers, present-
adhesive cementation of advanced ceramic materials. ers, sponsors, and attendees, I invite you to open your mind
Fact is, our patients are getting older and keeping their and embrace the significant information presented at the 5th
natural teeth longer. We owe it to them to preserve tooth IAD. Enjoy the reading and join us in shaping the future of our
structure and prevent the need for full-coverage restorations beloved profession!
and prosthetic tooth replacement as much as possible.
As members of an academic institution, it is our responsibility Sincerely,
to understand and participate in the future of our profession. We
were, therefore, delighted when Professor Junji Tagami and the
Japanese Adhesive Society asked us to host The 5th International
Congress on Adhesive Dentistry (IAD). Close to 600 attendees
representing 20 countries joined the congress at the University Markus B. Blatz, DMD, PhD
of Pennsylvania in Philadelphia on June 14-15, 2013, marking the Chair and Professor of Preventive and
Restorative Sciences at Penn Dental Medicine
first time the IAD was held in the United States.
President of the 5th IAD and Head
The intense 2-day programpreceded by a day of hands-on of the Organizing Committee
www.compendiumlive.com Compendium 1
A Guide for Clinical Practice
FRANCIS K. MANTE, DMD, PHD; FUSUN OZER, DDS, PHD; RICARDO WALTER, DDS, MSC; ALAN M. ATLAS, DMD; NAJEED SALEH, DMD;
DIDIER DIETSCHI, DMD, PHD; AND MARKUS B. BLATZ, DMD, PHD
Abstract Learning Objectives

Adhesive dentistry is key to minimally invasive, esthetic, and tooth- After reading this article, the readers
preserving dental restorations. These are typically realized by bonding should be able to:
various restorative materials, such as composite resins, ceramics, or Discuss the use of composite resins for direct
even metal alloys, to tooth structures or other materials with composite restorations.
resin luting agents. For optimal bond strengths and long-lasting clinical Explain the nature of the adhesive resin bond
success, however, these material and tooth substrates require their to dental materials.
respective pretreatment steps, based on their natures and compositions. Describe the most common clinical problems
Today, dental adhesion is used in almost all dental specialties. This article with bonded indirect posterior restorations.
summarizes key aspects and guidelines for clinical success with adhesive
dentistry and summarizes information presented at the 5th International
Congress on Adhesive Dentistry.
Introduced to restorative dentistry in the mid 1950s,1 adhesion by matrix metalloproteinase (MMPs), which has been
to tooth structures and particularly dentin has evolved the recent focus of extensive research.6 Application of
significantly in recent decades. Yet, the complexity of the chlorhexidine, benzalkonium chloride, or the antibacterial
dentin substrate continues to challenge researchers in the monomer methacryloyloxydodecylpyridinium bromide to
development of the ideal dental adhesive system. One prevent such degradation has not proven effective in the
significant milestone was the introduction of the total-etch long term. Meanwhile, self-etch adhesives seem not to be
technique in the late 1970s.2 Despite initial concerns about affected by MMPs to the same extent, which may be due
potential damage of pulpal tissues by phosphoric acid, this to the fact that collagen is exposed to a lesser depth and is
technique is still used today. better infiltrated by the adhesive system. Self-etch adhe-
Current adhesive systems are divided into two main sives, particularly two-step systems, have shown excellent
categories: etch-and-rinse (total-etch) and self-etch (etch- bonding performance to dentin through implementation
and-dry). Etch-and-rinse systems comprise two or three of functional monomers such as 10-methacryloyloxydecyl
steps and typically involve the use of phosphoric acid dihydrogen phosphate (MDP), which provides some
pretreatment of the dentin with subsequent infiltration of chemical adhesion to hydroxyapatite. Without the use
the demineralized collagen to form a hybrid layer.3 Self- of phosphoric acid, however, the bondespecially to
etch systems are one- or two-step solutions of different pH uncut enamelmay be compromised.7 Therefore, self-
levels that interact with the tooth structures via functional etch adhesives are recommended particularly for cavities
monomers.4 Nakabayashi et al5 introduced the hybrid layer predominantly in dentin, while etch-and-rinse systems
concept in 1982: its formation and quality is key in the are preferred for indirect restorations and cavities that
establishment of proper adhesion. are mostly in enamel.7
Both concepts have advantages and disadvantages in The performance of bonding agents in the laboratory
different clinical situations. Phosphoric acid with etch- and even in controlled clinical trials may not necessarily
and-rinse adhesives not only removes the layer of debris translate to the clinical situation in the dental office. One
from tooth preparation (smear layer) but also opens the influencing factor is operator experience and familiarity
dentinal tubules and exposes the underlying collagen with a specific adhesive system.8,9 Recent multimode (uni-
mesh. Exposed dentinal tubules are sealed by the adhesive versal) adhesive systems may help minimize this problem
resin. However, neither acetone nor ethanolvehicles in as they can be used in both etch-and-rinse and self-etch
etch-and-rinse adhesive systemsprovide complete infil- modes. This feature can simplify the process and familiar-
tration of the demineralized dentin. The exposed collagen ize clinicians with new bonding systems.
fibrils may consequently suffer hydrolytic degradation Another key factor for the successful implementation of
2 November/December 2013 Volume 34 Special Issue 9

adhesive dentistry in clinical practice is the understanding Current trends suggest simplification of the placement
that any type of bonding surface contamination from technique with low-shrinkage-stress bulk-fill composite
saliva, blood, sulcus, or other fluids significantly affects resins.16,17 These new materials have varying properties
resin bonds in a negative way.10 Isolation of the operating and are often applied as flowable base materials veneered
field through use of a rubber dam or similar means is, with more viscous hybrid composite resins or inserted in
therefore, a necessity. 4-mm to 5-mm thick increments and cured in one step to
It is fair to say that the search for the ideal dental adhe- eliminate time-consuming layering techniques. To date,
sive system is ongoing. Based on the current literature, an scant evidence is available to validate material placement
adhesive should: 1) minimize phosphoric acid pretreatment in one layer. The recommended placement technique
of dentin and only require selective etching of enamel; 2) be continues to be small increments to allow for flow of the
a mild self-etch with a universal adhesive monomer such as composite material away from free space and toward a
MDP; 3) be solvent free; and 4) have antibacterial properties. bonded substrate.18 This technique ensures an optimal
conversion rate upon photopolymerization and a restora-
COMPOSITE RESINS FOR tion with superior physical properties.
DIRECT RESTORATIONS An advanced system for evaluating the clinical perfor-
Composite restorative materials have been steadily evolv- mance of contemporary composite materials and bonding
ing since R.L. Bowen introduced them in the last century.11 interfaces applies noninvasive, nondestructive, high-resolu-
Their applications include anterior and posterior restoration cross-sectional light-wave imaging technology called
tions both direct and indirect, and luting agents for all swept-source optical coherence tomography (SS-OCT).19,20
types of indirect restorative materials. With this technology, Nazari et al21 demonstrated superior
Patient demand for tooth-colored esthetic and minimally cavity adaptation of a new stress-decreasing composite
invasive restorations, as well as environmental concerns resin placed up to 3 mm in depth compared with conven-
about mercury, are slowly reducing the use of amalgam tional flowable composite.
for direct posterior restorations and replacing amalgam Rapid developments in resin composite technologies
with composite resin. and formulations have made direct composite restorations
However, questions remain about the clinical long-term highly predictable, as long as materials and application
performance of direct composite-resin restorations; clinical techniques are properly selected and applied.
trials to evaluate novel dental composites are expensive and
arduous to complete.11 Underperforming composite materi- THE ADHESIVE RESIN BOND
als, patient noncompliance, and operator error are main TO DENTAL MATERIALS
reasons for failure, leading to secondary caries, fracture, Composites
marginal deficiencies, wear, and postoperative sensitivity.12 Adhesion between two composite resin layers is achieved in
For anterior composite restorations, loss of retention is the presence of an oxygen-inhibited layer of the unpolymer-
no longer a main reason for failure, provided dependable ized resin. Successful bonding depends on establishing
adhesive systems are used correctly.13 Instead, marginal a surface with a high number of unreacted vinyl groups
deterioration and discoloration have become primary rea- (C=C) that can then be cross-polymerized to the resin in
sons for replacement. They are mainly caused by improper the bonding composite.22 Because already polymerized
adhesive technique, subgingival placement on root dentin composites contain fewer free radicals on their surfaces,
or cementum, overfinishing of the restoration, incorrect several methods have been suggested to improve the
material selection, and inadequate oral hygiene. compositecomposite adhesion. Surface roughening with
Posterior composite restorations are subject to greater airborne particle abrasion, etchants such as acidulated
failure due to masticatory forces, difficulty of placement, phosphate fluoride, hydrofluoric acid, or phosphoric acid
and secondary caries, especially in the long term.14 Caries with the use of intermediate adhesive resins (IARs) either
risk plays a significant role in restoration survival. A 12- in a silane and/or an adhesive system have been recom-
year prospective study concluded that large four- to mended. The preferred method is a combination of air
five-surface composite restorations have better survival abrasion, application of a silane coupling agent and an IAR.23
than amalgam restorations of the same size in patients
with low risk for caries.14 Patients at high risk for caries and Ceramics
bruxism have significantly higher failure rates in shorter The popularity of all-ceramic restorations has increased
periods than patients with low risk.15 The effect of oral significantly in recent years due to better esthetics and
hygiene and nutrition has not been sufficiently studied durability. The two major categories of all-ceramic materials
but may also play a significant role in restoration survival. are: silica-based (ie, feldspathic, leucite-reinforced, and
lithium disilicates) and non-silicabased (ie, zirconia or have to be considered. The bio-inert high-crystalline and
yttria stabilized zirconia, alumina) high-strength ceram- low-glass structure makes high-strength ceramics corrosion-
ics. The clinical success of either resin-bonded or repaired and acid-resistant, rendering adhesion protocols applied for
ceramic restorations depends on the quality and durability silica-based ceramics ineffective.26 The preferred surface
of the bond between the composite resin and ceramic. treatment method is air-particle abrasion with aluminum
This bond typically depends on the surface topography oxide, which removes loose contaminated layers, and the
of the substrate, surface energy, and chemical interaction roughened surface provides some degree of mechanical
with the resin.24 interlocking with the adhesive material. Application of
a special ceramic primer containing an acidic adhesive
Silica-Based Ceramics monomer such as MDP provides superior bond strengths to
Hydrofluoric acid (HF) etching followed by application air-abraded high-strength ceramic surfaces.26 Alternatively,
of a silane coupling agent is recommended for use with silica coating followed by silanization or chemical activation
glassy matrix ceramics.24,25 HF selectively dissolves the seems similarly successful.24,25
glass or weak crystalline components of the ceramic and The selective infiltration-etching technique by heat
produces a porous, irregular surface of increased wettabil- treatment has been recently proposed to improve zirconia
ity. Application of a silane coupling agent on the etched bonding. The surface is coated with a glass-containing
ceramic surface increases the chemical adhesion between conditioning agent (composed of silica, alumina, sodium
the ceramic and resin materials by coupling the silica (sili- oxide potassium oxide, and titanium oxide) and heated
con oxides) in glassy matrix ceramics to the organic matrix above its glass-transition temperature. After cooling, the
of resin materials by means of siloxane bonds. glass is dissolved in an acidic bath, creating a porous
Silica-based ceramics are brittle. Therefore, blunt surface and achieving promising bond strengths.27
surface-roughening methods such as air-particle abrasion
or grinding, which cause microcracks and may ultimately METAL-FREE ENDODONTIC POSTS
lead to fractures, should be avoided. The primary purpose of a post is to retain the coronal res-
A clinical example of a resin-bonded silica-based ce- toration in an endodontically treated tooth with extensive
ramic (porcelain laminate veneers) restoration is depicted loss of coronal structures. Prefabricated fiber-reinforced
in Figure 1 and Figure 2. polymer (FRP) posts have become very popular because of
satisfactory clinical results as well as reduction in treatment
High-Strength Ceramics time and cost.28,29 They are usually luted with resin cements
Alumina- (Al2O3) and zirconia-based (ZrO2) ceramics are to increase retention and mechanical performance of the
typically used for copings and frameworks that are veneered restored teeth while reducing the risk of root fracture.
with feldspathic porcelains or composites, full-ceramic The FRP posts are made of carbon or silica fibers sur-
restorations, or implant components due to their excellent rounded by a matrix of polymer resin, usually epoxy resin.
mechanical properties.24,26 The high strength allows for ce- Because fiber posts are passively retained in the root canal,
mentation with conventional cements. If adhesive bonding is the effectiveness of the adhesive cement and luting pro-
selected for final insertion, however, some unique properties cedure plays an important role. Ideally, the intracoronal
Fig 1. Preoperative intraoral view of failing composite res- Fig 2. Postoperative intraoral view after restoration of all
torations in the two maxillary central incisors. In addition, maxillary incisors with minimally invasive adhesively bonded
the patient was dissatisfied with the esthetics of the maxil- porcelain laminate veneers. Clinics by Dr. Markus B. Blatz;
lary incisors. dental technology by Cusp Dental Laboratory, Boston, MA.
1. 2.

dentin is treated with etch-and-rinse adhesives and eth-
ylenediaminetetraacetic acid (EDTA).30
The organic component of fiber posts, generally epoxy
resin, has a high degree of conversion and crosslinks.
This polymer matrix is virtually unable to react with the
monomers of resin cements.31 A silane coupling agent is
typically applied to the post surface to enhance adhesion.
The recently developed resin-based self-adhesive ce-
ments eliminate the multiple and technique-sensitive
tooth- and material-pretreatment steps. They have also
become popular for cementation of fiber posts.32 Self-
adhesive resin cements contain multifunctional hydrophilic
monomers with phosphoric acid groups, which can react
with hydroxyapatite and also infiltrate and modify the
smear layer. They can offer bond strengths comparable
to etch-and-rinse systems.
3.
METAL ALLOYS
The development of techniques for adhesion of composite
resins to metallic substructures has greatly expanded re-
storative treatment options. Early techniques relied solely
on mechanical retention of composite resin to the metal-
lic substrate through retentive perforations or meshes.33
Macro-mechanical retention techniques yielded unreliable
bond strengths, gap formation, and microleakage at the
bonding interfaces.34 Micromechanical retention tech-
niques began with pretreatment of metal-bonding surfaces
with air-particle abrasion,34 which became increasingly
successful when combined with resin cements containing
special adhesive monomers (MDP) to also provide true
chemical bonds.35 4.
Other efforts to improve metal-composite bonds have
included various etching techniques36 and acidic adhesive Fig 3. Diagrammatic illustration of a modern concept
monomers37 that chemically bond to oxides on base-metal for Indirect Adhesive Restorations in the Posterior,
alloys. The nonreactive surface of noble metal alloys pre- presented by Dr. Didier Dietschi. The different layers
indicate the concepts of dual bonding/immediate den-
sented a special challenge, which led to the development of
tin sealing (IDS), cavity design optimization (CDO), and
electrochemical plating of tin, oxidation, and acid pickling. cervical margin relocation (CMR).
Treating metal alloy surfaces with silica intermediates
Fig 4. Preoperative view of defective tooth-colored res-
and silane coupling agents began in 1984.38 Silica was torations. Improper adaptation and open margins neces-
introduced onto the metal surface from application of sitate replacement.
silicon dioxide (SiO2) in a flame. Other systems embed
silica-coated aluminum particles into the metal surface
through air-particle abrasion.39,40 The silica coat is then teeth are excellent examples of the significant develop-
treated with silane, which acts as a coupling agent be- ments and improvements that have been made in adhesive
tween the metal surface and resin. These techniques have dentistry, as they combine distinct clinical protocols with
proven successful to both base and noble metal alloys. modern adhesive technologies to tooth structures and indi-
Current development of adhesion to noble dental alloys rect dental materials. The most common clinical problems
has focused on the use of functional monomers, especially with bonded indirect posterior restorations include hard
those containing sulfur.41 Multifunctional adhesives for both tissue conservation (cavity design might lead to signifi-
noble and base metal alloys typically contain monomers cant loss of sound tissue), impression taking, and adhesive
with functional groups, such as sulfur, amino, and carboxyl, cementation (deep proximal preparations are a challenge
and have demonstrated high and durable bond strengths.42 and make working field isolation more difficult), as well
as provisional restorations. Conventional acrylic provision-
INDIRECT ADHESIVE RESTORATIONS als are time consuming and the cement contaminates the
IN POSTERIOR TEETH interface, while simplified soft light-curing provisionals
Bonded indirect tooth-colored restorations for posterior are lost easily and trigger sensitivity due to leakage. An
Fig 5. Situation after removal of the failing restorations.
Recurrent caries involved proximal areas, leading to ex-
tensive proximal cavities. The remaining enamel is very
thin or even absent along the cervical margins. A direct
approach is not indicated due to cavity dimensions, mar-
gin position, and dentin quality.
Fig 6. A curved metal matrix is placed and fitted pre-
cisely along cervical margins. A highly filled flowable
composite is applied to relocate the proximal margin
and fill all undercuts.
Fig 7. All cavities were lined (dentin bonding agent and
flowable composite). Enamel margins were refinished,
5. and cavities are ready for final impression.
6. 7.
original treatment protocol to overcome these problems

was introduced by Dietschi and Spreafico43 in 1998 and
includes four main concepts, which are illustrated in Figure
3 through Figure 10.
The first concept, dual bonding, relates to the substrate
treatment.44,45 It was later referred to as immediate dentin
sealing, which is to seal the dentin with a dentin bonding
agent after the cavity is isolated with a rubber dam.46 This
prevents further tissue dehydration and contamination,
and protects the tooth against sensitivity while improving
8.
bond strength and stability of the adhesive interface.47
Cavity design optimization (CDO)43 limits removal of
sound tooth structure during preparation by applying a
flowable composite liner to fill all undercuts and create an
ideal cavity geometry. The third concept, cervical margin re-
location (CMR),43,47 is applied for deep proximal preparations
(intrasulcular), which complicate impression taking and
cavity isolation during cementation. After placing a matrix, a
first layer of flowable or restorative composite is applied to
reposition the margin more coronally (Figure 6 and Figure
7). A highly filled flowable composite or low-shrinkage flow-
able base is recommended. Cementation is performed with
a light-cure composite rather than a dual-cure composite 9.
for optimal working time and control. Controlled adhesive
cementation (CAC) has major advantages in complex cavity
Fig 8. Pressed and stained lithium disilicate ceramic
designs. Combined with the CMR technique, visual margin
restorations on the master cast.
examination and proper cement removal are simplified. A
Fig 9. Cementation with a light-cure composite material
highly filled fine/microhybrid composite is recommended for
(typically a microhybrid).
cementation, and its viscosity is reduced during restoration

Fig 10. Definitive restora-
tions. The restorative ap-
proach ensures optimal
biologic and physical in-
tegration for predictable
and reliable results.
Clinics by Dr. Didier

Dietschi.
10.
placement with a special ultrasonic or sonic cementation tip. Alan M. Atlas, DMD
Clinical Professor, Department of Preventive and Restorative
Various studies have verified adequate light transmission
Sciences, University of Pennsylvania School of Dental
and conversion rates for light-cure composites underneath Medicine, Philadelphia, Pennsylvania
ceramic inlays/onlays with proper curing lights and expo-
sure times.48-50 The reduced restoration thickness (CDO Najeed Saleh, DMD
Professor of Clinical Restorative Dentistry, Director of
concept) supports proper light transmission.
Comprehensive Care Clinics, Department of Preventive and
These clinical concepts address the most frequent Restorative Sciences, University of Pennsylvania School of
difficulties with indirect adhesive restorations in the Dental Medicine, Philadelphia, Pennsylvania
posterior, leading to more predictable and improved
treatment outcomes.51-54 Didier Dietschi, DMD
Senior lecturer, Department of Cariology & Endodontics,
School of Dentistry, University of Geneva, Switzerland;
SUMMARY Adjunct Professor, Department of Comprehensive Dentistry,
Today, offering patients minimally invasive dentistry is not Case Western University, Cleveland, Ohio
just another treatment option, it is an ethical obligation.
Adhesive dentistry facilitates minimally invasive, esthetic,
Markus B. Blatz, DMD, PhD
Professor of Restorative Dentistry, Chairman of the Department of
and tooth-preserving dental treatment and applies to Preventive and Restorative Sciences, University of Pennsylvania
almost all dental materials and specialties. The various School of Dental Medicine, Philadelphia, Pennsylvania
tooth structures and dental materials, however, require
specific bonding protocols for long-term clinical success,
as discussed in this article. Adhesive techniques, technolo- References
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ANSWER SHEET
1. Self-etch adhesives are recommended particularly for 4. All-ceramic materials that are non-silicabased include: 8. The preferred surface treatment method for alumina-
cavities predominantly in: A. feldspathic. B. leucite reinforced. and zirconia-based ceramics is:
A. dentin. B. enamel. C. lithium disilicates. D. zirconia. A. rinse with silane.
C. cementum. D. deciduous teeth. B. rinse with hyaluronic acid.
5. Hydrofluoric acid etching followed by application of C. rinse with phosphoric acid.
2. Adhesion between two composite resin layers is a silane coupling agent is recommended for what type D. air-particle abrasion with aluminum oxide.
achieved in the presence of an: of ceramics?
A. oxygen-inhibited layer of the polymerized resin. A. pressed B. high density 9. Metal-free endodontic posts are usually luted with:
B. oxygen-inhibited layer of the unpolymerized resin. C. low density D. glassy matrix A. ZnPO4 B. glass ionomer.
C. oxygen-enriched layer of the polymerized resin. C. resin cements. D. eugenol.
D. oxygen-enriched layer of the unpolymerized resin. 6. Silica-based ceramics are:
A. compliant. B. brittle. 10. Cavity Design Optimization limits removal of sound
3. Successful bonding depends on establishing a surface C. elastic. D. slightly flexible. tooth structure during preparation by applying what to fill
with a high number of unreacted: all undercuts and create an ideal cavity geometry?
A. vinyl groups. 7. Alumina- and zirconia-based ceramics are typically A. a hybrid glass ionomer
B. calcium carbonate molecules. used for copings and frameworks that are: B. IRM
C. esterine polymers. A. out of occlusion. B. veneered. C. a flowable composite liner
D. hydroxyapatite chains. C. subgingival. D. supragingival. D. calcium hydroxide
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SCIENTIFIC AWARD WINNING ABSTRACTS
1ST PLACE
Non-destructive Non-staining 3D Analysis of Marginal and Internal Microgaps

SADR A*, SHIMADA Y, BISTA B, BAKHSH TA, SUMI Y, TAGAMI J.
*Tokyo Medical and Dental University, Japan
OBJECTIVES: The objective of this work was to (3D) visualize marginal and internal gaps using optical coherence tomography (OCT). MATERIALS AND METHODS: Tapered cylindrical cavities (diameter
of 3 mm, depth of 2 mm) were prepared on flattened occlusal surfaces of molars and treated with the two-step self-etch adhesive Clearfil SE Bond (CSE, Kuraray); or all-in-one adhesives Clearfil S3
Bond Plus (S3P, Kuraray), G-aenial Bond (GCB, GC), or Xeno V (XNV, Dentsply). Preparations were bulk-filled with low-viscosity composite (Estelite Flow Quick, Tokuyama). After 24 h, the specimens
were scanned using swept-source dental OCT (Prototype-II, Panasonic Health Care). 3D image segmentation was performed in Avizo software (VSG). Depth-dependent interfacial binary thresholds
were defined to overcome OCT signal attenuation while detecting the defects. Quantitative 3D comparisons were performed by calculating the proportion of sealed interface. RESULTS: Enamel
interfacial microgaps were observed in the form of detached areas extending from external margins towards internal walls that only occasionally continued into dentin walls. The majority of
dentin microgaps were detected as interconnected areas of debonding at the pulpal floor extending towards the bottom-third of the walls. These areas were rarely in continuation with the external
marginal gaps. Smaller isolated patches of interfacial defects were less frequently observed through the dentin interface. Overall, the following order was observed in sealed area CSE=S3P>GCB>XNV.
Cross-sectional microscopy showed adhesive-composite detachment at the bottom with all-in-one adhesives. CONCLUSIONS: 3D analysis of microgaps without dye penetration suggested that
debonding of external margins and gaps at the pulpal floor under high-C factor occurred independently. Some all-in-one adhesives showed short-term results compared to the gold-standard
two-step self-etch. CLINICAL SIGNIFICANCE: OCT enables non-destructive evaluation of marginal and internal microgaps potentially providing new means of producing evidence at clinical trials.
2
3
QCM-D Analysis of Chemical Adsorption Monomers Interaction to Collagen Studied
N
R
D
D
PL
PL
of Functional-monomer with HAp Sensor by Saturation Transfer Difference NMR
A
A
C
C
E
E
TAKAGAKI T*, NIKAIDO T, MATSUI N, SATO T, TAGAMI J. HIRAISHI N*, OTSUKI M, TAGAMI J.
*Tokyo Medical and Dental University, Japan *Tokyo Medical and Dental University, Japan
OBJECTIVES: It has been previously reported that the functional monomer, 10-methacry- OBJECTIVES: The interaction of adhesive monomers with collagen is not well understood at
loxydecyl dihydrogen phosphate (MDP), chemically binds to hydroxyapatite (HAp). This study a molecular/atomic level. The saturation transfer difference NMR spectroscopy is a power-
investigated the chemical adsorption of four different functional monomers on HAp. MATERIALS ful method in drug delivery studies for screening ligands for their binding to proteins and
AND METHODS: Quartz crystal microbalance with dissipation (QCM-D, Q-Sense) was used to to determine the ligand binding epitopes. The objective of this study was to examine the
measure the amount of functional monomer adsorbed on the HAp sensor in real time. Four molecular/atomic level interactions of dental resin monomers with collagen model. MATERIALS
different functional monomer solutions containing 0.1% functional monomer (MDP, 4-META, AND METHODS: Saturation transfer difference NMR experiments were performed to investigate
GPDM or Phenyl-P), 2% ethanol and 8 mM HEPES were prepared (pH adjusted to 7.0 with the binding interaction of three adhesive monomers:2-Hydroxyethyl methacrylate (HEMA),
NaOH). Frequency change and the shift of energy dissipation were recorded at a flow rate of 4-methacryloyloxyethyl trimellitate anhydride (4-META) and 10-methacryloyloxydecyl dihy-
1 ml/min. The QCM-D chamber and liquid samples were temperature-stabilized to 37.00.1 C. drogenphosphate (MDP), with atelocollagen as a triple-helical peptide model. The ligands
Each of the four functional monomer solutions was injected after frequency and dissipation HEMA, 4-META and MDP were dissolved in deuterated dimethyl sulfoxide (d6-DMSO) to 20
became stable with the control solution without functional monomer. After the reaction was mM and each one was added to the atelocollagen solution. Final concentration for saturation
completed, the control solution was again injected to wash the unreacted functional monomer transfer difference NMR measurement was 4 mM. NMR experiments were performed at 298
on the HAp surface. RESULTS: Immediately after injection of the functional monomer solutions, K on 600 MHz and 800 MHz spectrometers equipped with a cryogenic probe (Bruker BioSpin
the HAp-sensor frequency dropped significantly in all the groups. In the MDP group, along Corporation). When the saturation transfer difference effect was detected, its epitope mapping
with the frequency drop, energy dissipation shifted sharply and even after the wash with the of ligands binding to atelocollagen was obtained by normalizing the largest value to 100%.
control solution. The frequency shift was leveled at a fixed position. Frequency change and RESULTS: High saturation transfer difference intensities were detected on the protons in MDP,
the shift of energy dissipation were material-dependent and depended on the design of the whereas they were not detected for HEMA and 4-META. The STD epitope mapping revealed that
monomer structures. CONCLUSIONS: The adsorption behaviors of the functional monomers the intense saturation transfer difference signals were primarily associated with the aliphatic
on HAp varied depending on the molecular structure. CLINICAL SIGNIFICANCE: The chemical region in MDP. CONCLUSIONS: The results imply that MDP has a relatively stable interaction with
adsorption of chemical monomers on HAp, particularly MDP, may potentially improve the the collagen, because of the hydrophobic interactions between the hydrophobic MDP moieties
bonding interface and reduce the risk of secondary caries. and the collagen surface. HEMA and 4-META have not such hydrophobic regions and no intense
saturation transfer difference signals were observed. CLINICAL SIGNIFICANCE: The hydrophobic
moiety allows the MDP monomer to form the monomer-collagen aggregate and may control
collagen degradation, which accounts for the stable property of hybrid layers.

BONDING TO TOOTH STRUCTURES
Antimicrobial Activity and Dentin Bond Strength of Adhesive Systems

ANDRE CB*, GOMES BPFA, MAGESTE T, STIPP RN, CHAN DCN, GIANNINI M
*State University of Campinas, Brazil
OBJECTIVES: To evaluate the microtensile bond strength (MTBS) and the antibacterial activity of three commercial bonding agents (Gluma 2 Bond/Heraeus Kulzer, Clearfil SE Protect/Kuraray and
Peak Universal Bond/Ultradent) against oral pathogens (Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis and Lactobacillus casei). MATERIALS AND METHODS: For antibacterial
activity (AA), 2% chlorhexidine solution was used as positive control and physiological saline solution as negative control. Bonding agents and control groups were inserted in sterilized plastic
cylinders and positioned on inoculated agar plate (n=5). After incubation according to the appropriate periods of time for each microorganism, the inhibition zones were measured. Data were
analyzed using one-way ANOVA and Tukey test (=0.05). For MTBS test, occlusal enamel of human third molars was removed to expose the dentin surface. The adhesives were applied according
to manufacturers recommendations and restored with Filtek Supreme (3M ESPE). Teeth (10/group) were sectioned to obtain specimens (10-12/tooth) with cross sectional area of 1.0 mm2 and then
tested in a universal testing machine (EZ-Test, Shimadzu) at 0.5 mm/min after artificial saliva storage for one week (half of the specimens) and one year (remaining specimens). RESULTS: were
evaluated using two-way ANOVA and Tukey post-hoc (=0.05). RESULTS: Clearfil SE Protect and 2% chlorhexidine solution produced inhibition zones against all oral pathogens tested, while Gluma
2 Bond and physiological saline solution did not form inhibition zone. Peak Universal Bond showed higher MTBS than Clearfil SE Protect for both evaluation times, and Gluma 2 Bond did not differ
among them. Water storage for one year did not reduce the MTBS. CONCLUSIONS: The AA and the MTBS were material dependent. Storage time had no effect on the MTBS. CLINICAL SIGNIFICANCE:
Clearfil SE Protect may be a better alternative in restorative procedures performed on dentin, considering its better AA and stable MTBS. Supported by FAPESP (2010/13599-0 and 2011/17841-2).
Incorporation of Proanthocyanidin into a Effects of Dentin Treatments on Bond Strength

Two-step Self-etch Adhesive of Etch-and-Rinse Adhesives
FANG M*, DOU Q, LIU RR, TANG CF, CHEN JH. CAMPOS EA*, SARAIVA JA, PICCIONI MA, NEVES TPC, TONETTO MR, KUGA MC.
*Fourth Military Medical University School of Stomatology, China *Universidade Estadual Paulista, Brazil
OBJECTIVES: Our previous studies demonstrated that proanthocyanidin (PA), a type of natural OBJECTIVES: The aim of this study was to evaluate the use of ethanol and chlorhexidine as
crosslinker, might increase dentin bond strengths of etch-and-rinse adhesives and enhance different surface conditioners on the microshear bond strength to dentin of two-step etch-and-
the stability of the bonded interface. This study aimed to investigate the effect of different rinse adhesive systems. MATERIALS AND METHODS: For this study, 64 sound human molars were
PA incorporation manners on the bonding performance of a two-step self-etch adhesive. selected. The occlusal surfaces of the teeth were removed with a low-speed diamond saw to
MATERIALS AND METHODS: PA was either mixed with ethanol to prepare pre-conditioners or expose flat dentin surfaces. Different two-step etch-and-rinse adhesive systems (Adper Single
incorporated into Clearfil SE primer (Kuraray), at different concentrations (0% - control, 1%, 3%, Bond 2, 3M ESPE; and OptiBond Solo Plus, Kerr) were applied on the previously etched dentin
and 5%). The optimal pre-conditioning time and the effects of the different pre-conditioners (phosphoric acid 35%), after one of the following dentin treatments: dentin saturated with
and primers on the degree of conversion (DC) of Clearfil SE Bond (Kuraray) were evaluated water; dentin impregnated with chlorhexidine in water; dentin impregnated with chlorhexidine
using FTIR. Then dentin-bonded specimens were prepared from 18 freshly extracted molars in ethanol; and dentin saturated with ethanol. Afterwards, transparent cylindrical tubes were
using Clearfil SE Bond with either PA pre-conditioner or PA-incorporated primer, and subjected placed on the dentin surface and were filled with a composite resin. After photoactivation
to microtensile bond strength (TBS) testing. Debonded specimens and bonded interfaces for 20 s, the tubes were immediately removed to expose the composite resin cylinders with
were observed under FE-SEM. One-way and two-way ANOVA, as well as Tukeys post hoc cross-sectional area of 0.38 mm2. After a storage period of 24 h in water at 37C, the specimens
test were used for statistical analyses. RESULTS: PA incorporation produced no significant were fitted with a device for microshear bond strength testing with a loading speed of 0.5 mm/
changes to DC, except when incorporated into Clearfil SE primer at a concentration of 5%. min. The differences between groups were determined using ANOVA and Tukeys test. RESULTS:
No statistically significant improvement in immediate TBS and quality of hybrid layer were There was no statistical difference between the etched dentin treatments when the adhesive
noticed in both incorporation manners, however, a trend towards improvement could be seen Adper Single Bond 2 was used. For Optibond Solo Plus, higher values were observed in the
in concentrations up to 3%. CONCLUSIONS: Pre-conditioning the dentin with PA/ethanol primers groups treated with pure ethanol and ethanol combined with chlorhexidine. CONCLUSIONS: It
or PA-incorporated Clearfil SE primer did not affect DC or TBS of Clearfil SE Bond significantly, was possible to conclude that ethanol may increase the immediate values of bond strength,
except when PA was added at a concentration of 5% to Clearfil SE primer (lower DC). CLINICAL depending on the adhesive system. Chlorhexidine did not alter the immediate microshear
SIGNIFICANCE: Self-etch adhesives might benefit from the addition of PA to their formulations, bond strength of the materials used in this study. CLINICAL SIGNIFICANCE: Ethanol added to
considering its potential cross-linking effect. (Funded by Natural Science Foundation of China the dentin prior to the adhesive can improve the immediate dentin bond strength of two-step
No.81000458 and No.81130078) etch-and-rinse adhesive. FAPESP Grant 2011/20271-3.

Effects of Phosphoric Acid Etching on Fatigue of correction was used for SFL data. RESULTS: Results in MPa are shown in the tables. Lowercase
Self-etch Adhesives and uppercase superscript letters show statistical differences in columns and rows, respectively.
CONCLUSIONS: Fatigue limits of enamel bonds increased when using phosphoric acid. On the
TAKAMIZAWA T*, BARKMEIER WW, TSUJIMOTO A, TSUBOTA K, LATTA MA, MIYAZAKI M. other hand, fatigue limits of dentin bonds tended to decrease in the phosphoric acid treated
*Nihhon University, Japan
groups. CLINICAL SIGNIFICANCE: Phosphoric acid etching prior to application of the self-etch
OBJECTIVES: To examine the effects of phosphoric acid etching on shear bond strengths (SBS) adhesives may have an adverse effect on dentin bond durability.
and fatigue limits of bonding. MATERIALS AND METHODS: Three self-etch adhesives, OptiBond
Enamel SBS (SD) SBS (SD) SFL (SD) SFL (SD) Ratio SFL/SBS Ratio SFL/SBS
XTR (Kerr), Scotchbond Universal (3M ESPE), and G-aenial Bond (GC) were selected for this H3PO4 w w/o w w/o w w/o
study. Fifteen specimens in each group were used to determine initial SBS to human enamel XTR 48.1 (6.1)a,A 29.8 (3.0)a,B 25.1 (1.8)a,A 17.8 (1.9)a,B .522 .597
and dentin, with or without phosphoric acid etching (37.5 %, 15 s) prior to application of the SU 46.4 (5.4)ab,A 28.4 (3.8)a,B 21.7 (2.3)b,A 12.9 (1.5)b,B .468 .454
adhesive. A staircase method of fatigue testing (25 specimens for each test) was then used GB 42.0 (3.5)b,A 28.1 (4.0)a,B 19.6 (4.8)b,A 12.8 (1.1)b,B .467 .456
with an ElectroPuls E1000 machine (Instron) to determine the shear fatigue limit (SFL) of
Dentin SBS (SD) SBS (SD) SFL (SD) SFL (SD) Ratio SFL/SBS Ratio SFL/SBS
composite (Z100) bonded to enamel and dentin using 10 Hz frequency for 50,000 cycles. A H3PO4 w w/o w w/o w w/o
stainless steel metal ring with an inner diameter 2.4 mm was used to bond composite to flat XTR 41.5 (7.7)a,A 50.8 (4.9)a,B 22.2 (5.9)a,A 25.3 (3.7)a,A .535 .498
ground (4000 grit) tooth surfaces for determination of both SBS and SFL. A two-way ANOVA and SU 40.8 (6.7)a,A 42.6 (4.0)b,A 17.6 (1.4)b,A 20.3 (2.7)b,A .431 .477
Tukeys post hoc test were used for analysis of SBS data and a modified t-test with Bonferoni GB 25.1 (3.0)b,A 27.3 (2.7)c,A 11.5 (2.8)c,A 15.9 (2.2)c,B .458 .582
Microleakage-free Restorations to Dentin: Bond Strengths of Self-etch Adhesives

Our Goal in Adhesive Dentistry to Acid-exposed Dentin
NAKABAYASHI N. RIKUTA A*, YOSHIDA F, FURUICHI T, YOKOKAWA M, MIYAZAKI M.
Tokyo Medical Dental University Institute of Biomaterials Bioengineering, Japan *Nihon University School of Dentistry, Japan
OBJECTIVES: Demineralized dentin is a defective and weak substrate. This study evaluated OBJECTIVES: This study examined the influence of acid exposure on dentin bond strengths
tensile bond strength and microleakage of an adhesive resin when applied to human dentin of single-step self-etch adhesives. MATERIALS AND METHODS: Three adhesives, BeautiBond
treated with different acid etch techniques. MATERIALS AND METHODS: Dentin was etched with (BB, Shofu), Fluoro Bond II (FB, Shofu) and Fluoro Bond Shake One (SO, Shofu) were used.
3% ferric chloride in 10% citric acid (10-3) for 10, 30, or 60 s; or with 10% phosphoric acid for 10 s Adper Single Bond Plus (SB, 3M ESPE) served as control. Bovine mandibular incisors were
(10P/10)(n=6). PMMA rods were bonded with the adhesive cement 5% 4-methacryloyloxyethyl mounted in self-curing resin, and wet ground with #600 silicon carbide paper to expose the
trimellitate anhydride (4-META) dissolved in MMA polymerized by partially oxidized tri-n- labial dentin. The dentin surfaces were treated with acidic solution (0.75 mM CaCl2 2H2O,
butyl borane in the presence of PMMA powder. The PMMA-to-dentin tensile bond strengths 0.1 M lactic acid buffer solution containing 0.45 mM KH2PO4, pH 4.75), and after 10 min and 7
were measured on mini-dumbbell specimens (2.0 x 3.0 mm bonded area). SEM was used
2
days of treatment, bond strength specimens were made using each adhesive. The adhesives
to investigate failure modes. For microleakage analysis, the samples were soaked in basic were applied according to the respective manufacturers instructions. After light irradiation
fuchsine dye (n=12). RESULTS: There were significant differences (p<0.05) in bond strength and of the adhesives, resin composites were condensed into a mold (4 mm in diameter, 2 mm in
microleakage between 10-3/10 and remaining groups. Mean (SD) bond strengths of test groups height) and polymerized. Ten samples per test group were stored in distilled water at 37C
were: 10-3/10 23.9 (5.5), 10-3/30 13.9 (1.7), 10-3/60 12.0 (1.5), 10P/10 14.6 (5.0) MPa. Specimens for 24 h, and then shear tested at a crosshead speed of 1.0 mm/min. Data were evaluated
fractured cohesively in impermeable hybridized dentin in the 10-3/10 group while the remaining using one-way analysis of variance followed by Tukeys Honestly Significant Difference test
test groups showed cohesive failures in demineralized dentin. There was no microleakage in (=0.05). RESULTS: Dentin bond strengths varied according to the acid exposure treatment
10-3/10 specimens while microleakage was observed in 10-3/30, 10-3/60, and 10P/10 groups. even though no differences were found for SO and SB. BB and FB, on the other hand, showed
CONCLUSIONS: Dumbbell-shaped specimens are reliable to measure tensile bond strength, as bond strengths varying from 15.3 (control) to 10.7 MPa (7 days of treatment) and 16.3 to 12.1
uniform stress can be given on the bonded specimens. In this study, dumbbell specimens MPa, respectively. Those differences were statistically significantly different. CONCLUSIONS:
were very beneficial to identify existence of permeable demineralized dentin, which was the Adhesive systems are affected differently when bonded to acid-exposed dentin. CLINICAL
weakest area in bonded specimens and detachment occurred at the defect (demineralized SIGNIFICANCE: Influence of acid exposure on dentin bond strengths of the single-step self-etch
dentin). Microleakage was only found at permeable demineralized dentin. Impermeable adhesives tested was material-dependent. Care should be taken when selecting the material
hybridized dentin did not permit diffusion of the dye, which is important for the durability of for bonding to acid-exposed dentin.
dental restorations. CLINICAL SIGNIFICANCE: The adhesive/application protocol 10-3/10 seems
to be clinically reliable in regards to bonding and prevention of microleakage.
Comparison of a Universal Adhesive with Contemporary Adhesives

BYUN CH*, JANG JH, KIM DS.
*Kyung Hee University Graduate School of Dentistry, Korea
OBJECTIVES: The purpose of this study was to compare the bond strength of a universal adhesive to that of etch-and rinse and self-etch contemporary dental adhesives. MATERIALS AND METHODS:
Extracted molars had their occlusal surfaces removed and were ground with 320-grit silicon carbide paper to expose flat dentin surface. Specimens were then allocated to be treated with:
three-step etch-and-rinse adhesive Optibond FL (Kerr), two-step etch-and-rinse adhesives One-Step Plus (Bisco) and Adper Single Bond Plus (3M ESPE), two-step self-etch adhesive Clearfil
SE Bond (Kuraray), and universal adhesive All-Bond Universal (Bisco) in both etch-and-rinse and self-etch modes. After adhesives application following the manufacturers instructions, 4-mm
composite build-ups were incrementally placed in 2-mm increments. After 24 h of storage in water, 20 composite-dentin beams of 1 mm2 were obtained for each adhesive. Microtensile bond
strength (TBS) was measured at a crosshead speed of 1 mm/min. Results were analyzed using Kruskal-Wallis and Tukeys post-hoc test at 95% significance level. RESULTS: Mean TBS for each
group was 35.19.9a for All-Bond Universal in the etch-and-rinse mode, 31.56.9a for Optibond FL, 27.38.6a,b for Adper Single Bond Plus, 27.24.7a,b for All-Bond Universal in the self-etch mode,
23.75.7b for Clearfil SE Bond, and 23.44.2b for One-Step Plus. CONCLUSIONS: Significant differences in TBS were only found between All-Bond Universal in the etch-and-rinse mode and Clearfil
SE Bond and One-Step Plus. Other materials had intermediate TBS. CLINICAL SIGNIFICANCE: Within the limitations of this study, the universal adhesive All-Bond Universal may be an acceptable
alternative for dentin-bonded restorations, despite of the application mode.
Dentin Bonding Efficacy of HEMA-containing Bond Strengths and Microleakage of Composites

and HEMA-free Self-etch Adhesives Bonded with Novel Adhesives
WANG XY*, NAKAJIMA M, MAMANEE T, HOSAKA K, TAGAMI J. SISO SH*, BAYRAK I, DONMEZ N.
*Peking University School and Hospital of Stomatology, China *Bezmialem Vakif University Faculty of Dentistry, Turkey
OBJECTIVES: For one-step self-etch adhesives, residual water content in oxygen inhibition layer OBJECTIVES: To evaluate microtensile bond strength (MTBS) and microleakage of composites
of the adhesives may compromise co-polymerization of the adhesive-composite interface, bonded with novel adhesives. MATERIALS AND METHODS: The occlusal surfaces of eight caries-free
leading to impaired bond strength to dentin. This study evaluated the effects of additional human third molars were sectioned and mid dentin was prepared (600-grit silicon carbide paper)
air-drying after curing of the adhesive and light-irradiation intensity through resin composite for MTBS. Teeth were allocated to be treated with the following adhesive agents: Adper Single
on dentin bonding of HEMA-containing and HEMA-free adhesives. MATERIALS AND METHODS: Bond Universal (etch-and-rinse/self-etch, 3M ESPE) + Filtek Z550 (3M ESPE); and All-Bond Universal
Two HEMA-containing adhesives, Clearfil Tri-S Bond (Kuraray-Noritake) and Clearfil SE ONE (etch-and-rinse/self-etch, Bisco) + Aelite All-Purpose (Bisco). Restored specimens were subjected
(Kuraray-Noritake), and one HEMA-free adhesive, BeautiBond Multi (Shofu) were applied to to thermocycling (1,000 cycles, 5-55C, 30 s dwell time) prior to being sectioned into beams (n=15)
dentin surfaces according to manufacturers instructions and light-cured for 10 s. The cured for MTBS. For microleakage experiments, Class V preparations (n=8) with coronal margins in enamel
adhesive surface was further air-dried with strong air pressure for 20 s or not. Then a resin and cervical margins in cementum were prepared on the buccal and lingual surfaces of premolars
composite with translucent shade (Clearfil Majesty, Kuraray-Noritake) was placed (2 mm in and restored according to the previous groups. Extra groups of Adper Single Bond Universal and
height) and light-cured with a light intensity of 350 mW/cm or 600 mW/cm for 20 s. After
2 2
All-Bond Universal were used in selective-etch mode and also evaluated for microleakage. After
24 h of water storage, specimens were cut into beams and the bond strengths to dentin were thermocycling (performed as previously described), teeth were immersed into 2% basic fuchsin
determined using the microtensile bond strength test (TBS) at a crosshead speed of 1 mm/ solution for 24 h. Teeth then were sectioned and dye penetration (microleakage) was evaluated
min. Data were statistically analyzed using three-way ANOVA and T-test (p<0.05). RESULTS: under stereomicroscope using 0-3 ordinal grading scale. Data were analyzed by Kruskal-Wallis
Mean (SD), n=15. Different superscript letters show statistical differences within rows (p<0.05). and Dunns tests at 0.05 level of significance. RESULTS: Different uppercase letters show statistical
CONCLUSIONS: Additional air-drying and light irradiation intensity affected TBS. Effects were differences within column (MTBS) and lowercase letters show statistical differences within rows
material-dependent. CLINICAL SIGNIFICANCE: Additional air-drying after curing of the adhesive (microleakage). CONCLUSIONS: Adper Single Bond Universal showed the highest MTBS and the
may improve the bond strength of HEMA-free adhesives to dentin. That may be explained by least microleakage when used in the etch-and-rinse mode. CLINICAL SIGNIFICANCE: Adper Single
the potential removal of water content in the oxygen inhibition layer. Bond Universal may be a good alternative for bonding to enamel and dentin.
Microleakage
Adhesive Application mode MTBS
350 mW/cm2 600 mW/cm2 Enamel Dentin
Air-dried Not air-dried Air-dried Not air-dried Etch-and-rinse 32.84.1A 0.810.98a 1.311.07b
Clearfil Tri-S Bond 40.4 (8.9)a 42.3 (5.8)a 40.2 (5.2)a 44.3 (10.7)a Adper Single Bond Universal Self-etch 24.12.1B 1.310.70a 2.180.98b
Clearfil SE ONE 35.1 (4.1)a 34.6 (6.5)a 41.9 (9.6)b 47.1 (6.9)b Selective etch - 2.310.79a 2.060.99a
BeautiBond Multi 35.1 (3.5)a 30.8 (4.9)b 35.4 (5.2)a 30.1 (5.3)b Etch-and-rinse 24.63.5B 1.251.12a 3.000.00b
All-Bond Universal Self-etch 28.72.8AB 1.681.07a 2.930.25b
Selective etch - 0.621.08a 3.000.00b

Bonding to Deproteinized Enamel and Dentin of AI Mouse Models
PUGACH MK*, OZER F, MULMADJI R, LI Y, KULKARNI AB, BARTLETT JD, GIBSON CW, LINDEMEYER RG.
*Forsyth Institute, USA
OBJECTIVES: Patients with amelogenesis imperfecta (AI) show varying degrees of success with bonded resin restorations. Mouse models have been developed to mimic different forms of AI.
This study compared the effect of deproteinization of enamel and dentin with NaOCl on shear bond strength (SBS) in mouse incisors mimicking two different AI variants using a self-etching
adhesive (SE). MATERIALS AND METHODS: Mandibular incisors were dissected from four-week old wild-type (WT), amelogenin null (AmelxKO) and matrix-metalloproteinase-20 null (Mmp20KO)
mice (n=24/group). The facial surfaces of incisors were polished flat with 800-grit SiC paper and composite inlay sticks (1.0 mm X 0.4 mm) were bonded to enamel surfaces with SE (Clearfil SE
Bond, Kuraray), with or without 5% NaOCl pretreatment for one minute. For the dentin bond strength, the enamel surfaces of samples were ground and the composite inlay sticks were bonded
with the SE to flat dentin surfaces. SBS was measured using a micro-shear tester with a crosshead speed of 0.5 mm/min. Data were analyzed using 2-way ANOVA. RESULTS: SBS of AmelxKO teeth
was similar in dentin and enamel, however, SBS in MMP20KO was higher in dentin. Treatment of AmelxKO, Mmp20KO and WT enamel surfaces with NaOCl did not significantly improve enamel
bond strength (p>0.05), although SBS of SE was slightly increased for WT and AmelxKO and slightly decreased for Mmp20KO. CONCLUSIONS: We have developed a novel system for testing SBS in
mouse incisors with AI variants. NaOCl pretreatment did not improve SBS of SE to AI-affected enamel surfaces. CLINICAL SIGNIFICANCE: In certain types of AI, enamel deproteinization may not be
an effective method for improving bonding performance and in some cases dentin bonding may be a better option.
An All-in-one Adhesive for Dry Bond Strength of Newly Developed

and Moist Tooth Conditions One-step Adhesive Systems
UNO S*, ABO T, SUYAMA Y, MORIGAMI M, SUGIZAKI J, YAMADA T. HANABUSA M*, AKIMOTO N, MOMOI Y.
*Toranomon Hospital, Japan *Tsurumi University School of Dental Medicine, Japan
OBJECTIVES: In clinical situations, moisture control is one of the crucial matters for adhesive OBJECTIVES: The purpose of this study was to evaluate the bond strength of newly developed
techniques. This study aimed to develop an all-in-one adhesive available for both dry and moist adhesive systems. MATERIALS AND METHODS: Occlusal enamel of non-carious extracted human
tooth conditions. MATERIALS AND METHODS: An experimental all-in-one adhesive (Youdent) was molars was removed with a diamond saw and the dentin surfaces were prepared with 600-grit
designed for this project. The major components were phosphoric acid monomers, Bis-GMA and sic paper. Three different systems were tested: primefil (Tokuyama Dental) consisting of
ethanol/acetone/water solvents. Bovine incisors were polished with #600 SiC paper to expose self-etching primer and proprietary flowable resin composite, Fusio (Pentron) self-adhesive
flat enamel and dentin surfaces. The teeth were divided into dry and moist groups (n=6). In flowable resin composite, and the one-step adhesive Bond Force (Tokuyama Dental) along with
the dry group, surfaces were strongly air-dried for 5 s before the adhesive was applied. In the flowable resin composite Estelite Flow Quick (Tokuyama Dental). The materials were applied
the moist group, surfaces were wet with 0.05 L of saliva-contaminated solution and then according to manufacturers instructions. Forty-five samples from 5 teeth were prepared for
air-dried with a mild stream of air for 5 s. The adhesive was applied onto the surface, thinned each system. After 24-h storage in distilled water at 37 C, microtensile bond strength testing
with a mild stream of air, and light activated for 10 s. A resin composite build up was placed (bonded area 1.0 x 1.0 mm, crosshead speed = 1.0 mm/min) was performed using a universal
onto the surface and light-cured for 30 s. Tensile bond strengths to moist and dry enamel and testing machine (Instron 4443, Instron). Data were analyzed by ANOVA and Tukeys test (=0.05).
dentin were measured after storage in water for 24 h. RESULTS: The tensile bond strengths to RESULTS: The mean microtensile bond strength values S.D. were 28.4 11.3 mpa for primefil,
enamel and dentin were: Dry group: 21.63.8 MPa and 20.32.0 MPa, respectively; and moist 3.4 5.2 mpa for Fusio, and 29.6 10.0 mpa for Bond Force. CONCLUSIONS: The microtensile
group: 21.61.8 MPa and 21.06.1 MPa, respectively. Statistical analysis revealed no significant bond strength of primefil was significantly higher than that of Fusio but not different than that
difference among groups (p>0.05). CONCLUSIONS: It was concluded that the experimental of Bond Force. CLINICAL SIGNIFICANCE: Under the limitations of this study, we can conclude that
all-in-one adhesive might be useful for both moist and dry conditions. CLINICAL SIGNIFICANCE: primefil is comparable to Bond Force in regards to their bond strengths to dentin.
The adhesive containing ethanol, acetone, and water as solvents is hardly influenced by
moisture condition of the tooth.
Elemental Analysis of the Resin-Dentin Interface Using TOF-SIMS

KIRIHARA M*, INOUE G, NIKAIDO T, TAGAMI J, MOMOI Y.
*Tsurumi University School of Dental Medicine, Japan
OBJECTIVES: The acid-base resistant zone (ABRZ), a structural layer formed at the tooth-bonding interface, has been confirmed by the previous studies. Thickness of the ABRZ is influenced by the
concentration of NaF in the adhesives. It has been difficult to determine, however, how deep the fluoride ion penetrates into dentin from a fluoride-releasing adhesive. The objective of this study
was to perform elemental analysis of the resin-dentin interface using time-of-flight secondary ion mass spectrometer (TOF-SIMS) for fluoride ion detection. MATERIALS AND METHODS: Experimental
adhesives with three different concentrations of NaF (0, 50 and 100 wt%) (F0, F50 and F100) were prepared based on the formulation of a commercially available adhesive (Clearfil Protect Bond,
F100, Kuraray Noritake Dental). Human molar dentin surfaces were ground with #600-grid SiC paper and the prepared teeth allocated to be treated with the adhesive systems. Specimens were
stored in water for 24 h, sectioned, embedded and ultrathin sectioned with a glass knife (sections were vertical to the interface). Specimens were analyzed using TOF-SIMS (Bi ion beam source,
25 kV, ToF-SIMS300, ION-TOF), focusing on fluoride ion. RESULTS: From the results of area analysis, fluoride ions were not detected in F0, but detected around the adhesive-dentin interface in F50
and F100 as an approximately 5 m-thick band on the dentin side of the interface. There was not obvious difference in the appearance between F50 and F100. CONCLUSIONS: TOF-SIMS is a useful
device to detect fluoride ion penetration into dentin at the resin-dentin interface. In F50 and F100, fluoride ions penetrating into dentin were detected up to 5 m from the interface. CLINICAL
SIGNIFICANCE: Fluoride released from fluoride-releasing adhesives may penetrate several microns into the dentin structure. Grant-in Aid from the Japan Society for the Promotion of Science No.
22592116 and 22791827.
Bond Strengths of Two Adhesives with Added The Role of MDP in a Two-step Self-etching
Bioglass to Dentin Bonding Agent
BAUER JRO*, CARNEIRO KK, CARVALHO CN, MEIER MM, LOGUERCIO AD, MARTINELLI JR, MANSO AP, CARVALHO RM. MATSUI N*, TAKAGAKI T, NIKAIDO T, ICHINOSE S, IKEDA M, TAGAMI J.
*Federal University of Maranho, Brazil *Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan
OBJECTIVES: To evaluate the effects of adding Niobium-Phosphate (Nb-P) glass on the micro- OBJECTIVES: The purpose of this study was to evaluate the role of a functional monomer,
tensile bond strength (TBS) of One-Step (OS, Bisco) and Prime & Bond 2.1 (PB, Dentsply) to 10-methacryloyloxydecyl dihydrogenphosphate (MDP), contained in the bonding resin of
dentin. MATERIALS AND METHODS: The Nb-P glass was produced by fusing NbO5, Na2CO3, CaO, a two-step self-etch adhesive system. MATERIALS AND METHODS: Clearfil SE Bond (Kuraray
and (NH4)2HPO4 at 1400C, cooled, and ground to average particle size < 25 m. The glass was Noritake Dental) contains MDP in both the primer and the bonding resin (MM). An experimental
further either silanated or not with - Methacryloxypropyltrimethoxysilane. It was then mixed adhesive containing MDP only in the primer was prepared (M0). For the microtensile bond
with OS and PB at a 40% (w/w). Forty-eight human molars had the occlusal surfaces prepared strength (TBS) testing, the adhesives were applied onto exposed flattened human dentin
flat and bonded in six different groups: OS without glass (control), OS with 40% non-silanated surface and a resin composite was placed. After the bonded specimens were thermocycled
glass, OS with 40% silanated glass, PB without glass (control), PB with 40% non-silanated glass, (0, 5000, and 10000), they were sectioned for the TBS testing. Additional specimens were
and PB with 40% silanated glass. Composite build-ups were placed and the specimens were prepared in similar manner for transmission electron microscopy (TEM) observation. After 24-h
stored for 24 h in water at 37C prior to preparation for TBS testing at 0.5 mm/min. The fracture water storage, the bonded specimens were divided into two groups. In one group, specimens
mode was recorded. Data were analyzed by one-way ANOVA and Bonferroni test (=0.05) for were subjected to ammonical silver nitrate and photo-developed for nanoleakage analysis. The
each adhesive. RESULTS: The addition of Nb-P glass caused significant decrease of TBS for other group was not subjected to ammonical silver nitrate and photo developing. Following,
OS regardless of silanation (p<0.001). No significant effects were observed for PB (p>0.05). All acid-base challenge was performed by exposing the specimens to a demineralization solution
groups showed a predominance of adhesive failure mode. Results are shown below in MPa. (pH 4.5) for 90 min and then 5% NaOCl for 20 min. The adhesive-dentin interface was observed
CONCLUSIONS:The results suggest that the effect of Nb-P filler addition was material dependent. by TEM. RESULTS: The TBS of MM was higher than that of M0 after 24 h. However, the TBS
CLINICAL SIGNIFICANCE:The addition of 40% of Nb-P bioactive glass to etch&rinse adhesive of MM significantly decreased after thermocycling, while that of M0 was stable. In the TEM
systems is desirable but may result in changes in the quality of bond for some materials. observations, the ABRZs were observed in both MM and M0. The mineral density of the ABRZ
in M0 was higher than in MM except for the forefront area, in which only MM was highly
Adhesive Control (no glass) 40% silanated 40% non-silanated dense. Nanoleakage expression at ABRZ was similar in both groups. CONCLUSIONS: MDP in the
One-Step 43.315.0 a 34.411.4 b 35.010.6 b
adhesive agent may adversely affect the dentin bonding durability. However, MDP may play
Prime & Bond 2.1 25.513.9A 28.112.1A 30.514.0A
an important role in apatite protection at the ABRZ forefront. CLINICAL SIGNIFICANCE: MDP may
be helpful protecting the bonded interface.

Adhesion of HEMA-free Adhesive Systems to Dentin

*BACELAR-SA R, BEDRAN-RUSSO AK, NIKAIDO T, TAGAMI J, AMBROSANO GMB, GIANNINI M.
*Campinas State University Piracicaba School of Dentistry, Brazil
OBJECTIVES: To evaluate the microtensile bond strength (MTBS), the morphology of resin-dentin interfaces (RDI) and failure mode of adhesive systems containing HEMA (HC) and HEMA-free (HF)
to dentin. MATERIALS AND METHODS:The following adhesives were tested: Adper Single Bond Plus (SB, 3M ESPE - HC), All Bond 3 (AB, Bisco - Adhesive Resin is HF), G-aenial Bond (GA, GC Corp. - HF)
and BeautiBond (BB, Shofu - HF). Forty human third molars were used (n=10). The adhesives were applied according to the manufacturers instructions and a Filtek Z350 XT (3M ESPE) resin block
(6-mm high) was incrementally built-up. After 24 h, the teeth were prepared for MTBS test. The adhesive interface and failure modes were evaluated under scanning electron microscopy. Failure
mode was classified as cohesive within the dentin, cohesive within the composite resin and adhesive along the composite-adhesive layer interface (AI). MTBS data were analyzed by one-way
Anova and Tukeys test (=5%). RESULTS: The mean MTBS (SD) to dentin were (MPa): SB - 47.4 (5.1)b, AB - 57.7 (4.3)a, GA - 21.5 (7.6)c, BB - 22.7 (3.0)c. The majority of the failures occurred at the
AI (SB - 87%, AB - 65%, GA - 94%, BB - 100%). The GA and BB adhesives presented thin hybrid layer and short resin tags compared to SB and AB. CONCLUSIONS: AB presented the highest mean
MTBS, which was significantly higher than the other groups. The MTBS of GA and BB also were significantly lower than that of SB. All groups showed AI as the predominant type of failure. The
morphology of RDI influenced MTBS. CLINICAL SIGNIFICANCE: The adhesive category (etch-and-rinse vs. self-etch, one- vs. two- vs. three-step) is more crucial than the composition of the bonding
agent (e.g., HEMA content) regarding bond strengths. Support by FAPESP (#2011/11415-1 and # 2012/19023-8), Brazil.
Shear Bond Strength of Modern Self-etch Shear Bond Strength of Two New Self-etch
Adhesives to Tooth Adhesives Containing MDP
*IRIE M, TANAKA J, MATSUMOTO T, MARUO Y, NISHIGAWA G, YOSHIYAMA M. *YESILYURT C, ALP C.K, AKDAG MS, YILDIRIM T.
*Okayama University, Japan *Karadeniz Technical University Faculty of Dentistry, Turkey
OBJECTIVES: One of the major concerns with composite restorations is their ability to achieve OBJECTIVES: The addition of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) to adhesives
effective initial bonding. The purpose of this study was to evaluate, at the initial stage, the is claimed to increase both enamel and dentin bond strengths. Recently, All-Bond Universal
shear bond-strength (SBS) of seven self-etch adhesives to enamel and dentin. MATERIALS AND (Bisco) and Scotchbond Universal (3M ESPE) adhesives were launched as self-etch adhesives
METHODS: The surfaces of polished enamel and dentin (# 1,000) were treated with Scotchbond containing MDP. The aim of this study was to evaluate and compare the shear bond strength
Universal (3M ESPE), OptiBond XTR (Kerr), All-Bond Universal (Bisco), G-aenial Bond (GC), (SBS) of those adhesives to enamel and dentin. MATERIALS AND METHODS: Ninety-six flat
BeautiBond Multi (Shofu), TOKUYAMA EE-BOND (Tokuyama Dental), and Clearfil SE Bond (Kuraray bonding sites were prepared on either enamel (n=48) or dentin (n=48) on freshly extracted
Noritake) following manufacturers instructions. A split Teflon mold with a cylindrical hole human third molars, using 600-grit silicon carbide paper. Both enamel and dentin samples
(diameter 3.6 mm; height 2 mm) was clamped to the prepared enamel and dentin surfaces were divided into four groups (n=12) according to the following adhesive systems: All-Bond
and filled with Clearfil AP-X (Kuraray Noritake). SBS were measured immediately after light- Universal, Scotchbond Universal, Clearfil SE Bond (Kuraray) and Clearfil S3 Bond (Kuraray). Each
activation or after 24-h storage in water (37C). Statistical analyses were performed by t-Test adhesive system was applied to the prepared sites according to manufacturers instructions.
(p<0.05). RESULTS: Mean SBS (SD) in MPa for n=10 is shown in the table. Different uppercase Immediately, a build-up of Filtek Z250 (3M ESPE) was placed. After 24 h of storage in water,
letters show statistically significant differences between immediate and 24 h SBS, within each SBS was determined in an Instron tester (0.5 mm/min). The data were statistically analyzed
substrate. CONCLUSIONS: After 24 h, SBS to enamel and to dentin increased significantly for using one-way ANOVA, post hoc Tukey HSD, and Students t-test (=0.05). RESULTS: Different
many SEA groups. CLINICAL SIGNIFICANCE: A post-cure interval of 24 h resulted in improved superscript letters in the same column are significantly different. CONCLUSIONS: The one step
adhesive behavior of composite restorations to enamel and to dentin. self-etch adhesives containing MDP demonstrated lower bond strengths in both enamel and
dentin compared to Clearfil SE Bond (not statistically significant to Scotchbond Universal in
Enamel Dentin enamel). CLINICAL SIGNIFICANCE: The recently developed universal adhesives may not perform
Immediate 24 h Immediate 24 h
as well as Clearfil SE Bond. Clinical and in vitro data with aged specimens are needed.
Scotchbond Universal 16.5 (3.5)A 21.6 (6.1)B 21.0 (6.5)A 25.8 (4.4)A
OptiBond XTR 16.3 (2.8)A 30.8 (6.3)B 17.1 (3.7)A 28.7 (5.2)B
Adhesive system Enamel (MeanSD) Dentin (MeanSD)
All-Bond Universal 10.6 (3.6)A 18.5 (5.5)B 14.4 (3.6)A 13.9 (3.7)A
All-Bond Universal 15.744.3 a 6.41.2 a
G-aenial Bond 19.9 (4.8)A 23.8 (5.5)A 15.3 (3.5)A 20.8 (4.8)B
Scotchbond Universal 19.354.7 ab 19.74.5 b
BeautiBond Multi 20.4 (4.4)A 25.9 (2.9)B 20.9 (5.0)A 26.1 (6.5)B
Clearfil SE Bond 23.884.1 b 26.475.5 c
Tokuyama EE-Bond 17.9 (2.0)A 22.3 (5.0)B 15.9 (3.1)A 21.8 (2.9)B
Clearfil S3 Bond 17.254.0 a 18.73.7 b
Clearfil SE Bond 23.2 (5.1)A 31.5 (5.7)B 25.0 (5.3)A 32.0 (6.5)B

Comparison of Bond Strengths of Self-adhesive Composite and Self-etch Adhesives
JOO SH*, SON HH, CHOI KK, KIM DS.
*Kyung Hee University Graduate School of Dentistry, Korea
OBJECTIVES: The aim of this study was to evaluate bond strengths of a self-adhesive composite and three contemporary self-etch adhesives to dentin. MATERIALS AND METHODS: Sixty recently
extracted molars were selected and randomly divided into four groups (n=15): Clearfil SE Bond (Kuraray), Xeno V (Dentsply), Adper Easybond (3M ESPE), and Vertise Flow (Kerr). Flat dentin
surface was exposed and polished. Adhesive systems were applied according to manufacturers instructions and a composite build-up (Z250 A2, 3M ESPE) of 2 mm was condensed into a mold
and light-cured. Vertise Flow was bonded directly to dentin without any surface treatment. Shear bond strength (SBS) was measured using a universal testing machine (EZ-Test, Shimadzu,
Japan). Bonded interfaces also were analyzed with transmission electron microscope (TEM). RESULTS: SBS (MPaSD) of each group was as follows: Clearfil SE Bond: 19.25.0a, Xeno V: 13.05.4b,
Adper Easybond: 19.22.9a, Vertise Flow: 4.03.2c. TEM analysis showed a homogenous adhesive layer and resin tag formation was observed in Clearfil SE Bond, Xeno V, and Adper Easybond
groups. Differently, a non-homogenous adhesive layer was observed in the Vertise Flow group. CONCLUSIONS: The SBS value of Clearfil SE Bond and Adper Easybond were higher than that of
Xeno V and Vertise Flow (p<0.05). The Vertise Flow group showed the lowest SBS (p<0.05). The non-homogenous adhesive layer in the Vertise Flow group might partially explain its low bond
strength. CLINICAL SIGNIFICANCE: This study showed that the bond strength of a new self-adhesive flowable composite was significantly lower than that of self-etch adhesive systems. Its clinical
use should be carefully considered.
Remineralization Assessment of Adhesive with Polymerization Shrinkage and Bond Strength of

Simulated Pulpal Fluid Using Micro-CT Low-shrink Dental Composites
JOVES GJ*, INOUE G, HAMBA H, NIKAIDO T, TAGAMI J. SUN X*, LI YC, XIONG J, CHEN JH.
*Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan *Fourth Military Medical University School of Stomatology, China
OBJECTIVES: This study aimed to evaluate the effect of an MDP-containing self-etch adhesive OBJECTIVES: This study was designed to determine whether low shrink composites exhibit better
system on remineralization of artificial caries-affected dentin (ACAD) under the simulated bonding performance to human dentin than conventional dimethacrylate-based composites.
pulpal fluid condition by using a micro-computed tomography (Micro-CT). MATERIALS AND MATERIALS AND METHODS: Four dimethacrylate-based composites and one silorane-based
METHODS: The ACAD model was created from crowns of human premolars. The root was cut composite with corresponding adhesive systems were investigated: Adper Easy Bond-Z350
and remaining pulpal tissue was carefully removed. Crown segments were attached to a pulpal (AE-Z350, 3M ESPE), Xeno III-TPH (XE-TPH, Dentsply DeTrey), Clearfil S3-Clearfil Majesty (S3-CM,
pressure (PP) device to simulate pulpal fluid pressure (11 mm Hg). A MDP-containing two-step Kuraray), Clearfil SE Bond-experimental composite (SE-SOC, Kuraray), and Filtek Silorane system
self-etch adhesive system, Clearfil SE Bond (SE, (Kuraray Noritake Dental) was applied to the (SA-FS, 3M ESPE). Polymerization volumetric shrinkage and stress development were measured
surfaces of sound dentin and ACAD according to the manufacturers instructions. A hybrid resin using micro-CT and universal testing machine. Microtensile bond strength (TBS) of the self-etch
composite (Clearfil AP-X, Kuraray Noritake Dental) was used for coronal build-up. Immediately, adhesive systems to mid coronal flattened dentin was also measured. RESULTS: The volumetric
24 h and 1 month after incubation of the specimens, the signal x-ray penetration intensity shrinkage of the resin composite/adhesive combinations ranged from 1.16% (SA-FS) to 3.48%
profiles of dentin below the adhesive interface was measured by using a micro-CT system (XE-TPH) when measured 30 min after light curing. SA-FS and SE-SOC had the lowest volumetric
to estimate the mineral density. For the 1-month incubation specimens, the simulated pulpal shrinkage (P<0.05). Those were statistically lower than S3-CM, AE-Z350, and XE-TPH, which
fluid was changed weekly. RESULTS: There was no difference in signal x-ray intensity among were different between each other. The polymerization stress of the materials ranged from
the incubation periods in the sound dentin group. However, higher signal x-ray intensity was 1.34 (SA-FS) to 3.46 MPa (S3-CM). Similar to volumetric shrinkage, SA-FS and SE-SOC showed
detected within the first 100 m depth from the interface after 24 h and 1 month than that significant lower polymerization stress at 30 min (P<0.05). Those were followed by AE-350,
detected immediately in the ACAD specimens. CONCLUSIONS: The ACAD model could be partially which presented polymerization stress statistically lower than XE-TPH and S3-CM (not different
remineralized using an MDP-containing self-etch adhesive system under simulated pulpal fluid between each other). TBS testing revealed no differences in bond strength among the different
condition. CLINICAL SIGNIFICANCE: The MDP-containing self-etch adhesive system has positive composites/adhesive systems (P>0.05). CONCLUSIONS: The silorane and experimental (SOC)
effects on remineralization of caries-affected dentin. This research was supported partly by the composites exhibited excellent characteristics of low volumetric shrinkage and stress develop-
Grant-in-Aid for Scientic Research (No. 22791827) from the Japan Society for the Promotion ment compared to conventional dimethacrylate-based composites. However, no differences
of Science, and partly from the Global Center of Excellence Program, International Research in the TBS were observed. CLINICAL SIGNIFICANCE: The silorane and the experimental (SOC)
Center for Molecular Science in Tooth and Bone Diseases at Tokyo Medical and Dental University. composites tested may result in better marginal adaptation and fewer undesirable side effects
as a consequence of shrinkage. Funded by Natural Science Foundation of China No. 30801309.
Bonding Performance of Self-adhesive Resin Cement on Contaminated Dentin Surfaces

YAMAN BC*, OZER F, TIRYAKI M, IRMAK O, BLATZ MB.
*Eskisehir Osmangazi Faculty of Dentistry, Turkey
treatment increased bond strengths of SAC to dentin. CONCLUSIONS:Bond strength values of
OBJECTIVES: This study evaluated the effect of saliva, blood or mixed contamination on shear SAC were significantly affected by SC, BC and MC. However, treatment of contaminateddentin
bond strength of the self-adhesive resin cement Clearfil SA (SAC, Kuraray) to dentin surfaces with Clearfil SE primer improved bonding. CLINICAL SIGNIFICANCE: Clearfil SE primer application
with or without primer application. MATERIALS AND METHODS: Forty non-carious human molar to dentin surfaces is advisable to get optimum bonding performance with SAC.
teeth were sectioned mesio-distally below the cemento-enamel junction to obtain 2-mm thick
dentin slabs. All slabs were further sectioned mesio-distally and bucco-lingually and embedded
in acrylic resin leaving occlusal dentin surfaces uncovered. The dentin surfaces were abraded
with #600 SiC paper and contaminated with saliva (SC), blood (BC) or mixture (MC) of both. MeanSD
G1: No contamination 6.21.1b
The primer (P) of Clearfil SE adhesive system (Kuraray) was used in the primer-treated groups.
G2: No contamination + primer 22.92.2d
Groups were treated as follows: G1: No contamination; G2: No contamination + P; G3: SC; G4: SC
G3: Saliva contamination 1.80.5a
+ P; G5: BC; G6: BC + P; G7: MC; G8: MC + P. After contamination/treatment, cylindrical composite G4: Saliva contamination + primer 19.33.3c
resin samples (2.1 mm in diameter, 3 mm in height) were bonded to dentin surfaces with SAC in G5: Blood contamination 1.20.5a
a special alignment apparatus under a load of 1,000 g. Shear bond strengths were measured. G6: Blood contamination + primer 19.13.6c
The results were analyzed with two-ANOVA and Tukeys HSD. RESULTS:Bond strengths were G7: Mixed contamination 1.10.2a
G8: Mixed contamination + primer 17.53.1c
significantly reduced by contamination of dentin in all groups (p<0.05). However, primer
Resin-dentin Bond Strength of an Influence of Oxygen-inhibited Layer on

Experimental Resin Cement Bond Strength of Chemical-cured Resin
KAWANO S*, KADOWAKI Y, FU J, HOSHIKA S, NAKAOKI Y, SANO H. KUROKAWA H*, YAMAJI A, TSUJIMOTO A, MIYAZAKI M.
*Hokkaido University, Japan *Nihon University School of Dentistry, Japan
OBJECTIVES: To evaluate the microtensile bond strength (TBS) between an experimental resin OBJECTIVES: To determine the influence of oxygen-inhibited layer on the surface free energy
cement and dentin. MATERIALS AND METHODS: Eighteen human molars were used. The teeth of one-step self-etch adhesives and on the bond strength of chemical-cured resin composite.
had their occlusal surfaces flattened to obtain dentin and resin cements [ECD-90 (experimental, MATERIALS AND METHODS: Materials used were the self-curing resin composite Clearfil F II
Tokuyama Dental Corp.), Clearfil Esthetic Cement EX (EC, Kuraray Dental), and Panavia 2.0 (PF, (Kuraray) and the one-step self-etch adhesive systems Bond Force (Tokuyama), Clearfil Tri-S
Kuraray Dental)] were applied in one 4-mm increment. All cements were either light activated Bond (Kuraray), and G-Bond Plus (GC). Adhesives were applied to flattened bovine dentin,
prepared under ambient light and activated with halogen light following manufacturers irradiated with light, and the oxygen-inhibited layer was either retained or removed with
instructions or allowed to set without light activation performed in a darkroom without ethanol. Surface free energy was determined by measuring the contact angles of three test
using halogen light curing. Bonding procedures were performed following manufacturers liquids placed on the cured adhesives. The resin composite was mixed, condensed into a Teflon
instructions. After water storage at 37C for 24 h, teeth were sectioned to obtain beams with mold, and allowed to set fro 10 min. Finished specimens were transferred to distilled water
a bonded area of 1.0 mm2. Specimens were tested in a universal testing machine at a 1.0 mm/ and stored for 24 h until shear bond strength testing (crosshead speed of 1.0 mm/min). Data
min crosshead speed. Data were analyzed with ANOVA and Games-Howell method (p<0.05). were analyzed by Students t-test and Tukeys HSD test. RESULTS: Values of the estimated
RESULTS: Two-way ANOVA indicated a significant interaction of resin cements and polymeriza- surface tension component SLW were relatively constant for all surfaces. Values for the S+
tion conditions. The mean TBS values (MPa) of specimens that were light activated were: 50.2 component increased slightly when the oxygen-inhibited layer was removed, whereas those
15.4 for ECD-90, 29.5 9.7 for EC, and 38.2 13.7 for PF. The following results were achieved of the S component decreased significantly. Bond strength of the chemical-cured resin
for specimens not exposed to light during setting of the resin cement: 48.7 17.2 for ECD-90, composite was significantly higher in specimens without an oxygen-inhibited layer than in
12.3 3.9 for EC, and 15.1 9.1 for PF. In both conditions, the TBS of ECD-90 was significantly those with an oxygen-inhibited layer. CONCLUSIONS: The results indicate that the absence
higher than that of the other two resin cements (p<0.05). The mean TBS values of specimens of an oxygen-inhibited layer in one-step self-etch adhesives promotes higher dentin bond
prepared with light activation were statistically higher than those not exposed to light (p<0.05). strength for the chemical-cured resin composite. CLINICAL SIGNIFICANCE: In clinical situations,
CONCLUSIONS: The TBS of the experimental resin cement, ECD-90, was statistically higher polymerization type of resin composites and adhesives should be understood to get optimum
than that of commercial resin cements. CLINICAL SIGNIFICANCE: In situations where adhesion bonding to the tooth structure.
is critical during cementation, ECD-90 might result in better clinical performance compared
to commercial resin cements.

Bonding Ability of Flowable and Universal Composites in Cervical Restorations
MARUYAMA S*, MASEKI T, NARA Y.
*The Nippon Dental University School of Life Dentistry at Tokyo, Japan
OBJECTIVES: To compare the bonding ability of a flowable and a universal resin composites in cervical restorations, in vitro. MATERIALS AND METHODS: Standardized Class V cavities (V-shaped, ~4.2
mm in width and 3.4 in height) with occlusal and gingival margins in enamel and dentin, respectively, were prepared in the cervical region of 30 extracted human lower premolars. The adhesive
system Adper Single Bond Plus (3M ESPE) was applied to the cavities according to the manufacturers instructions. Preparations were restored with the flowable resin composite Filtek Supreme
Ultra Flowable Restorative (FLOW, 3M ESPE) or the universal resin composite Filtek Supreme Ultra Universal Restorative (ULTRA, 3M ESPE). Preparations were bulk-filled. Restored specimens were
fixed in a multiple function apparatus and subjected to a combination of stress simulating oral environment, thermocycling (5-55C 200 cycles), and simultaneous repeated load (12 kgf 104
cycles). Each specimen was vertically sectioned into two slabs of 1.0 mm in thickness and the slabs were trimmed into standardized dumbbell-shaped specimens. Microtensile bond strength
(TBS) was measured at a crosshead speed of 1.0 mm/min. The data were analyzed using Students t-test and Weibull analysis. RESULTS:Mean TBS in MPa/Weibull modulus values were 30.1/2.9
for FLOW and 24.4/1.2 for ULTRA. There was no difference between mean TBS. However, the Weibull modulus of FLOW was significantly greater than that of ULTRA (p<0.01). The estimated TBS
(13.8 MPa) of FLOW at 10% probability of failure level was statistically greater than the value (3.4 MPa) for ULTRA (p<0.01). CONCLUSIONS:The bonding ability of FLOW to Class V preparations was
significantly superior. CLINICAL SIGNIFICANCE: The flowable resin composite Filtek Supreme Ultra Flowable Restorative seems to be a better restorative option than the universal resin composite
Filtek Supreme Ultra Universal Restorative for cervical restorations.
Bonding of Flowable Composites to Cavity-floor Influence of Irradiation Distance on

Dentin after Thermomechanical Aging Dentin Bond Strength
OZER F*, YAMAN B, BASHLLARI A, BLATZ MB. YOSHIKAWA K*, MATSUDA T, IWATA N, YAMAMOTO K.
*University of Pennsylvania School of Dental Medicine, USA *Osaka Dental University, Japan
OBJECTIVES:To evaluate the bond strengths of flowable composites and a self-etch adhesive OBJECTIVES: With the promotion of treatment based on the minimally invasive concept,
system to the cavity floor of high C-factor Class I cavities after thermomechanical aging. composite resins have increasingly been used for Class II restorations. However, it may not
MATERIALS AND METHODS: Eighteen standard (5 x 3 x 3 mm) box-type Class I cavities were always be possible to place the tip of the light curing unit close to the restorative material
prepared on extracted non-carious human mandibular third molars following the removal of resulting in irradiation in a diagonal direction or at a distance, which may compromise proper
occlusal cusps. The teeth were then divided into three test groups of six teeth each: Group 1: polymerization of deep Class II cavities. This study examined the influence of irradiation
Adhesive [FL Bond II (FLB)] + flowable composite [Beautiful Flow Plus F03 (FP03)] + composite distance on tensile bond strength (TBS) during composite resin restorations using the Elipar
resin [Beautiful II (BII)]; Group 2: FLB + BII; and Group 3: FLB + bulk-fill flowable composite S10 LED (3M ESPE) and the halogen light XL3000 (3M ESPE). MATERIALS AND METHODS: Extracted
[Beautiful Flow Plus F00 (FP00)]. The samples were submitted to thermal (5-55 C x 2,000) bovine teeth had their buccal surfaces ground to expose dentin and then polished up to #600
and mechanical cycling in a chewing simulator (50 N x 50,000). All specimens were sectioned silicon carbide paper. The composite resin Clearfil AP-X (Kuraray) was bonded with the bonding
perpendicular to the adhesive-tooth interface to obtain rectangular 1 mm x 1 mm micro- system Clearfil SE Bond (Kuraray). The light irradiation distance was set to 0, 5, 10, 20, and 30
specimens and subjected to microtensile bond strength test (MTBS). Obtained data were mm. The bonding agent was polymerized for 10 s and the composite resin for 20 s. TBS was
analyzed with ANOVA and Tukeys test. RESULTS: results are presented in the table. Same measured after 24-h water storage at 37C. The results obtained were statistically analyzed using
superscript letters indicate no significant difference (p<0.05). N=6. CONCLUSIONS: The restoration one-way analysis of variance and Scheffes test at the significance level of 1%. RESULTS: Results
technique and choice of composite play an important role in adhesion of resin-based restorative (meanSD) are presented in the table. Different superscript letters show statistical differences
materials, in particular in high C-factor cavities. CLINICAL SIGNIFICANCE: The bulk-fill flowable within light curing unit. CONCLUSIONS: The tendency for the tensile adhesive strength to lower
composite restoration provided satisfactory bond strength in high C-factor Class I preparations when irradiating at a greater distance suggests that radiation levels on the adhesive surface
after thermomechanical aging. may decrease with the distance. CLINICAL SIGNIFICANCE: When restoring Class II preparations
using composite resins, it may be necessary to consider prolonged curing time in order to
MTBS [MPa]
Groups Mean SD ensure sufficient adhesive strength.
G1: FLB+FP03+BII 20.99 5.0 a
G2: FLB+BII 18.64 4.5a 0 mm 5 mm 10 mm 20 mm 30 mm

G3: FLB+FP00 25.18 5.7b XL3000 24.34.4a 23.24.5a 16.67.5a,b 7.33.0b,c 4.12.6c
Elipar S10 LED 24.90.6A 22.93.1A 16.93.7A,B 8.44.0B,C 4.51.2C
Dentin Bonding Durability of Resin Cements in Self-curing Mode

TOKUI H8, FUSEJIMA F, KUMAGAI T.
*GC Corporation, Japan
OBJECTIVES: To assess the bonding durability of resin cements to dentin under opaque indirect indicate statistically significant difference (p<0.05, one-way ANOVA). CONCLUSIONS: The outcome
restorations condition. MATERIALS AND METHODS: The resin cements compared in this study are the was cement-dependent. After thermocycling, G-CEM LinkAce showed the highest TBS value (not
following: Self-adhesive type: G-CEM LinkAce (GC), RelyX Unicem 2 Automix (3M ESPE), Maxcem Elite different from Multilink Automix). This result suggested the reliability of the self-adhesive cement
(Kerr) and SpeedCEM (Ivoclar Vivadent); conventional type: Multilink Automix (Ivoclar Vivadent) G-CEM LinkAce and its probable dentin bonding ability under opaque restorations. CLINICAL
and Variolink II (Ivoclar Vivadent). For evaluation of dentin bonding durability in self-curing mode, SIGNIFICANCE: The self-adhesive G-CEM LinkAce seems to be a good alternative for clinical cases
tensile bond strength (TBS) was measured before and after thermocycling. Test specimens were that light cannot be adequately transmitted through indirect restorations.
prepared according to ISO/TS 11405. Bovine incisors were utilized. Dentin surface was prepared
with 600-grit SiC abrasive paper and the cements applied according to each manufacturers 24 hours 5,000 thermocycles
instructions. Application of the cements was performed using a stainless steel rod (bonding area G-CEM LinkAce 10.1(2.2) A 9.4(2.6) a
of 3 mm in diameter). The specimens were stored in 100% relative humidity at 37C for 1 h prior to RelyX Unicem 2 Automix 6.4(3.4) B 1.9(3.0) b*
immersion in 37C water for one day under dark conditions. Tensile test was conducted after the Maxcem Elite 3.5(0.3) C 0.1(0.1) b*
storage for one group (n=6) and 5,000 thermocycles (5-55C) for the other (n=6). RESULTS: The SpeedCEM 6.5(0.8) B 2.0(2.3) b*
Multilink Automix 10.3(3.3) A 6.5(7.3) a
followings are mean TBS values in MPa SD. Different letters in a condition and asterisk in a cement
Variolink II 5.5(2.9) BC 2.1(1.7) b*
Dentin Bond Strength of an A New Ion-releasing Core Build-up

Experimental Composite Core Material Containing S-PRG Filler
KADOWAKI Y*, KAWANO S, FU J, HOSHIKA S, IKEDA T, SANO H. KIMOTO K*, SHIOI H, SHINNO K, NAGAFUJI A, JOGETSU Y, TATEISHI S, NAKATSUKA T.
*Hokkaido University, Japan *Shofu Inc., Japan
OBJECTIVES: To evaluate the microtensile bond strength (TBS) of an experimental composite OBJECTIVES: Due to the widespread recognition of the minimal intervention concept and
resin core. MATERIALS AND METHODS: Eighteen human molars were used. The materials used growing need of esthetic restorations in recent years, resin-based core materials have become
were the experimental composite resin core TDK-03 (experimental adhesive ELT, Tokuyama widely used. We have developed a novel core build-up composite resin system (BCS) consisting
Dental Corp.), Clearfil DC Core Automix (Clearfil S3 Bond Plus, Kuraray Noritake Dental Inc.), and of one-step adhesive (BDB) and ion-releasing dual-cure composite resin (BC) containing S-PRG
UniFil Core (G-nial Bond, GC Corp.). Occlusal surfaces were flattened to exposed dentin and filler. This study aimed to evaluate BCSs adhesion to dentin and its acid-neutralizing effect.
the surfaces treated with the adhesive systems and core materials, which were applied in one MATERIALS AND METHODS: The buccal surface of bovine teeth was polished with 600-grit SiC
4-mm increment. Core materials were either light activated prepared under ambient light paper to obtain dentin. That surface was treated with BDB and BC, which was allowed to
and activated using a halogen light following the manufacturers instructions or allowed to dual-cure. The test specimens prepared were tested for shear bond strength (SBS) using a
set in the absence of light, in the dark. After setting, specimens were stored in water at 37C universal testing machine after 10 min of preparation, after 24 h of immersion in 37C water,
for 24 h prior to sectioning into beams. Specimens were tested in a universal testing machine and after 2,000 thermal cycles (between 4C and 60C). Data were analyzed using one-way
at a 1.0 mm/min crosshead speed. Data were analyzed with ANOVA and Games-Howell method ANOVA and Tukeys test. For evaluation of acid-neutralizing effect of BC, disc specimens of cured
(p<0.05). RESULTS: Two-way ANOVA showed statistical significant interaction of core materials BC (diameter: 15 mm, thickness: 1 mm) were prepared and immersed in 5 mL of lactic acid
and polymerization conditions. Mean TBS values for light activated specimens were: 60.0 solution (pH 4.0). The pH change in the solution was measured for to 12 h using a pH electrode.
17.1 for TDK-03, 15.9 10.3 for Clearfil DC Core Automix, and 28.0 16.6 for UniFil Core. Specimens RESULTS: SBS of BCS were 16.91.4 when measured 10 min after bonding, 16.65.6 after 24 h
allowed to set in the absence of light had mean TBS values of: 54.6 15.7 for TDK-03, 8.4 4.8 of water immersion, and 14.22.1 after thermocycling. No significant differences were present
for Clearfil DC Core Automix, and 9.5 6.6 for UniFil Core. In both conditions, the mean TBS (p>0.05). For acid neutralization evaluation, the pH of the solution shifted from 4.0 (initial)
of TDK-03 was significantly higher than the other materials. Mean values of light activated to 4.6 at 1 h to 5.5 at 12 h. CONCLUSIONS: BCS showed excellent bond durability. The system
groups were higher than that of groups not exposed to light. CONCLUSIONS: The TBS of the also exhibited acid-neutralizing effect. CLINICAL SIGNIFICANCE: Strong adhesion to root canal
experimental composite resin core TDK-03 was statistically higher than those of commercially dentin of this material is expected, which should provide good prognosis for the treated site.
available composite resin cores. CLINICAL SIGNIFICANCE: TDK-03 might be an effective alternative BCS is also expected to neutralize acid produced by bacteria remaining in the root canal and
to commercially available composite resin cores. potentially reduce the risk of secondary caries.

Ultra-high-speed Fracture Observation in Resin-dentin Interface under Microtensile Load

HOSAKA K*, TAKAHASHI M, NAKAJIMA M, NISHITANI Y, PASHLEY DH, TAGAMI J.
*Tokyo Medical and Dental University, Japan
OBJECTIVES: To investigate the fracture phenomena at the resin-dentin interface as it fails under microtensile load using an innovative ultra-high-speed imaging technique. MATERIALS AND METHODS:
Mid-coronal flat dentin surfaces of human molars were prepared with 600-grit SiC paper. After application of an adhesive system (Clearfil SE Bond, Kuraray) according to the manufacturers
instruction, resin composite (Clearfil AP-X, Kuraray) was incrementally built-up. After 24 h of water storage at 37C, the specimens were sectioned into sticks (0.7 x 1.4 mm) and subjected to the
microtensile bond strength (MTBS) test at a crosshead speed of 1 mm/min (n=25). Images of the bonded interface during failure were captured using a digital ultra-high-speed camera (Phantom
V1610, Vision Research) at 600,000 frames/second. The captured images were dynamically analyzed using camera control software. Fractured surfaces of each specimen were also analyzed
using SEM. RESULTS:The extremely rapid fracture phenomena of the specimens at the breaking point, such as cracking opening, deformation, and the fragments flying in the cracks could be
successfully observed. The extending crack propagation was captured in five specimens. The crack location patterns were the composite-adhesive interface (14 specimens, 65.1 MPa), within
the adhesive layer (8 specimens, 61.4 MPa), and within the dentin (3 specimens, 61.3 MPa). One-way ANOVA revealed that there was no significant difference in MTBS among the crack location
patterns. CONCLUSIONS:The fracture phenomena within the resin-dentin interface could be successfully observed using ultra-high-speed imaging technique. The crack location did not affect the
MTBS in this study. CLINICAL SIGNIFICANCE: The innovative ultra-high-speed fracture observation enables dynamic fracture examination of resin-dentin interfaces. Understanding of the fracture
mechanism aids in the selection of the adhesive systems for clinical applications and in the development of new adhesives. Supported by GCOE program at TMDU and JSPS Grants-in-Aid #23792165.
Bonding Performance of a Resin Cement in Effects of Application Mode and

Saliva-Contaminated Root Canals Cement on FRC Post Bonding
YAMAN BC*, OZER F, KARABUCAK B, AHMED SF, BLATZ MB. ZHU Z*, MCCOMB D, TAM L, PRAKKI A, STAUDINGER L.
*Eskisehir Osmangazi Faculty of Dentistry, Turkey *Shanghai 9th Peoples Hospital, China
OBJECTIVES: This study investigated the effects of Clearfil SE Bond primer (Kuraray) application OBJECTIVES: The aim of this in vitro study was to compare the push-out bond strengths of
and acid etching with 35% phosphoric acid on the bond strength of a fiber post (Ice Light Post, fiber-reinforced carbon (FRC) posts using commercial luting cements and to compare the effects
Danville Dental) to saliva-contaminated root canal dentin with a self-adhesive resin cement of application methods of a self-adhesive resin cement. MATERIALS AND METHODS: Standard
(Clearfil SA, Kuraray). MATERIALS AND METHODS: Thirty-six extracted single-rooted human step-by-step root canal preparations and post space preparations (RelyX Fiber Post system, 3M
premolars were endodontically treated and randomly allocated into six groups (see table). ESPE) were performed on 25 human single-rooted teeth, which had been sectioned transversely
Restored roots were thermocycled for 2,000 cycles between 5-55 C and cut into 1 mm-thick 2 mm coronal to the cemento-enamel junction. Posts were cemented to roots that had been
dentin slabs. The bond strength was measured with an hourglass microtensile test method at divided into five groups (n=5) according to different cements and application methods: (1)
a crosshead speed of 0.5 mm/min. The data were analyzed with two-way ANOVA and Tukeys RelyX ARC (3M ESPE) + lentulo; (2) RelyX Luting Plus clicker (3M ESPE) + lentulo; (3) RelyX
HSD tests. RESULTS: Clearfil SE Bond primer and phosphoric acid applications increased bond Unicem (3M ESPE) clicker + lentulo; (4) RelyX Unicem Aplicap (3M ESPE) + lentulo; (5) RelyX
strengths of Clearfil SA to the root canal walls. CONCLUSIONS: Bond strength values of Clearfil SA Unicem Aplicap + cannula. The adhesion between posts and root canals was investigated using
were significantly affected by saliva contamination (two-way ANOVA). However, both Clearfil SE a thin-slice push-out test and analyzed using one-way ANOVA (=0.05), after 24 h of water
Bond primer and 35% phosphoric acid increased the bonding ability to root canal dentin after storage at 37C. RESULTS: The push-out bond strength of RelyX Luting Plus (6.3 5.6 MPa) was
saliva contamination. CLINICAL SIGNIFICANCE: It is advisable to use Clearfil SE Bond primer or comparable to RelyX Unicem clicker + lentulo (9.1 5.2 MPa) but significantly lower than that
35% phosphoric acid on the root canal dentin to optimize bonding performance of Clearfil SA, of other groups. There was no significant differences among RelyX Unicem clicker + lentulo,
in case of saliva contamination RelyX ARC + lentulo (13.6 7.4 MPa), RelyX Unicem Aplicap + lentulo (12.7 9.2 MPa), and RelyX
Unicem Aplicap + cannula (12.8 5.8 MPa). CONCLUSIONS: Etch-and-rinse and self-adhesive resin
Saliva-contaminated [MPa] Decontaminated
cement systems provided similar post retention, which was higher than the resin-modified
Fiber post + cement 6.22.0 a 10.72.6 b
cement RelyX Luting Plus (except for RelyX Unicem clicker + lentulo). No significant bond
Primer + fiber post + cement 14.82.8 c 17.63.7 cd
strength differences among application modes were noted. CLINICAL SIGNIFICANCE: This study
Phosphoric acid + fiber post + cement 16.73.3 cd 19.43.5 d
suggests that both self-etching and etch-and rinse resin cement systems can be used for
bonding of FRC posts. Application can be performed with lentulo or via cannula.

Effect of Cyclic Load on Bonding Reliability of Metal-free Onlay Restorations
YAMADA T*, MASEKI T, NARA Y.
*The Nippon Dental University School of Life Dentistry at Tokyo, Japan
OBJECTIVES: To examine the effect of cyclic load stress on bonding reliability of ceramic onlay restorations to intra-cavity dentin walls. MATERIALS AND METHODS: Standardized preparations for
MODB restorations were prepared in 32 extracted human lower molars. The preparations were coated with an all-in-one adhesive system (Clearfil S3 Bond, Kuraray Dental) and a low viscosity
resin (Clearfil Protect Liner, Kuraray Dental). Onlays were made with a hybrid ceramic material (Estenia C&B, Kuraray Dental) and bonded to the preparations with a dual-cure resin luting cement
(Clearfil Esthetic Cement, Kuraray Dental). Restored specimens were divided into two groups (n=16): A group with cyclic load stress (S+) simulating mastication and a group without the stress
(S-, control). For the S+ group, cyclic load stress (90 times/min, 16.0 kgf 3 105 times) was applied to the restored specimens in water at 37 C. For S- group, no stress was applied. Two slabs
of 1.0 mm in thickness were obtained from each specimen. Each slab was trimmed to a standardized dumbbell specimen and microtensile bond strength (TBS) to pulpal and axial walls was
measured. The data were examined using ANOVA and Weibull analysis. RESULTS: Mean TBS in MPa and Weibull modulus value [Wm] for S+/S- were pulpal floor: 7.9[4.0]/10.5[7.4]; axial wall:
9.6[4.7]/10.1[4.4]. The mean TBS and Wm of the pulpal floor under S+ was significantly lower than the values under S- (p<0.01). No differences in both TBS and Wm to axial wall between S+ and
S- were recognized. Debonding mainly occurred at the interface between onlay and luting cement. CONCLUSIONS: The TBS and bonding reliability to the pulpal floor was decreased significantly
by the cyclic load stress. Bonding to the axial wall was not affected by loading. CLINICAL SIGNIFICANCE: Clinical mastication might injure the bonding on pulpal floor more than on axial wall.
Effect of Storage Conditions on Microleakage and Bond Strength of

Dentin Bond Strength of Resin Cements Three Glass Ionomer Restoratives
SUH BI*, DURAY SJ, CHEN L. TARIN B*, VEOLU HS, RIBOZ E, ARICAN B.
*Bisco Inc., USA *Marmara University Faculty of Dentistry, Turkey
OBJECTIVES: The aim of the study was to demonstrate the effect of storage conditions (immersion OBJECTIVES: This study evaluated the bond strengths and microleakage of three different glass-
in water versus storage at 100%-relative humidity) on shear bond strength of self-adhesive resin ionomer restoratives (GIRs) to dentin. MATERIALS AND METHODS: Three commercially available GIRs
cements to dentin. MATERIALS AND METHODS: An experimental self-adhesive resin cement was (Chemfil Rock, Dentsply Caulk; Ionofil Molar AC/Quick, Voco; and Equia Fil, GC) were used in the
chosen for the study. Axial dentin surfaces of human molars were surfaced on wet 320 grit SiC study. Disc-shaped dentin specimens (n=30) were obtained from recently extracted non-carious
paper. Shear bond strength (SBS) specimens were prepared by cementing pre-polymerized human molars and embedded in acrylic resin for shear bond test. Following preparation, two-split
composite posts (4.4 mm in diameter) to dentin (moist and dry). The cement was permitted to plexiglass molds (inner diameter and height of 4.25 mm) were fixed onto the bur-cut dentin
self-cure for 15 min at 37 C prior to immersion in deionized water or storage in a humidor at surfaces and filled with the GIRs (n=10 per GIR) according to the manufacturers instructions.
100% relative humidity for 2 h. Specimens were then loaded to failure (5 mm/min) on an Instron Samples were stored in water for one week until testing. Samples were subjected to shear
universal testing machine. The data were analyzed statistically using a Students t-test (p = 0.05). bond test in a universal testing device with a load cell of 50 kg and a crosshead speed of 1 mm/
RESULTS: Results are shown in the table below. min. For microleakage evaluation, standardized Class V cavities (3 x 2 x 2 mm) were prepared
on the buccal surfaces of molar teeth and restored with the GIRs (n=10 per GIR) following the
Mean SBS (SD) [MPa] for moist and dry specimens in each storage medium (n=9-10)
manufacturers instructions. After finishing and polishing, the teeth were stored in distilled
Moist Dry
water for one week, coated with nail varnish, immersed in 0.5% basic fuchsin dye for 24 h, and
Water 2.9 (1.1) 3.0 (1.6)
Humidor 11.1 (5.0) 9.8 (4.4) sectioned longitudinally. Dye penetration was examined under a stereomicroscope and scored
p-value 0.0002 0.0002 on a 0-3 ordinal scale. Data were analyzed statistically using one-way ANOVA, Tukey HSD and
chi-square tests (p<0.05). RESULTS: Although the highest shear bond strength values were
CONCLUSIONS: Storage of specimens in 100% humidity has a profound positive effect on SBS. obtained with Ionofil Molar AC/Quick, no statistically significant differences were observed among
Most self-adhesive resin cements exhibit low SBS, yet perform well clinically. Perhaps water the shear bond strength values of the test GIRs. Similarly, there were no significant differences
immersion is not an accurate technique for modeling an in vivo situation. CLINICAL SIGNIFICANCE: in microleakage among the test materials. CONCLUSIONS: All the test materials showed similar
In in vitro test models, storage in humidor at 100% humidity may be more clinically relevant performances in regards of adhesion and microleakage. CLINICAL SIGNIFICANCE: The test GIRs
than storage in water. seemed to exhibit comparable adhesion and microleakage properties.
Effect of Antioxidant Following Bleaching on Bond Strength to Enamel

TURKMEN C*, GULERYUZ N.
*Marmara University Faculty of Dentistry, Turkey
OBJECTIVES: Antioxidizing agents have recently been suggested to minimize the immediate negative effects of bleaching agents on bond strengths of resin-based materials to enamel. This
study compared the shear bond strength (SBS) of two different adhesives to bleached enamel, with and without the use of an antioxidizing agent. MATERIALS AND METHODS: The enamel surfaces
of 140 freshly extracted intact human incisors were divided into 14 groups (n=10). Negative controls consisted of unbleached groups where Adper Single Bond 2 (3M ESPE) and Clearfil Tri S Bond
(Kuraray) were used. The remaining 120 specimens were assigned to be treated with 35% Beyond Max (Beyond, groups 1-6) and 38% Opalescence Xtra Boost (Ultradent, groups 7-12). Each bleaching
group was further divided into two subgroups that were bonded with Adper Single Bond 2 and Clearfil Tri S. Specimens were bonded (1) immediately after bleaching, (2) after using 10% sodium
ascorbate (SA) gel, or (3) after 1 week of immersion in artificial saliva. All groups were restored with Clearfil Majesty Esthetic (Kuraray) composite resin. After 10,000 rounds of thermocycling, SBS
was measured and the data were analyzed with one-way ANOVA, Tukey HSD, and Student-t tests. RESULTS: There was no statistically significant difference between control groups. No significant
differences in SBS were noted between the SA-treated groups, while all delayed bonding groups had SBS statistically similar to that of controls. The lowest SBS values were noted for the groups
bonded immediately after bleaching. CONCLUSIONS: Delaying bonding seems to be a better option than using SA towards achieving the maximum possible SBS to enamel after bleaching. CLINICAL
SIGNIFICANCE: Ascorbic acid application seems to be ineffective in preventing the reduction of bonding ability to bleached enamel.
Influence of Cement Type and Thickness on Efficacy of Antioxidants on Bond Strengths to

Polyfiber Post Adhesion Bleached Enamel
UZUNOGLU E*, TURKER SA,YILMAZ Z. SENAWONGSE P*, VONGPHAN N,LEETRAKULWANNA C.
*Hacettepe University Faculty of Dentistry, Turkey *Mahidol University Faculty of Dentistry, Thailand
OBJECTIVES: To examine the effect of cement type and thickness on push-out bond strength of OBJECTIVES: To evaluate the effect of two antioxidants, 10% sodium ascorbate solution (SA) and
polyfiber endodontic posts (888102 Spirapost PFS Tapered, Zenith Dental) luted with different 100 micromolar rosmarinic acid solution (RA), on bond strengths of Adper Single Bond 2 (3M
resin cements into canals obturated with gutta-percha and an epoxy-resin based sealer (AH26, ESPE) to bleached enamel. MATERIALS AND METHODS: Enamel discs 2-mm thick were prepared
Dentsply). MATERIALS AND METHODS: Forty-eight single-rooted teeth were decoronated, filed, from 120 extracted premolars and divided into five groups. Four groups were bleached with
cleaned, and sequentially shaped with ProTaper (Dentsply Tulsa) rotary files up to #F3. Teeth 10% carbamide peroxide (VivaStyle 10%, Ivoclar Vivadent) for 8 h during 7 days. One group
were divided into two groups of 24 specimens each and obturated with gutta-percha and served as control (no bleaching). The bleached teeth were treated according to one of the
AH26. Post space preparation and cementation were completed a week after obturation. following protocols: (1) no irrigation, (2) irrigation with SA/10 min, (3) irrigation with RA/5 s,
Ten-millimeter-deep post spaces were prepared using size 4 (group 1) and 6 (group 2) Gates or (4) irrigation with RA/10 s. Build-ups for microshear bond strength test were immediately
Glidden drills. The teeth in each group were then divided into three subgroups according to placed using Filtek Z250 (3M ESPE). The bonded specimens were stored in distilled water for
luting cements (RelyX Unicem, 3M ESPE; Panavia F4, Kuraray; Clearfil SA, Kuraray). Following 24 h, 3 months, 6 months, and 12 months before testing. Normal distributions were analyzed
cementation of the polyfiber posts, 1-mm thick horizontal sections were obtained from with Komogorov-Smirnovs test and equality of variances was analyzed with Levenes test.
specimens and subjected to push-out test. The data were statistically analyzed with two-way Two-wayANOVA was used to determine the effects of antioxidant application and storage time.
ANOVA and Bonferroni tests. RESULTS: Both cement type and thickness had significant effects Differences between the groups were further analyzed using post-hoc Dunnett Ts multiple
on bond strength values (p<0.05). The push-out bond strength varied significantly between range test at a 95% confidence level. RESULTS: The statistical analysis revealed that different
the two groups, irrespective of luting agent; specimens in group 1 showed higher bond strength surface treatments and storage times significantly affected bond strengths (p<0.01). In the
values than group 2 (p<0.05). In other words, bond strength values decreased with increasing control group, stable bond strengths were observed. The group that was bleached and had
thickness of the cements. Regarding luting agents, while RelyX Unicem showed the highest no irrigation treatment showed lower bond strengths when compared to the other groups.
bond strength values in group 1 and 2 (11.13.1 MPa and 6.52.3 MPa, respectively), Panavia The use of SA/10 min and RA/10 s improved the compromised bond strength of bleached
F4 exhibited the lowest values (8.93.6 MPa and 4.62.0 MPa, respectively). CONCLUSIONS: enamel up to 12 months. CONCLUSIONS: Irrigation with Sa/10 min and RA/10 s improved bond
Push-out bond strength values achieved with the Spirapost system are significantly affected strengths of a two-step etch-and-rinse adhesive to bleached enamel. CLINICAL SIGNIFICANCE:
by the thickness and type of resin cement. CLINICAL SIGNIFICANCE: The fit between endodontic The use of antioxidant with proper application times may be recommended when immediate
posts and post spaces should be as tight as possible for higher adhesion. bonding procedures are necessary.

Bonding of Ceramic-Cement, Cement-Tooth & Ceramic-Cement-Tooth
CHEN L*, SHEN H, SUH BI.
*Bisco Inc., USA
OBJECTIVES: To compare shear bond strengths (SBS) of ceramic-cement, cement-tooth, to ceramic-cement-tooth. MATERIALS AND METHODS: Four commercial resin cement systems were chosen
for the study: eCEMENT (Bisco), eCEMENT Veneer (Bisco), Multilink (Ivoclar Vivadent), and Variolink (Ivoclar Vivadent). The eCEMENT was applied with Porcelain Primer and All-Bond Universal.
Multilink was applied with Monobond Plus and the dedicated adhesive Primer A&B. Variolink was applied with Monobond Plus and ExciTE. Lithium disilicate bars (IPS e.max) were etched (25 s, 4%
HF) and silanated. Dentin (unetched) and enamel (etched 15 s, 37% phosphoric acid) were treated with the adhesive prior to bonding of the ceramic bars. Resin cements were either light-cured
(500 mW/cm2, 40 s) or self-cured (37C, 15 min). SBS was tested using the Ultradent jig method (bond area 4.5 mm2), after storage in de-ionized water (37C, 24 h). The data were analyzed
statistically by ANOVA and Student-t Tests (p<0.05). RESULTS: Different upper and lowercase letters represent statistical differences in each row and column, respectively. N=7. CONCLUSIONS: The
SBS of ceramic-cement-tooth were not significantly different from the bond strength of the weaker side (ceramic-cement or cement-teeth). CLINICAL SIGNIFICANCE: The bonding of ceramics to
teeth depends on the weaker link of ceramic-cement and cement-tooth. In order to achieve a strong ceramic bonding on teeth, the materials with strong bonding in both ceramic-cement and
cement-tooth should be used.
Dentin SBS [MPa] Dentin SBS [MPa]
Ceramic-cement Cement-tooth Ceramic-cement-tooth Ceramic-cement Cement-tooth Ceramic-cement-tooth
Light 39.24.7 Aa 29.54.6 Ba 33.95.6 ABa - - -
eCEMENT
Self 34.05.6 Aa 29.84.1 Aa 37.912.5 Aa - - -
eCEMENT Veneer Light - - - 34.17.5 Aa 34.45.5 Aa 31.49.0 Aa
Light 26.16.7 Bb 24.78.2 ABab 18.74.8 Bb - - -
Multilink
Self 23.54.4 Bb 18.92.4 Bb 15.24.1 Bb - - -
Variolink Light - - - 21.16.6 Bb 34.111.1 Aa 27.95.8 ABa
Influence of Chlorhexidine on Effect of Dentin Desensitizers on

Resin Cement Bond Strength Over Time Resin Cement Bond Strengths
QUAGLIATTO PS*, STAPE THS, MENEZES MS, AGUIAR FHB, SOARES CJ, MARTINS LRM. GARCIA RN*, TAKAGAKI T, SATO T, MATSUI N, NIKAIDO T, TAGAMI J.
*Federal University of Uberlndia, Brazil *University of the Region of Joinville, Brazil
OBJECTIVES: This study investigated the effect of dentin pretreatment with chlorhexidine on the OBJECTIVES: The aim of this study was to evaluate the effect of dentin desensitizers on bond
long-term bond strength of resin cements. MATERIALS AND METHODS: Composite blocks were strengths of a resin cement to dentin. MATERIALS AND METHODS: Twenty bovine teeth were
luted to caries-free human coronal dentin using a conventional (RelyX ARC, 3M ESPE: ARC) or a prepared to obtain flat surfaces of median dentin. A standardized smear layer was created
self-adhesive (RelyX U100, 3M ESPE: U100) resin cement with or without dentin pretreatment by (#600-grit SiC paper) just prior to the adhesive procedures. The surfaces of twenty composite
2% chlorhexidine. Chlorhexidine was applied for 60 s on etched dentin for ARC and on the smear blocks, 3 mm thick (Estenia C&B, Kuraray Noritake) were abraded with aluminum oxide (50 m),
layer covered dentin for U100. Bonded teeth (n=10) were stored in water for 24 h and sectioned and then silanized. The samples were randomly divided into the following four groups (n=5): no
in 0.9 mm x 0.9 mm sticks for microtensile bond strength (MTBS) test. Composite-dentin sticks treatment (control), Gluma Desensitizer (GD, Heraeus Kulzer), Super Seal (SS, Phoenix Dental),
from each bonded tooth were randomly divided to be tested immediately or after two years of and Teethmate Desensitizer (TMD, Kuraray Noritake). The dentin surfaces were then treated
storage in artificial saliva. Fracture modes were determined by scanning electron microscopy. with ED Primer II (Kuraray). The composite blocks were bonded to the dentin surfaces with the
RESULTS: Repeated measures factorial ANOVA and Tukey Kramer Test (=0.05) revealed that resin cement Panavia F2.0 (Kuraray Noritake) according to the manufacturers instructions. After
resin cement, time, and the interaction between resin cement, time, and dentin pretreatment 24-h storage (37C, 100% relative humidity), the bonded samples were cut into beamshaped
(p<0.001) had significant effects on the dentin MTBS. U100 provided reduced bond strengths microtensile specimens and loaded in tension until failure. Data were analyzed with one-way
at 24 h and two years compared to ARC (p<0.05) and two-year storage did not lower the U100 ANOVA and the Dunnetts test (=0.05). Scanning electron microscopy was used to examine
bond strength (p>0.05). Pretreatment with 2% chlorhexidine reduced the dentin bond strength the fracture modes. RESULTS: The microtensile bond strengths (MPa) were: 24.43.2 (control),
of ARC after storage (p<0.05) and there was no adverse effect on the 24-h and two-year storage 14.05.6 (GD), 8.64.7 (SS), and 34.74.6 (TMD); there were significant differences among the four
of U100 MTBS (p>0.05). CONCLUSIONS: Chlorhexidine may reduce the long-term bond strength groups (p<0.05). CONCLUSIONS: The efficacy of the desensitizing agents is material-dependent;
of ARC, which might compromise the longevity of indirect restorations. Chlorhexidine use with GD and SS decreased the TBS, however TMD improved it. More studies about the mechanism
U100 does not impair its immediate or aged dentin bond strength. CLINICAL SIGNIFICANCE: Resin of TMD, a calcium-phosphate-containing cement, are necessary to explain this difference.
cements are routinely used for luting composite crowns, all-ceramic restorations and posts. CLINICAL SIGNIFICANCE: The calcium-phosphate-containing material TMD may serve as a useful
Chlorhexidine may be used along with U100 without compromising its bond strength to dentin. new generation desensitizing agent for use prior to the cementation of indirect restorations.
BONDING TO DENTAL MATERIALS
Effect of Tribochemical Silica Coating on Resin Adhesion to Titanium

KILIARSLAN MA*, ZAK ST, ZKAN P, MUMCU E.
*Ankara University, Turkey
OBJECTIVES: The aim of this study was to evaluate the effects of different tribochemical silica coating methods on the bond strength between a resin cement and titanium surface. MATERIALS
AND METHODS: Sixty titanium disks were prepared. Specimens were divided into five groups to receive different surface treatments as follows: 1) No treatment control; 2) Sandblasting with 110
m aluminium oxide Rocatec Pre (3M ESPE); 3) Sandblasting with 30 m aluminium oxide and SiO2 Rocatec Soft; 4) Sandblasting with 110 m aluminium oxide and SiO2 Rocatec Plus; 5)
Sandblasting with 30 m silicatized sand Cojet (3M ESPE). Surface roughness of the specimens was measured using a profilometer and the topographic patterns were examined by scanning
electron microscopy. Roughness data for all specimens were analyzed with the Kruskal Wallis nonparametric multiple comparison test (P<0.001). The same specimens were then used for shear
bond testing (SBS). A resin cement (RelyX U200 Self-Adhesive Resin Cement, 3M ESPE) was attached to titanium surfaces using an Ultradent testing jig and SBS was performed using a universal
testing machine at a crosshead speed of 0.5 mm/mi. SBS results were analyzed by one-way ANOVA (P<0.001). The correlation coefficient between surface roughness and SBS was checked using
the Spearman correlation test (P<0.001). RESULTS: The highest surface roughness and SBS were observed for Rocatec Plus (2.22 m and 16.9 MPa, respectively). SBS of sandblasted groups were
significantly higher than of control. A positive correlation was found between SBS and surface roughness. CONCLUSIONS: Tribochemical silica coating improved SBS between a resin cement and
titanium. Expansion of silica modified aluminium oxide particles such as Rocatec Plus increased the efficacy of the method. CLINICAL SIGNIFICANCE: Chemical interaction obtained with tribochemical
silica coating could increase bonding of resin cements to titanium surfaces.
Effect of Zirconia Type Effect of Air-particle Abrasion Protocols

and Primer on Resin Bond on Bond Strength to Zirconia
XIANGFENG M. OZER F*, SINMAZISIK G, OVECOGLU HS, YAMAN B, BLATZ MB.
The Affiliated Stomatological Hospital of Nanjing University, China *University of Pennsylvania, USA
OBJECTIVES: To evaluate the bond strengths of a self-adhesive resin cement to zirconia after OBJECTIVES: This study evaluated and compared the effect of different air-particle abrasion
pre-treatment with a zirconia primer. MATERIALS AND METHODS: Forty blocks of VITA In-Ceram protocols [50 m aluminum oxide Korox 50 - BEGO (50-AOB), 50 m aluminum oxide -
YZ (Vident) and InCoris ZI (Sirona Dental Systems, Inc.) were sintered and polished. Half of the Danville (50-AOD), 125 m aluminum oxide - Renfert (125-AOR), 110 m Rocatec Pre - 3M
specimens were pre-treated with a zirconia primer (Z-PRIME Plus, Bisco) while the other half ESPE (110-RP), and 30 m Siljet Powder - Danville (30-SP)] on bonding of a resin cement
received no treatment and served as control. Composite cylinders were bonded to the zirconia to zirconia. MATERIALS AND METHODS: A total of 120 square blocks (5 x 5 x 3 mm) of zirconia
specimens using a self-adhesive resin cement (BisCem, Bisco). Specimens in each zirconia group were fabricated and divided into six groups (n=20). The top surfaces of the blocks were
were divided into two subgroups (n=10) to be either immediately tested or subjected to 10,000 abraded with the study abrasives (at a pressure of 2.8 bar for 15 s). Non-blasted samples
cycles of thermocycling prior to testing. The data were analyzed by three-way ANOVA test and served as control. Cylindrical composite samples (2.1 mm in diameter, 3 mm in height)
independent sample t test. RESULTS: Bond strength was affected by ceramic type, the use of were bonded to primer [Danville zirconia primer (DZP)]-treated surfaces with a resin
primer and thermocycling (p<0.001). Interactions among the three factors were significant luting cement (Multilink Automix, Ivoclar Vivadent). A load of 1,000 g was applied to the
(p<0.001). Immediate shear bond strengths of specimens pre-treated with Z-PRIME Plus were cylinders during cementation procedures. Shear bond strengths (SBS) were immediately
26.81.7 MPa and 25.12.7 MPa for VITA In-Ceram YZ and InCoris ZI, respectively. These values determined. Data were analyzed with ANOVA and Tukeys HSD. One sample from each
were significantly higher than that of specimens not pre-treated with Z-PRIME Plus (16.92.0 group was examined with scanning electron microscopy (SEM) to evaluate surface
MPa for VITA In-Ceram YZ; 15.42.7 MPa for InCoris ZI). The majority of the failures occurred morphology. RESULTS: SEM micrographs showed different surface morphologies.
at the adhesive interface. Thermocycling significantly decreased the bond strengths with the
SBS [MPa]
exception of VITA In-Ceram YZ/no Z-PRIME Plus. Among thermocycled groups, there was no Groups
Mean SD
difference between VITA In-Ceram groups (16.63.8 MPa for no Z-PRIME Plus; 15.73.4 MPa for Control 9.7 2.2a
Z-PRIME Plus), while InCoris Zi groups were significantly different between each other (6.21.5 30-SP+DZP 26.6 4.6c
MPa for no Z-PRIME Plus; 13.92.7 MPa for Z-PRIME Plus). All thermocycled specimens failed 125-AOR+DZP 21.6 5.6b
at the adhesive interface. CONCLUSIONS: Z-PRIME Plus improved the immediate shear bond 110-RP+DZP 27.2 5.2cd
50-AOB+DZP 31.4 4.9d
strengths of the zirconia materials when used along with BisCem, however, that improvement
50-AOD+DZP 24.7 4bc
was material-dependent after thermocycling. CLINICAL SIGNIFICANCE: Appropriate bonding
procedures should be selected depending on the zirconia used. CONCLUSIONS: The hardness and size of the air-abrasion particles affect bonding
performance of Multilink Automix to zirconia. CLINICAL SIGNIFICANCE: Air-abrasion
procedures should be selected according to the substrate to be treated.

Liner Effect on Veneer/Zirconia Bond Strength Using Slow Cooling Protocol

MARTINEZ G*, BAUTISTA A, PACHECO LF, GARZON H.
*Universidad del Valle School of Dentistry, Colombia
OBJECTIVES: To compare the influence of liner material on the bond strength of veneering porcelain to two zirconia systems using a slow cooling protocol. MATERIALS AND METHODS: Twenty zirconia
blocks were fabricated (12 x 11 x 4 mm), sintered, and layered with a veneering porcelain (5 x 11 x 4 mm, IPS e.max Ceram, Ivoclar Vivadent) using a slow cooling protocol. Four groups were
evaluated: IPS e.max ZirCAD (Ivoclar Vivadent) with liner (IL) and no liner (IX), Ecco-Zirconia (Amann Girrbach) with liner (EL) and no liner (EX). Shear bond strength (SBS) test was conducted and
modes of failure were recorded. RESULTS: One-way ANOVA revealed no significant differences between the four groups (p=0.662). The mean SBS values (SD) in MPa were 15.2 (1.7) MPa for EX,
15.3 (2.0) MPa for EL, 16.4 (4.2) MPa for IX and 13.5 (1.4) MPa for IL. In all the samples, a combined adhesive/cohesive failure was observed. CONCLUSIONS: The application of liner material did
not alter the bond strength between veneering porcelain and zirconia using a slow cooling protocol. There were no differences between the test zirconia blocks. CLINICAL SIGNIFICANCE: This study
suggests that the application of liner to zirconia frameworks using a slow cooling protocol does not affect the bond strength. 1.5-2 mm of veneering ceramic has been shown to diminish residual
stress. Therefore, liner application may be explored with the goal of improving esthetic outcomes. The coefficient of thermal expansion must be considered to avoid chipping or delamination
of the veneering porcelain.
Effects of Pretreatment of Zirconia Interfacial Microstructures of

with Warmed Acids on Bonding Two Veneered All Ceramics
HAIFENG X*, ZHANG F. YI Y*, TIAN J, WANG X, WANG C, YANG D.
*Nanjing Medical University, China *General Hospital of Armed Police Forces, China
OBJECTIVES: To evaluate bond strengths to zirconia after conditioning with warmed acids. OBJECTIVES: Reliable bonding is essential for ceramic-ceramic systems to resist chipping.
MATERIALS AND METHODS: Zirconia blocks were fabricated, divided into six groups, and randomly Therefore, this study investigates interfacial bonding microstructures of veneer porcelains to
assigned to different surface treatments according to the table (n=8). Light-cured composite dental zirconia and lithium disilicate. MATERIALS AND METHODS: Bilayer zirconia and lithium
resin cylinders (Valux Plus, 3M ESPE) were prepared and bonded on the treated zirconia blocks disilicate veneer blocks were manufactured through hand layering. Bonding interface specimens
using a bisGMA-based resin cement (Choice 2, Bisco). Specimens were subjected to shear bond were made and divided into two groups. One group was etched with 9% hydrofluoric acid
strength (SBS) testing after 24 h or 40 days of water storage and the results were statistically gel and analyzed using scanning electron microscopy (SEM); the other was prepared by ion
analyzed. Additional specimens were fabricated for observation of the treated zirconia surfaces polishing and observed with high-resolution transmission electron microscopy (TEM). RESULTS:
using scanning electron microscope (SEM). Data were statistically analyzed using one-way The interface between lithium disilicate and veneer porcelain was connected by continuously
ANOVA and Fishers Least Significant Difference test (=005). glassy matrix. A 1-2 microns interface zone was formed by dissolved crystals in the glass matrix,
Group Zirconia treatment while the interface around individual lithium disilicate crystals was distinct with crystal lattice
C Alumina sandblasting (110 m) to glass matrix. The interface between zirconia and veneer porcelain was a direct connection
CP Alumina sandblasting (110 m) + Clearfil Ceramic Primer between tetragonal zirconia crystal and non-crystal glass matrix. Energy dispersive x-ray (EDX)
CoS Tribochemical silica coating (Cojet, 3M ESPE) + silane and TEM did not reveal elements inter-diffusing across the bonding interface. Melting glass
AcidS Warmed (100C) H2SO4/(NH4)2SO4 + Clearfil Ceramic Primer
did not erode grain boundaries of zirconia. Also, vapor or possible residue stress due to the
AcidFN Warmed (100C) HF/HNO3 + Clearfil Ceramic Primer
dentin porcelain firing cycles did not transform the tetragonal zirconia lattice at the interface
AcidSFN Warmed (100C) H2SO4/HF/HNO3 + Clearfil Ceramic Primer
or the grain boundaries. CONCLUSIONS: Tetragonal zirconia can be wetted well by glassy matrix.
RESULTS: Group C showed the lowest while group CoS showed the highest initial SBS. No Zirconia lattice was stable at the bonding interface as well as between the grain boundaries.
statistical differences in 24-h SBS were found among the other groups. After aging, all specimens Element inter-diffusion could not be detected at both sites. Bilayer lithium disilicate exhibited
of group C debonded spontaneously. Groups CoS, AcidS, AcidFN showed statistically higher chemical bonding microstructure at the interface. CLINICAL SIGNIFICANCE: To decrease the risk of
SBS. Moreover, groups AcidS and AcidFN showed increased SBS compared to 24-h results. veneer chipping, adequate wettability free of defects is essential for bonding between porcelain
CONCLUSIONS: The use of warmed acids for conditioning of zirconia showed improved in vitro and dental ceramics. Improved veneering techniques and ceramics should be developed in
bond durability compared to alumina sandblasting. CLINICAL SIGNIFICANCE: Warming acids the future. The authors are grateful for the financial support from National Natural Science
for pretreatment of zirconia prior to bonding may result in improved durability of the bonded Foundation (grant no. 30700961).
interface and consequently of the restoration.

Adhesive Properties of One-step Self-etch Adhesive to Metal and Zirconia
BAI W*, LIN H, ZHENG G.
*Peking University Stomatological School and Hospital, China
OBJECTIVES To compare the adhesive properties of one-step self-etch with two-step self-etch and two-step etch-and-rinse adhesives on the bonding to metals and zirconia. MATERIALS AND
METHODS: Ten cobalt-chromium alloy (DeguDent) and 10 zirconia ceramic (Lava Frame, 3M ESPE) disks were prepared and treated with the adhesive systems in the table. Prior to bonding
procedures, disks were ground with 600 silicon carbide abrasive paper and sandblasted with 50 m aluminum oxide. Adhesives were used according to the manufacturers instructions. Then a
split mould with inner diameter of 3 mm and height of 3 mm was placed on the bonding surface and filled with Filtek Z350 (3M ESPE). Specimens were kept in 37 C water for 24 h and the shear
bond strengths were tested at a crosshead speed of 1.0 mm/min. RESULTS: Data was analyzed by one-way ANOVA at a significance level of =0.05. N=10.
Shear bond strength [MPa]SD
Classification Product name
Cobalt-chromium alloy Zirconia
One-step Adper Easy One (3M ESPE) 22.84.8 15.57.0
self-etch OptiBond All-In-One (Kerr) 20.14.9 10.62.1
Two-step
One Coat Self-etching Bond (Coltene/Whaledent) 29.63.6 27.83.8
self-etch
Two-step etch-and-rinse Super-Bond Brush-dip (Sun Medical) 35.71.8 38.53.1
CONCLUSIONS: Shear bond strength of the test one-step self-etch adhesives to cobalt-chromium alloy and zirconia ceramics is lower than that of test two-step elf-etch and two-step etch-and-rinse
adhesives. CLINICAL SIGNIFICANCE: One-step self-etch adhesives seem not to be the best alternative for bonding procedures involving cobalt-chromium alloy and zirconia.
Evaluation of Surface Roughness of Zirconia Evaluation of Preservation Stability

Ceramics after Different Treatments for a New Prosthetic Primer
KIRMALI O*, AKIN H, KAPDAN A. DODOMI A*, HIRATA K, KIMURA M, YAMAMOTO H.
*Akdeniz University Faculty of Dentistry, Turkey *Tsukuba Research Laboratory, Japan
OBJECTIVES: This study aimed to investigate the effects of different mechanical surface treat- OBJECTIVES: To evaluate the preservation stability of a newly developed prosthetic primer
ments of zirconium oxide in the attempt to improve its bonding potential. (Tokuyama Universal Primer, UP, Tokuyama). MATERIALS AND METHODS: The surfaces of the
MATERIALS AND METHODS: One hundred and twenty IPS e-max ZirCAD (Ivoclar Vivadent) pre- following prosthetic materials were ground with SiC paper and sandblasted with 50 m
sintered zirconia blocks (7 mm diameter, 3 mm height) received six different surface treatments Al2O3: (1) precious metal (CASTMASTER12S, Au12/Pd20/Ag54/Cu12/other2, Tokuyama Dental),
(n=20): Group C - untreated (control), Group E - Er:YAG laser irradiated, Group N - Nd:YAG (2) non-precious metal (ICROME, Co57.8/Cr31.6/Mo5.6/other5, Tokuyama Dental), (3) indirect
laser irradiated, Group SB - sandblasted, Group SN - sandblasted + Nd:YAG laser irradiated, composite (PEARLESTE DA2, Tokuyama Dental), (4) porcelain (VMK68, VITA), (5) zirconia (TZ-3Y-E,
Group SE - sandblasted + Er:YAG laser irradiated. After the surface treatments, the average Tosoh). The prepared area was prepared for bonding by limiting it to 3 mm in diameter using
surface roughness (Ra, m) of each specimen was determined with a profilometer. Then, all double-stick tape. UP, stored under the following conditions: (a) immediate after production,
the specimens were sintered. The surface roughness values were analyzed through one-way (b) stored at 25C for 15 months, (c) stored at 25C for 24 months, (d) stored at 4C for 24 months,
ANOVA and Tukeys test. Changes in the morphological characteristics of the pre-sintered and was applied to the prepared surface and a stainless steel rod (8 mm in diameter) was bonded
post-sintered zirconium oxide were examined through scanning electron microscopy (SEM). using the resin cement (BISTITE2, Tokuyama) following the manufacturers recommendation.
RESULTS: Sintered sandblasted + Er:YAG laser treatment resulted in rougher surface compared to Specimens were stored at 37C and 100% humidity for 1 h and then for additional 24 h in water
the other treatments, whereas all surface treatments increased surface roughness and provided at 37C. Tensile bond strength was measured using a universal testing machine (Autograph,
significant morphological changes. CONCLUSIONS: Only Er:YAG and Nd:YAG laser irradiation AG-150KN, SHIMADZU) at a crosshead speed of 1 mm/min. The data were statistically analyzed by
alone were not effective altering the zirconia surface morphology. CLINICAL SIGNIFICANCE: one-way ANOVA and post hoc Tukeys test (p<0.05). RESULTS: No statistical differences in bond
Certain treatments are capable of altering the zirconia surface morphology in such way that strength were found. CONCLUSIONS: It was found that the bond strength of UP did not decrease
may improve bonding to that substrate. during a period of 24 months, showing excellent preservation stability. CLINICAL SIGNIFICANCE:
UP should show help promoting excellent and reliable bond strength for a variety of prosthetic
materials during the course of the 24-month warranty period.
Shear Bond Strengths of Bis-acrylic Materials to Single Bond Plus

APARICIO A*, JAYANETTI J, NGUYEN R, MENDEZ A.
*Louisiana State University Health Sciences Center School of Dentistry, USA
OBJECTIVES: The spot-etch technique has been advocated when provisionalizing partial veneer crowns. The purpose of this study is to compare the bond strengths of a bonding agent (Adper Single
Bond Plus, 3M ESPE) to four types of bis-acrylic temporary materials. MATERIALS AND METHODS: Forty samples of composite resin were sandblasted, bonded with one layer of bonding agent, and
divided intofour groups: S1 (Integrity, Dentsply), S2 (Visalys Temp, Kettenbach), S3 (Protemp, 3M ESPE), and S4 (Integrity Multi-cure, Dentsply). A matrix was used to allow application of the test
bis-acrylic temporary materials. Immediate shear bond strengths were determined using a knife-edged blade in a universal testing machine (Instron, Instron) at a crosshead speed of 1.0 mm/
min. Scanning electron microscopy images (SEM) of the fractures specimens were examined. RESULTS: One-way ANOVA indicated that there was a statistically significant difference among the
mean bond strength values of the experimental groups (P>0.05). Tukey test showed that the bond strength of the S4 group was significantly higher than that of the S1, S2, and S3 groups. SEM
examination of the fractured interfaces showed variations among the groups (P>0.05) with fractographic analysis showing adhesive failures consistently in S1, S2, and S3. In contrast, S4 showed
just cohesive failures. CONCLUSIONS: Integrity Multi-core showed higher bond strengths than the other experimental groups. The better bonding of that material to Adper Single Bond Plus was
confirmed with SEM analysis. CLINICAL SIGNIFICANCE Clinicians should consider the significant difference in bond strength of the test materials when selecting a material for provisionalization of
partial veneer crowns using Adper Single Bond Plus with the spot-etch technique.
Bonding between Indirect Composite and Influence of Light on Bonding Performance

Modified Surface of Zirconia of Dual-cure Resin Cements
FUSHIKI R*, KOMINE F, BLATZ MB, KOIZUKA M, TAGUCHI K, MATSUMURA H. OZER F*, KASHYAP K, YAMAN B, MANTE F, BLATZ M.B.
*Nihon University School, Japan *University of Pennsylvania, USA
OBJECTIVES: To evaluate the effect of feldspathic porcelain coating of zirconia and application OBJECTIVES: To measure and compare shear bond strength (SBS) of dual-cure composite
of priming agents on durability of bond strengths of an indirect composite to modified zirconia resin cements (EXP, experimental cement, Tokuyama; PAF, Panavia F 2.0, Kuraray; and MAM,
framework. MATERIALS AND METHODS: An indirect composite (Estenia C&B, Kuraray Noritake) Multilink Automix, Ivoclar Vivadent) to composite (Estelite, Tokuyama), ceramic (IPS e.max,
was bonded to 330 zirconia specimens (Katana, Kuraray Noritake) pretreated as follows: 50 Ivoclar Vivadent), zirconia (Nobel Procera, Nobel Biocare), and metal (Pentron Alloy, Pentron)
m Al2O3 (ZR-AB), 50 m Al2O3 to feldspathic porcelain coated on zirconia (ZR-PO-AB), and surfaces with and without light irradiation. MATERIALS AND METHODS: Forty square blocks (10
acid etching with 9.5% hydrofluoric acid gel for 1 min to the feldspathic porcelain coated on x 10 x 3 mm) were prepared for each cement group from the test materials. The top surfaces
zirconia (ZR-PO-HF). Before bonding, the modified surfaces were treated using no (CON) of the blocks were acid-etched with hydrofluoric acid (4.8%) for 60 s in composite and ceramic
or one of four primers: Clearfil Photo Bond (CPB, Kuraray Noritake ), Clearfil Photo Bond groups. The zirconia and metal surfaces were air-particle abraded with aluminum oxide (50
with Clearfil Porcelain Bond Activator (CPB+Activator, Kuraray Noritake ), Estenia C&B Opaque m particle size for 12 s). Composite samples (2.1 mm in diameter, 3 mm in height) were
Primer (EOP, Kuraray Noritake), and the liquid B of Porcelain Liner M (PLB, Sun Medical). Shear bonded to the surfaces with one of the study cements in a special alignment apparatus,
bond strengths were measured after 0 and 100,000 thermocycles (5-55, 1 min in each bath). where a load of 1,000 g was applied for 10 min. Half of the specimens were light-cured, while
RESULTS: Bond strengths (MPa) of CPB and CPB+Activator groups were the highest at baseline the other half was prepared and kept in a darkroom without light exposure. The light-cured
(21.1 and 21.4, respectively) and after 100,000 (19.7 and 20.5, respectively) thermocycles in specimens were irradiated for 40 s from three sides. The specimens were thermocycled for
ZR-AB. For ZR-PO-AB and ZR-PO-HF, PLB (20.1 and 18.5, respectively) and CPB+Activator (21.2 10,000 cycles (5-600 C). SBS was determined at a crosshead speed of 0.5 mm/min. Data (MPa)
and 19.7, respectively) groups showed the highest bond strengths before thermocycling, while were analyzed with ANOVA and Tukeys HSD tests. RESULTS: SBS were significantly lower without
CPB+Activator (25.8 and 22.4, respectively) group exhibited the significantly highest bond light curing with the exception of MAM to ceramic (p<0.05). EXP showed the highest SBS to
strengths in all groups after thermocycling (not different from CPB in ZR-AB). For CON group, zirconia (9.42.1) and ceramic (17.94.5) after light irradiation. The SBS was the highest for
ZR-PO-HF showed significantly higher pre- and post-thermocycling bond strengths than that of MAM to metal surfaces (13.84.5) with light curing. However, MAM exhibited the lowest bond
the other groups. CONCLUSIONS: Depending of primer treatment, feldspathic porcelain coating strength to zirconia without light irradiation (3.22.1). CONCLUSIONS: Self-curing capacity of
on the test zirconia framework provided higher or at least equal long-term bond strength dual-cure resin cements significantly affects their bonding performance to ceramic, zirconia,
of Estenia C&B to zirconia, when compared to air-abraded zirconia. CLINICAL SIGNIFICANCE: and metal surfaces. CLINICAL SIGNIFICANCE: Light curing of dual-cure resin cements is important
Feldspathic porcelain coating on zirconia frameworks can be an effective method to achieve for achieving adequate polymerization.
stable bonds between indirect composite and zirconia.

Bond Strength of Adhesives to Mineral Trioxide Aggregate
SEO MS*, CHOI ML.
*Wonkwang University Dental Hospital, Republic of Korea
OBJECTIVES: It is known that etch-and-rinse bonding systems produce stronger bonds than self-etch bonding systems to white mineral trioxide aggregate (WMTA). The purpose of this study was
to evaluate the bond strength of a 3-step etch-and-rinse bonding system and two one-step etch-and-rinse bonding systems (acetone-base and ethanol-base) to WMTA. MATERIALS AND METHODS:
Fifty cylindrical acrylic blocks with a hole (4-mm in diameter and 2-mm in height) were prepared using a 3-D printer. The holes were filled with WMTA and the specimens were stored for 72 h
at 37 C and 100% humidity. The specimens were then divided into five groups: Group 1: Adper Scotchbond Multipurpose Plus (3M ESPE); group 2: Adper Scotchbond Multipurpose Plus without
primer; group 3: Adper Single Bond 2 (3M ESPE); group 4: Prime & Bond NT (Dentsply DeTrey); and group 5: control (no adhesive system). After application of the adhesive systems, composite
resin (Filtek Z250, 3M ESPE) was applied over the WMTA. Shear bond strengths (SBS) were measured using a universal testing machine. SBS results were analyzed by one-way analysis of variance
test. RESULTS: Group 4 showed significantly higher bond strengths to WMTA than the other groups (P < .001). Group 3 showed significantly higher bond strengths than group 1 and 3 (P < .001).
Groups 1 and 2 presented similar mean bond strengths (P = .236). CONCLUSIONS: It was concluded that the acetone-based one-step etch-and-rinse adhesive system mediated a stronger bond to
WMTA. CLINICAL SIGNIFICANCE: The placement of composite material over WMTA using acetone-based one-step etch-and-rinse bonding system may be appropriate.
Fracture Mechanics of Bi-Material Joint Bond Strength of a Resin Composite to

Interface: A Composite Repair Model Glass-Ionomers
KIM SH*, MANTE FK. HARNIRATTISAI C*, CHANCHALERMCHAI P, KUPHASUK W, SENAWONGSE P.
*University of Pennsylvania School of Dental Medicine, USA *Mahidol University Faculty of Dentistry, Thailand
OBJECTIVES: To investigate the effect of filler load in composite resins on fracture toughness OBJECTIVES: To assess the shear bond strength (SBS) of a resin composite (Premise, Kerr) to two
of adhesive joints. MATERIALS AND METHODS: A composite resin-dentin joint was mimicked by glass-ionomer materials (Fuji II LC and Fuji IX GP, GC) using two adhesive systems. MATERIALS
creating bi-material interface structures to determine fracture toughness (KIC) in a composite AND METHODS: Forty-five cylindrical specimens (5 mm in diameter and 2 mm in height) of
resin repair model. The effect of filler load in composite resins on KIC was investigated. Following each glass-ionomer material were prepared and divided into three subgroups (n=15). Groups
the ASTM E399, single-edge-notched bar samples were made with two composite resins with were as in the table. After surface treatment, a cylindrical tube (0.75 mm in diameter and 1
different filler loads (SureFil, Dentsply; EsthetX, Dentsply) and two adhesive systems (Prime mm in height) was placed on each specimen and filled with Premise. SBS (crosshead speed
& Bond NT, Dentsply; Clearfil SE Bond, Kuraray). Four different types of composite-adhesive 0.5 mm/min) was tested after 24 h of water storage. Normal distributions were analyzed
bars were prepared for each composite: full bar (FB), bi-sectioned old half bar bonded to a with Kolmogorov-Smirnovs test and equality of variances was analyzed with Levenes test.
new half bar (HB) without adhesive, bi-sectioned old half bar bonded to a new half bar with Two-way ANOVA was used to determine the effects of materials and adhesive used. Differences
Clearfil SE Bond (CF), and bi-sectioned old half bar bonded to a new half bar with Prime & between the groups were further analyzed using post-hoc Dunnett Ts multiple range test at
Bond NT (PB). Data were analyzed using one-way ANOVA and post-hoc Holm Sidak paired-test a 95% confidence level. RESULTS: The mean SBS values in MPa (SD) are detailed in the table.
(=0.05). RESULTS: The KIC of SureFil was 1.4 0.1 MPa.m . CF restored KIC up to 88% of FB,

Different lowercase and uppercase letters show statistically significantly differences in rows
while HB and PB showed significantly decreased KIC values. The KIC of EsthetX (1.8 0.5 MPa. and columns, respectively.
m ) was statistically greater than SureFil regardless of lower concentration of primary filler

Fuji II LC Fuji IX GP
particles (Ba-B-F silicate) and secondary filler particles (Ba-B-Al silicate). CF and PB showed Optibond XTR 12.53.1 Ca 10.54.2 Ba
different fracture behavior compared to FB. KIC values were comparable to previous studies, Optibond Solo Plus 16.92.1 Ba 10.12.2 Bb
and a strong correlation between KIC and the previously reported Youngs modulus was found. Optibond Solo Plus, no phosphoric acid 21.54.2 Aa 17.35.0 Aa
CONCLUSIONS: Fracture mechanics approaches may accurately model adhesive joints fracturing CONCLUSIONS: The SBS of Premise to Fuji II LC was higher than that to Fuji IX GP. Treatment
under a non-uniform stress distribution. Composite filler compositions may be tuned to control of glass-ionomer surfaces with Optibond Solo Plus without etching revealed the highest
fracture toughness of composite resin restoration. CLINICAL SIGNIFICANCE: A composite repair SBS. CLINICAL SIGNIFICANCE: In a restoration using the open-sandwich technique, etching
model may be used to predict the clinical success of composite-dentin joints. of glass-ionomer materials should be avoided for better adhesion at the resin composite/
glass-ionomer interface.
Removal of Saliva-contamination on and bonded to core-build-up cement-filled PMMA-cylinders using light-cured MLM following
Silicate/Metal-oxide Ceramics Before manufacturers instructions. Storage in water for 24 h at 37C or 10,000 thermo-cycles (5-55C,
Adhesive Cementation 45 s dwell-time) preceded TBS testing. RESULTS: Results in MPaSD. Same letters denominate
statistical equivalence (ANOVA, Tukey-B, p<0.05).
BOCK T*, MEIER F, KOCH S, SALZ U, HIRT T.
*Ivoclar Vivadent AG, Liechtenstein Lithium-disilicate ZirCAD
24 h 10,000 cycles 24 h 10,000 cycles
OBJECTIVES: During intraoral try-in of ceramic restorations the to-be-bonded surfaces are Uncontaminated 42.519.4 a 44.47.0 a 47.010.5 A 36.812.5 A
almost invariably contacted with saliva. This study investigated the effects of saliva removal Saliva/water-spray 22.713.7 b 0.0 c 15.819.6 B 0.0 C
by water-spray, phosphoric acid or the universal cleaning-agent Ivoclean (Ivoclar Vivadent) on Saliva/phosphoric acid 44.76.9 a 37.621.3 a 9.38.2 C 0.0 C
Saliva/Ivoclean 45.09.95 a 44.07.1 a 45.56.9 A 46.09.2 A
tensile bond strength (TBS) to lithium-disilicate (LD2, e.max, Ivoclar Vivadent) and zirconia (ZIR,
ZirCAD, Ivoclar Vivadent). MATERIALS AND METHODS: TBS (n=5) was determined on HF-etched CONCLUSIONS: Saliva contamination could not be removed by water-spray, severely lowering
LD2 or sandblasted ZIR using Monobond Plus (MBP, Ivoclar Vivadent) and Multilink Automix TBS and resistance to thermocycling. Though phosphoric acid effectively decontaminated LD2,
(MLM, Ivoclar Vivadent). Scenarios studied were: Uncontaminated reference, 60-s saliva + 10-s passivation of ZIR is evident from much reduced TBS and resistance to thermocycling. Only
water-spray, 60-s saliva + 10-s phosphoric acid, 60-s saliva + 10-s Ivoclean. Phosphoric acid Ivoclean proved effective decontaminating either ceramic surface. CLINICAL SIGNIFICANCE: A
and Ivoclean were applied to ceramics with micro-brushes and left to dwell without agitation proper protocol for decontamination of saliva-exposed ceramic surfaces must be followed
for 20 s before rinsing with water-spray. Decontaminated samples were primed with MBP for proper clinical success.
Influence of Cleaning Methods on Effect of Surface Treatments

Bond Strength to Contaminated Zirconia on Composite Repair Strength
YAMAN BC*, ZER F, IRMAK , KILIARSLAN MA, MANTE FK, BLATZ MB. RASHIDI-MEIBODI F*, FOROOZIA M, YOUSEFI-JORDEHI A, JAFARI-HORESTANI M.
*Eskiehir Osmangazi University Faculty of Dentistry, Turkey *Qazvin University of Medical Sciences School of Dentistry, Iran
OBJECTIVES: This study evaluated the influence of saliva contamination and cleaning procedures OBJECTIVES: Repair of composite restorations is superior to replacement in terms of cost,
on shear bond strength of the self-adhesive resin cement Clearfil SA Cement (SAC, Kuraray) to time and preservation of tooth structure. Various surface treatments have been introduced to
zirconia. MATERIALS AND METHODS: One hundred and sixty zirconia blocks (5 x 5 x 3 mm) were improve the weak bond strength between new and aged composites. The aim of this study
divided into eight groups of 20 samples. The top surfaces of the blocks were contaminated was to evaluate the effect of silane and two bonding agents on shear bond strength (SBS)
with saliva. The contaminated surfaces of the samples were then cleaned with the study primer of repaired composite restorations. MATERIALS AND METHODS: Forty Filtek Supreme Ultra (3M
(P, Danville Zirconia Primer, Danville) and/or 10% hydrofluoric acid (HF). The groups were as ESPE) composite specimens were made and divided into five groups (four experimental groups
in the table. Cylindrical composite resin samples (2.1 mm in diameter, 3 mm in height) were and one control group). Experimental specimens were stored in distilled water at 37C for 30
bonded to zirconia surfaces with SAC in a special alignment apparatus under a load of 1,000 days and their surfaces were roughened with medium grit diamond. Silane and two bonding
g. Shear bond strengths were determined at a crosshead speed of 0.5 mm/min. The results systems were applied as follows: G1: Single Bond (3M ESPE), G2: RelyX Ceramic Primer (3M ESPE)
were analyzed with ANOVA and Tukeys HSD tests. RESULTS: Bond strength values to zirconia + Single Bond, G3: Clearfil Repair (Kuraray), G4: Clearfil SE Bond (Kuraray). Then fresh composite
were significantly reduced by saliva contamination (p<0.05). The different cleaning methods was bonded to the treated surfaces. Specimens were stored in distilled water at 37C for 24
influenced the bond strength of SAC to zirconia (p>0.05). h prior to measuring SBS with a universal testing machine at a crosshead speed of 0.5 mm/
min. Data were analyzed using one-way ANOVA and Tukey test. RESULTS: Clearfil SE Bond (G4)
Treatment groups Shear bond strength [MPa]SD
showed higher SBS than Single Bond (G1) when silane was not used. SBS in groups where the
G1: no contamination + SAC 7.31.5 a
G2: saliva contamination + SAC 5.61.4 a silane was applied (G2, G3) were significantly higher than groups without silane application
G3: no contamination + P + SAC 17.62.3 c (G1, G4) (p<0.05). CONCLUSIONS: The use of silane prior the application of adhesive enhanced
G4: saliva contamination + P + SAC 13.83.7 b the adhesion between old and newly added composites. CLINICAL SIGNIFICANCE: Silane primer
G5: P + saliva contamination + P + SAC 20.53.4 c may improve adhesion when repairing composite restorations. If silane is not available, Clearfil
G6: no contamination + HF + P + SAC 17.13.1 c
SE Bond may be a better alternative than Single Bond.
G7: saliva contamination + HF + P + SAC 16.13.6 bc
G8: P + saliva contamination + HF + P + SAC 17.12.6 c
CONCLUSIONS: Primer application to zirconia surfaces increased the bond strength of SAC.
However, HF treatment of contaminated zirconia did not influence bonding performance of SAC.
CLINICAL SIGNIFICANCE: Primer treatment of saliva contaminated zirconia surfaces is necessary
to get optimum bonding with SAC.

Water Aging Effects on Cement Bonds to Aesthetic Porcelains

MOON PC*, NASCIMENTO RF, GOMES ACR, GIANNINI M, MIGUEL LCM, GARCIA RN.
*Virginia Commonwealth University, USA
OBJECTIVES: To compare the shear bond strength (SBS) of two resin cements bonded to leucite-reinforced porcelains at one week to bonds aged 1 year. MATERIALS AND METHODS: Porcelain blocks
(4 mm wide, 14 mm length and 2 mm thick) were abraded with aluminum oxide (90 m) and randomly divided into 16 groups (n=5). Two resin cements (RelyX ARC and RelyX U100, 3M ESPE)
were bonded to the porcelains Creapress (CRE - Creation/Klema), Finesse All-Ceramic (FIN - Dentsply/Ceramco), IPS Empress Esthetic (IPS - Ivoclar Vivadent) and Vita PM9 (PM9 - Vita). Porcelain
blocks were treated with 10% hydrofluoric acid (for 1 min) and silane. Then three Tygon 3-mm tubes (area=0.38 mm2) were positioned over each block and filled with the resin cements and
light-cured for 40 s. Specimens were stored in relative humidity at 242C for one week. The 1-year specimens were stored in water at 37C. All bonds were tested in shear (applied of the base
cylinder with a thin wire - 0.2 mm) using an Instron at a crosshead speed of 0.5 mm/min. The results were analyzed by three-way ANOVA and Tukey test (p<0.05). RESULTS: There was a decrease
in SBS overtime for all ceramic subgroups in the ARC group. Ceramic subgroups presented similar SBS at 1 year in the ARC group. For U100, SBS of FIN and IPS remained stable overtime. While
FIN presented the highest SBS at 1 year in the U100 group, PM9 showed the lowest. The bonds of ARC cement were significantly lower than those of U100 cement for all porcelains. CONCLUSIONS:
The ARC cement was also weakened the most by aging. FIN porcelain with U100 cement proved the most stable strong bond. CLINICAL SIGNIFICANCE: RelyX U100 bonding to crowns and veneers
made of aesthetic porcelains may be more stable thanRelyX ARC.
Aging Decreases Bond Strength of Composites Fracture Resistance of Direct

to CAD/CAM Indirect Composite and Indirect Laminate Veneers
VIDOTTI HA*, CARVALHO RM, VALLE AL, PAULA VG, BONFANTE EA. DUZYOL M*, SEVEN N, AKGUL N.
*University of So Paulo, Bauru, Brazi *Ataturk University Faculty of Dentistry, Turkey
OBJECTIVES: Layering direct composites to CAD/CAM composites may be needed for improve- OBJECTIVES: To evaluate fracture resistance of two veneering materials using three production
ment in esthetics, anatomical changes, or repair. This study evaluated the effect of water storage techniques. MATERIALS AND METHODS: Twenty-seven extracted human central incisors were
on themicrotensile bond strengths of direct and indirect composites bonded to CAD/CAM prepared using similar preparation design (intra-enamel) and restored with (1) resin nano
composites. MATERIALS AND METHODS: Twenty composite CAD/CAM blocks (Lava Ultimate, 3M ceramic (Lava Ultimate, 3M ESPE) milled by CAD/CAM technology (CEREC 3D milling system,
ESPE) were polished to 600-grit silicon carbide paper, sandblasted (50 m Al2O3), and cleaned Sirona), (2) direct composite technique (nano-hybrid composite Filtek Z550, 3M ESPE), and (3)
in ultrasonic bath. A one-step self-etch adhesive (Adper Easy Bond, 3M ESPE) was applied, left indirect composite laminate technique (Tescera ATL, Bisco). Indirect restorations were cemented
undisturbed for 30 s for solvent evaporation, and light-cured for 10 s. An indirect composite with the dual-cured luting cement Duo-Link Universal (Bisco) and all specimens were stored in
(n=10, Ceramage, Shofu) or a direct composite (n=10, Filtek Supreme, 3M ESPE) was then distilled water at 37C for 2 weeks. For mechanical testing, specimens were supported by a small
incrementally placed (1.5-mm increments), light-cured for 60 s, and longitudinally sectioned block of polyethylene material to act as a shock absorber. A steelblock with a spherical ball
with a diamond saw under water irrigation. Hourglass-shaped samples with approximate 0.5 (1 mm in diameter) was placed on the incisal edge of the veneer material and the specimens
mm cross-section area were prepared with an ultrafine diamond bur. Half of the samples were
2
loaded to fracture. The fracture resistance was evaluated using a universal testing machine
tested 24 h after the bonding procedures and the other half was stored in distilled water for 6 (Instron 3344, Instron Inc.). Results were analyzed with ANOVA, Tukey-LSD, and Duncan post
months before testing. Microtensile bond strength was performed at 0.5 mm/min. Data were hoc tests. RESULTS: Results are shown in the table below.
analyzed using two-way ANOVA and Bonferroni Multiple Comparison Post Test. RESULTS: Mean
(I) groups Mean SD (J) groups Mean Difference SE Significance
24-h bond strength values were 80.1(17.8) and 81.7(15.3) MPa for Ceramage and Filtek Supreme, (MPa) (I-J)
respectively. After 6 months of water storage, the mean values were 32.4(9.8) and 42.2(15.5) Tescera Lava Ultimate -39.7 24.2 0.114
92.1 22.7
MPa for Ceramage and Filtek Supreme, respectively. No statistical difference was detected ATL Filtek 550 -68,30667* 24.2 0.009
between materials (P= 0.139). However, aging caused a significant decrease (P <0.001) in bond Tescera ATL 39.7 24.2 0.114
Lava
131.8 51.0
strengths for both materials. CONCLUSIONS: Aging reduced the bond strengths of both direct Ultimate Filtek 550 -28.6 24.2 0.249
and indirect composites bonded to the CAD/CAM indirect composite. CLINICAL SIGNIFICANCE: The Tescera ATL 68,30667* 24.2 0.009
results highlight the implications of aging on composite/composite bond strength and raise Filtek 550 160.4 69.3
Lava Ultimate 28.6 24.2 0.249
concerns about the stability of veneering and repairing of CAD/CAM composite restorations.
CONCLUSIONS: In terms of fracture resistance, the most favorable veneering technique among
the test materials is the direct technique using Filtek 550. CLINICAL SIGNIFICANCE: Direct
composite veneers seem to be a reliable technique in regards to fracture resistance.

Effect of Primers on Bond Strength of Polyamide Thermoplastic Resins
SHINPO H*, SAKURAI T, OKAYAMA S, TOKUE A, OHKUBO C, TSUCHIKAWA M.
Tsurumi University School of Dental Medicine, Japan
OBJECTIVES: Recently, thermoplastic resin has been frequently used to fabricate flexible dentures without metal clasps. Because polymethyl methacrylate (PMMA) resin does not bond to polyamide
thermoplastic resin, it is necessary to develop a bonding methodology for denture repair or relining. In this study, the bond strength of PMMA resin to polyamide thermoplastic denture base resins
was evaluated using new primers. MATERIALS AND METHODS: The surfaces of polyamide (nylon 6) thermoplastic resin (Bioplast, High Dental, Japan) plates (10 10 2 mm) were polished using
600-grit abrasive paper and sandblasted with 50-m alumina particles (0.48 MPa). Then the primers Pre-primer (Pre-P, Relining-Pre primer, High Dental, Japan) and Val-fuse Repair Liquid (Val,
Valplast, USA) were used on the surface. Specimens without primer and heat-polymerized denture base resin (Acron, GC, Japan) were prepared as controls. Autopolymerized PMMA resin (Provista,
Sun Medical, Japan) was mixed, poured into a Teflon ring (3 mm in diameter, 1 mm in height) stabilized on the experimental groups, and polymerized according to the manufacturers instructions.
After polymerization, the specimens were stored in 37C distilled water for 24 h. The tensile bond strengths were measured on an autograph (AG-IS, Shimadzu, Japan) at a crosshead speed of 2.0
mm/min. The results (n=5) were analyzed by ANOVA and Tukeys test (=0.05). RESULTS: The use of Val resulted in higher bond strength than Pre-P (p<0.05). Bonding to the thermoplastic resin
Bioplast with Val and heat-polymerized denture base resin showed similar bond strengths (p>0.05). CONCLUSIONS: PMMA resin exhibited the greatest bonding strength to polyamide thermoplastic
resin when treated with Val. CLINICAL SIGNIFICANCE: Polyamide thermoplastic resin can be repaired and relined with PMMA resin after treatment with Val-fuse Repair Liquid.
DENTAL MATERIALS
Efficacy of ICON on Artificial Enamel Carious Lesions

ARSLAN S*, ZORBA YO, ATALAY MA, OZCAN S, DEMIRBUGA S, PALA K, OZER F.
*University of Erciyes Faculty of Dentistry, Turkey
OBJECTIVES: The aim of this study was to evaluate the effect of the resin infiltration technique on surface roughness, microhardness, and antibacterial surface properties of artificial enamel carious
lesions and compare the results with other surface therapies. MATERIALS AND METHODS: Artificial white spot lesions were produced in the human enamel of 150 square-shaped specimens which were
randomly divided into five groups: Group I- Untreated (control); Group II- APF gel application; Group III- Enamel Pro Varnish (Premier) application; Group IV- Excite F (Ivoclar Vivadent) application;
and Group V- ICON (DMG) application. Specimens were evaluated for Vickers hardness, surface roughness, and antibacterial surface properties. Statistical analysis was performed using one-way
ANOVA and Kruskal-Wallis tests at p=0.05. RESULTS: ICON showed significantly lower surface roughness and higher hardness values than the other groups (p<0.05). Although Enamel Pro Varnish
showed the highest antibacterial effect on S. mutans, it was followed by ICON, indicating its own high antibacterial effect. CONCLUSIONS: The increase in microhardness and decrease in surface
roughness of demineralized enamel with low bacterial attachment showed that the resin infiltration technique may be a good therapeutic option for white spot lesions. CLINICAL SIGNIFICANCE:
The use of a resin infiltrant may be considered as a microinvasive treatment of smooth-surface white spot lesions.
The Effect of Whitening Mouthrinses on Color Evaluation of Aged Dental Composite Resins:
Parameters of Composite Simulating Clinical Failures
HARORLI OT*, BARUTCIGIL C. CHIANG HK*, CHUMBLE AA, DIXON SW, BEST AM, MOON PC.
*Akdeniz University Faculty of Dentistry, Turkey *Virginia Commonwealth University School of Dentistry, USA
OBJECTIVES: The aim of this study was to investigate the bleaching effects of six commercial OBJECTIVES: The objective of this study was to compare mechanical properties of in vitro aged
whitening mouth rinses on a stained universal composite resin, in vitro. MATERIALS AND and unaged composite resins. Chip force and flexure strength tests were used to simulate
METHODS: Sixty composite resin specimens were prepared with the universal composite resin composite failures, marginal chipping, and bulk fracture from clinical occlusal contacts.
Filtek Z250 shade A2 (3M ESPE). Baseline CIE L* a* b* color coordinates were measured with MATERIALS AND METHODS: Four composite resins (Z250, 3M ESPE; Esthet-X, Dentsply Caulk;
a spectrophotometer. Specimens were submitted to two cycles of staining with coffee and Filtek Supreme, 3M ESPE; and Heliomolar, Ivoclar Vivadent) were cured to form test samples
cherry juice. Stained composites were then distributed into six whitening groups: Listerine (n=8) for aged and unaged chip force and flexure strength tests. The unaged test groups
Whitening Vibrant (Johnson and Johnson), Scope White (Oral B), Crest 3D White (Procter and remained in deionized water and the aged test groups in 0.1 M NaOH at 60 C for a two-week
Gamble), Oral-B 3D White (Procter and Gamble), Signal White Now (Unilever), and Colgate period before testing. Chip force was measured using a Vickers diamond indenter placed 0.4
Optic White (ColgatePalmolive). Specimens were immersed in the whitening mouth rinses mm from the edge of the test sample. Flexure failure was recorded by an Instron at a crosshead
and changes in color coordinates were measured after 24 and 72 h. Baseline measurement was speed of 0.5 mm per minute. Flexure strength was calculated using the sample dimensions and
taken after staining. Data were analyzed by one-way ANOVA and Tukeys test. RESULTS: After the fracture forces measured via a three-point bend test. RESULTS: Two-way ANOVA indicated
24 and 72 h of immersion periods, all whitening mouth rinses caused a perceptible bleaching that there was a significant difference between the unaged and aged NaOH groups, but
effect (E*>3.3). There were no statistical differences between hydrogen peroxide-containing significant degradation did not occur for all composites (Tukey multiple comparison procedure
mouth rinses Listerine Whitening Vibrant, Scope White and Crest 3D White groups, and Signal p<0.05). In aged composite samples, the flexure strength of Esthet-X was the lowest but was
White Now and Colgate Optic White, which do not contain hydrogen peroxide, in both time not significantly lower than the other composites. Also for aged composites, the chip force of
periods. CONCLUSIONS: Discolored composite resin specimens exposed to tested mouth rinses Z250 and Filtek Supreme were significantly lower than Esthet-X and Heliomolar. NaOH aging
were perceptibly whitened. CLINICAL SIGNIFICANCE: The results of this in vitro study show had the greatest reduction in the mechanical properties of Z250, Esthet-X, and Filtek Supreme.
that whitening mouth rinses may be capable of bleaching stained composite resins after a CONCLUSIONS: The mean strengths of the aged samples were all lowered at least slightly, but
prolonged exposure period. the amount of the decrease depended on the composite. CLINICAL SIGNIFICANCE: This is the
preliminary effort to explore the development of a laboratory method for correlating clinical
composite failures with aging.

Different Curing Protocols on Internal Adaptation in Class I Cavities
TIAN FC*, WANG XY, WANG ZH, GAO XJ, SADR A, TAGAMI J.
*Peking University School and Hospital of Stomatology, China
OBJECTIVES: To assess the effect of adhesive-composite curing protocol on tooth-restoration interface integrity with swept source optical coherence tomography (SS-OCT). MATERIALS AND
METHODS: Standard Class I cavities (3 mm in diameter, 2 mm in depth) were prepared on occlusal surfaces of 32 human molars. Each cavity was restored with an all-in-one adhesive (Clearfil SE
One, Kuraray) and a dual-cure composite (Clearfil DC Core One Automix, Kuraray) in bulk. Four groups were obtained based on different curing protocols (n=8): Group 1: Light-cured adhesive with
dual-cured composite; Group 2: Uncured adhesive with dual-cured composite; Group 3: Light-cured adhesive with self-cured composite; Group 4: Uncured adhesive with self-cured composite.
After 24-h incubation in 37C water, 12 B-scan images were obtained from each restoration with SS-OCT. All specimens were subjected to 5,000 thermal cycles (5-55C), after which the OCT scan was
repeated. Gap percentage at the interface was calculated using image analysis software. Statistical analysis was performed at a significance level of 0.05. After trimming and polishing, CLSM and
SEM observation were carried out on three specimens in each group to confirm and locate the gaps. RESULTS: Group 2 showed the highest gap percentage (63.7%13.2%), which was significantly
higher than group 3 (22.3%20.7%) before thermocycling. Group 1 and Group 4 showed intermediate gap formation. After thermocycling, there was no significant difference between groups.
CLSM and SEM observations showed gaps of Group 1 and Group 3 located between adhesive and composite while for Group 2 and Group 4 it was predominantly between adhesive and dentin.
CONCLUSIONS: Restorations with light-cured adhesive and self-cured composite showed better interface integrity before thermocycling, but gaps could not completely be prevented by any curing
protocol when specimens were subjected to a thermal stress challenge. CLINICAL SIGNIFICANCE: The curing protocols tested will not prevent gap formation at the adhesive-restoration interface.
Quantitative Microleakage Analysis of Morphological Assessment of the Effect of

Resin Cements through Lipopolysaccharide Fluoride-containing Solutions onto Dentin
Penetration Model INOUE G*, SHINAGAWA J, TAGAMI J.
*Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan
JANG JH*, SON HH, SEO DG.
*Kyung Hee University Dental Hospital at Gangdong School of Dentistry, Korea
OBJECTIVES: Acid-base resistant zones (ABRZs) may be observed beneath the hybrid layer
OBJECTIVES: To analyze the sealing ability between dentin and ceramic restored with etch- when self-etching primer systems are used on dentin. Also, it has been found that a fluoride-
and-rinse and self-adhesive resin cements in a 5-week period using fluid transport and containing solution makes the ABRZ thicker and more durable compared with normal tooth.
lipopolysaccharide (LPS) penetration models. MATERIALS AND METHODS: Standardized round The purpose of this study was to compare the effects of three fluoride-containing solutions
preparations (1 mm in diameter and 2 mm in depth) were cut on 12 ceramic disks made from on artificial caries affected dentin before application of two-step self-etching primer adhesive
ceramic blocks (IPS Empress CAD, Ivoclar Vivadent). Similar preparations were made on human system. MATERIALS AND METHODS: Human dentin disks, which had been artificially demineralized
premolars (n=12). Prepared ceramic and dentin specimens were randomly assigned into 4 to mimic caries-affected dentin, were treated according to the following (fluoride-containing)
groups (n=6) to be treated as follows: G1 etch-and-rinse resin cement (Variolink II, Ivoclar groups: Nanoseal (Nihon Shika Yakuhin, Japan), Teethmate Desensitizer (Kuraray Noritake
Vivadent) and ceramic specimens, G2 etch-and-rinse resin cement and dentin specimens, Dental, Japan) and APF Gel (Bee Brand Medico Dental, Japan). Control specimens were not
G3 self-adhesive resin cement (SmartCem2, Dentsply Caulk) and ceramic specimens, G4 treated with fluoride. Disks of treated and untreated (control) specimens were treated with
self-adhesive resin cement and dentin specimens. The preparations on the ceramic blocks Clearfil SE Bond (Kuraray Noritake Dental) and bonded to each other with an intermediate layer
were filled with resin cements using the techniques recommended by the manufacturers and of the resin composite Majesty LV (Kuraray Noritake Dental). The composites (disk-composite-
underwent thermocycling (10,000, 5-55C). The sealing ability of all samples was evaluated disk) were light-cured for 40 s from each side. Specimens were stored in water for 1 day
using the LPS penetration models. The samples were analyzed by a spectrophotometer using and then subjected to a demineralizing solution (pH 4.5) for 90 min followed by immersion
Limulus amebocyte lysate assay kit during 5 weeks. RESULTS: Luting cement was a significant in 5% NaOCl for 20 min. Specimens were argon-ion-etched for 40 s and observed using a
factor for ceramic and dentin interfaces. G1 and G2 showed less LPS penetration in comparison scanning electron microscope. RESULTS: ABRZs were observed in all specimens. Experimental
with G3 and G4. G1 presented the best sealing ability over the study period. LPS leakage was fluoride-containing-treated groups showed thicker ABRZs than the control group. There was no
detected from the beginning in G3 and G4, and after 4 to 5 weeks in G2. CONCLUSIONS: Variolink significant difference among the three experimental groups. CONCLUSIONS: Application of the
II, which is an etch-and-rinse resin cement, had better sealing ability than SmartCem2, which is test fluoride-containing solutions onto artificial caries affected dentin resulted in thick ABRZs.
a self-adhesive resin cement, when tested in a leakage model for LPS as a major virulence factor Results were material-dependent. CLINICAL SIGNIFICANCE: It may be possible to remineralize
from bacteria. CLINICAL SIGNIFICANCE: Although leakage was noticed at the resin cement-dentin and reinforce demineralized dentin by application of fluoride-containing solutions prior to
interface, Variolink II outperformed SmartCem2 in regards to leakage over a 5-week period. restorative treatment (bonding).
Thus, Variolink II may be a better alternative for cementation of indirect ceramic restorations.
DENTAL MATERIALS
Efficacy of High-intensity LED Curing-units on Polymerization of Resin Cement

WATANABE H*, KAZAMA R, ASAI T, ISHIZAKI H, FUKUSHIMA M, OKIJI T.
*Niigata University Graduate School of Medical and Dental Sciences, Japan
OBJECTIVES: This study aimed to evaluate the effectiveness of high-intensity LED curing-units on the Knoop hardness of a dual-cured resin cement when irradiated through a ceramic plate. MATERIALS
AND METHODS: A halogen unit (Jetlite 3000, Morita), an LED unit (Demi, Kerr), and two high-intensity LED units (PenCure 2000, Morita and Valo, Ultradent) were tested. Plates of feldspathic ceramic
(VITABLOCS Mark , A3, Vita Zahnfabrik) were prepared at 1.0-, 2.0-, and 3.0-mm thicknesses. A dual-cured resin cement (Clearfil Esthetic Cement, Kuraray Noritake Dental) was irradiated directly
or through one of the ceramic plates under different curing-time protocols (5, 10, 15, and 20 s for high-intensity LED units and 20, 40, 60, and 80 s for halogen and LED units). Control specimens
were irradiated directly. Knoop hardness test was used to determine the level of photopolymerization of the resin cement. Data were analyzed by three-way ANOVA and a post-hoc Tukeys test
(p<0.05). RESULTS: Knoop hardness number (KHN) values tended to decrease with increasing the plate thickness, and increase with extending the irradiation time. When the plate thickness was
3.0 mm, only 20-s irradiation with Valo showed KNH values equivalent to those reached after the direct irradiation. CONCLUSIONS: Ceramic thickness and irradiation time negatively affected the
polymerization ability of different curing units. CLINICAL SIGNIFICANCE: When resin cements are irradiated through ceramic restorations, high-intensity LED curing units can be useful since they
can compensate for the improper polymerization caused by the presence of the restoration. Extended polymerization times may be necessary though.
A New Ion-releasing Bulk Fill Composite Resin Evaluation of Pulpal Microleakage of

Containing S-PRG Filler Four Pulp Capping Agents
FUJIMURA H*, MIYATA S, KASABA H, KOBAYASHI H, KIMOTO K, NAKATSUKA T. YALCIN M*, BARUTCIGIL C, SISMAN R, YAVUZ T, ORUCOGLU H.
*Shofu Inc., Japan *nn University Faculty of Dentistry, Turkey
OBJECTIVES: Recently, bulk fill composite resins have been attracting attention because of their OBJECTIVES: The aim of this study was to assess sealing ability of various materials against
ease use that enables 4 mm-thick increments to be polymerized at once. We have developed a leakage on direct pulp capping with a computerized fluid filtration method. MATERIALS AND
novel bulk fill composite resin having bioactive effects induced by the addition of S-PRG filler METHODS: Sixty recently extracted sound human molars were sectioned at the level of highest
that utilizes pre-reacted glass-ionomer (PRG) technology. This study aimed to evaluate the pulp horn to obtained dentin discs of 0.5 0.2-mm thickness. The dentin discs were numbered
light-curing properties and acid-neutralizing effects of this material. MATERIALS AND METHODS: and permeability measurement was done before and after treating the samples. For the
The test material was filled in a cylindrical mold (diameter: 4 mm, depth: 8 mm) and light-cured simulated direct pulp capping, dentin discs were perforated with standard diamond bur and
from the top surface. Each cured specimen was vertically sectioned and Vickers hardness (VH) restored with four different capping materials: Dycal (Dentsply), Calcimol LC (Voco), ProRoot MTA
was measured up to 4 mm depth at 1 mm intervals. Results were expressed in VH retention (Dentsply) and DiaRoot BioAggregate (DiaDent). Fluid movement measurements were made
rate (%) for each measurement depth point with reference to VH of the irradiated surface as at 2-min intervals for 8 min, and the mean was calculated for each material. RESULTS: Calcimol
100%. For evaluation of acid-neutralizing effect, specimens cured into a disc shape (diameter: LC showed significantly higher fluid conductance values than other pulp capping materials
15 mm, depth: 1 mm) were prepared and immersed in 5 mL of lactic acid solution (pH 4.0). (p<0.05). There was no significant difference between ProRoot MTA, DiaRoot BioAggregate and
The change in pH in the solution was measured up to 12 h using a pH electrode. RESULTS: VH Dycal groups (p >0.05). CONCLUSIONS: Within the limitations of this study, it can be concluded
retention rates (%) were: 99.4 at 1 mm, 97.7 at 2 mm, 94.0 at 3 mm and 91.6 at 4 mm. For acid that the effects of pulp capping agents on dentin permeability are material-dependent. CLINICAL
neutralization evaluation, the pH of the solution shifted to the neutral region from 4.0 (initial) SIGNIFICANCE: The results obtained from this in vitro study suggest that ProRoot MTA, DiaRoot
through 4.7 at 1 h to 5.6 at 12 h. CONCLUSIONS: This bulk fill composite resin showed excellent BioAggregate and Dycal are preferred direct pulp capping materials regarding sealing ability.
light-curing properties (at 4 mm depth) and acid-neutralizing effect. CLINICAL SIGNIFICANCE:
A 4-mm bulk fill technique using this product is expected to exhibit sufficient polymerization
at the deepest part of the restoration (resin-dentin interface). The product also is expected
to reduce the risk of secondary caries due to its neutralizing effect on cariogenic bacteria.

DENTAL MATERIALS
Characterization of Three Glass Ionomer Restorative Materials

VEOLU ML*, TARIN B, VEOLU HS, GKE H, SINNMAZIIK G, TRKAYDIN D.
*stanbul Technical University, Turkey
OBJECTIVES: This study aimed to compare some characteristics of three different glass ionomer restoratives both in the capsulated form and polymerized bulk samples. MATERIALS AND METHODS:
Physical characterization investigations were carried on capsulated powders and polymerized bulk samples of ChemFil Rock (CR, Dentsply Caulk), Ionofil Molar AC Quick (IM, Voco), and Equia Fil
(EF, GC) glass ionomer restoratives. Powder particle size measurements were performed in a Mastersizer laser particle size analyzer (Malvern) using dry and wet media (deionized water). True
density measurements of powders and polymerized bulk samples were carried out in an AccuPycTM II 1340 pycnometer (Micromeritics). X-ray diffraction (XRD) tests were conducted using a
D8 Advance diffractometer (Bruker) on both powders and bulk samples. Data were analyzed statistically using one-way ANOVA and Tukeys HSD tests (p<0.05). RESULTS: Mean particle sizes of
the powders measured in dry conditions varied between 5-9 m and exhibited uni modal distribution. EF and IM measured in wet conditions varied unreliably with measurement time. Mean
particle size values of CR in wet conditions increased from 5 m to 7 m. Whereas true densities varying between 2.53 g/cm3 (IM) and 2.72 g/cm3 (CR) were measured for powders, those for the
bulk samples were between 2.28 g/cm3 (IM) and 2.33 g/cm3 (CR). XRD investigations revealed amorphous patterns for the powder samples except for IM. On the other hand, bulk XRD patterns
exhibited a single SiO2 peak for all samples. CONCLUSIONS: Among the three glass ionomer restoratives, CR is least affected by water. True densities of bulk samples are about 10% less than those
of powders due to liquid treatment. CLINICAL SIGNIFICANCE: ChemFil Rock exhibited the most stable characteristics among the test materials.
Mechanical Properties and Radiopacity of Glass Biofilm Inhibition by Composites

Ionomer Restoratives Containing Bioactive Glass-Ursolic Acid
VEOLU HS*, TARIN B, GMR B, VEOLU ML. KIM S*, OH M, KIM H, PARK JW.
*Marmara University Faculty of Dentistry, Turkey *Gangnam Severance Dental Hospital Yonsei University, Korea
OBJECTIVES: The objective of this study was to evaluate the mechanical properties and OBJECTIVES: This study investigated the antibacterial effect of composite resins containing
radiopacity of three different glass-ionomer restoratives (GIRs). MATERIALS AND METHODS: bioactive glass (BAG, 62mol% SiO2, 31mol% CaO, 4 mol% P2O5, and 3 mol% F) - ursolic acid (UA)
Three commercially available GIRs (ChemFil Rock, Dentsply Caulk; Ionofil Molar AC/Quick, stored in distilled water for 6 months, on the adhesion of Streptococcus mutans. MATERIALS
Voco; and Equia Fil, GC) were tested in this study. Bar-shaped samples for flexural strength/ AND METHODS: Four antibacterial composites [BAG, BAG filler coated with UA (UA-BAG), UA
three-point bending (n=10 per GIR) and cylindrical samples for compressive strength tests added to resin matrix (BAG+UAM), UA added to BAG and resin matrix (UA-BAG+UAM)] and a
(n=10 per GIR) were prepared from each of the GIRs. Following distilled water storage for 7 conventional composite used as control group were developed. For biofilm assay, Streptococcus
days, flexural and compressive strengths of the samples were measured using a universal mutans was incubated for 24 h with each composite resin disk specimen in a biofilm medium
testing device with a load cell of 50 kg and a crosshead speed of 1 mm/min. Fragments of the with either glucose or sucrose in the presence or absence of a salivary coating. The adherent
three-point bending test were used to determine Vickers hardness (load 200 g, dwell time 30 bacteria were quantified after sonication of the specimen by counting the colony forming units
s). For radiopacity evaluation, 10 standard disc specimens (5 mm x 1 mm) were prepared from (CFU) of viable bacteria. All specimens were then stored in distilled water for 6 months. After
each of the GIRs and radiographs were taken together with 1-mm-thick tooth slices and an sterilization with ethylene oxide gas, biofilm assay was performed again on all five groups.
aluminum (Al) stepwedge using Drr Vistascan Mini digital imaging system (Drr Dental). The Two-way ANOVA with Bonferroni correction was used for comparison between time 0 and
data were analyzed statistically using one-way ANOVA and Tukey HSD tests (p<0.05). RESULTS: water-stored samples (=0.05). RESULTS: Before water storage, decreased CFU values were
Statistically significant differences were observed between the mean flexural strength, compres- observed in the experimental groups. However after 6-month water storage, no significant
sive strength, and Vickers hardness values among the test materials. ChemFil Rock revealed the differences were observed regardless of carbohydrate source and salivary condition (>0.05).
highest flexural strength but the lowest compressive strength and microhardness values. The CONCLUSIONS: Within this experimental condition, experimental composites containing BAG
highest mean compressive strength and radiopacity values were obtained with Ionofil Molar and/or UA showed antibacterial effect on short-term period, but they did not show significant
AC/Quick. Equia Fil showed the highest Vickers hardness values. CONCLUSIONS: Among the GIRs reduction of Streptococcus mutans biofilm formation after water storage for 6 months. CLINICAL
tested, ChemFil Rock was superior in flexural strength, Ionofil Molar AC/Quick in compressive SIGNIFICANCE: BAG and ursolic acid may be helpful suppressing Streptococcus mutans growth
strength and radiopacity, and Equia Fil in microhardness. CLINICAL SIGNIFICANCE: None of the early after placement. Their long-term effect is questionable.
test GIRs showed outstanding properties in all performed tests. They were advantageous in
different mechanical aspects.

Bacteriocidal Copper-modified Adhesive Resins
MENNITO A*, RENNE WG, SCHMIDT MG, CHUMANOV G, WOLF BJ.
*Medical University of South Carolina, USA
OBJECTIVES: To evaluate the effects of copper iodide nanoparticles additions to available adhesive resins in antimicrobial activity and shear bond strength (SBS) to dentin. MATERIALS AND METHODS:
Solutions (10 mg/ml) of polyacrylic acid coated cui or cuo nanoparticles were used to create the adhesives by uniformly distributing them into either XP Bond (Dentsply) or Optibond XTR (Kerr).
Assessment of the antimicrobial activity of the adhesive was accomplished by inoculating the surface of the adhesive discs with 100 ml of a defined concentration of viable anaerobic bacteria.
Antimicrobial efficacy was determined between the viability at time 0 and at 18 h. Toxicity studies were done using human gingival fibroblasts and human periodontal ligament cell lines.
Specimens (n=10/group) also were prepared for SBS testing, which was performed using the Ultradent tester at a crosshead speed of 1 mm/min. Control groups bonded with the commercially
available adhesives and experimental groups (XP + 1000 g/ml, XP + 500 g/ml and XTR + 1000 g/ml) were tested. RESULTS: Discs treated with XP + 1000 g/ml, XP + 500 g/ml and XTR + 1000
g/ml had 99.999%, 99.99% and 79.65% reduction in viable S. mutans cell count, respectively, with no statistically significant change in SBS compared to controls. Preliminary MTT studies showed
that XP + 500 g/ml discs had no significant increase in toxicity in HGF cells when compared to XP discs alone after 36 h of incubation. CONCLUSIONS: Copper nanoparticles infused into adhesive
resins significantly increase antimicrobial properties without inversely affecting SBS. CLINICAL SIGNIFICANCE: Copper iodide-modified adhesive systems create a bacteriocidal environment within
the hybrid layer that may increase restoration longevity. Funded by SC Cobre for Oral Health Research P20RR017696 and the Center for Oral Health Research
Assaying Endogenous MMP-8 in Acid-etched

The Effects of Capping Materials on Dentinal Cavity Walls
Dental Pulp Stem Cells
KANG J*, IZUTANI N, DANGELO M, BUIS W, IMAZATO S, BLATZ MB, OZER F.
*University of Pennsylvania School of Dental Medicine, USA
YALCIN M*, KENAR H, DAYI B, KARAOZ E.
*nn University Faculty of Dentistry, Turkey
OBJECTIVES: Inhibition of matrix metalloproteinase (MMP) activity is expected to increase
OBJECTIVES: The purpose of this study was to evaluate the effects of different pulp capping long-term stability and durability of resin-based restorations by preventing degradation
materials (PCMs) on the odontogenic differentiation of dental pulp mesenchymal stem cells of denuded collagen fibrils in the hybrid layer (HL). In order to determine endogenous MMP
(DP-MSCs). MATERIALS AND METHODS: Eighty discs (2 x 9 mm) were prepared from PCMs, activity in the HL, their identification and quantification in dentinal cavity walls are imperative.
namely ProRoot (Dentsply), DiaRoot (DiaDent), Calcimol (Voco) and Dycal (Dentsply), using The objective of this study was to assay MMP-8. MATERIALS AND METHODS: Occlusal surfaces of
specially designed Teflon molds and applied in vitro on the DP-MSCs derived from molar tooth. eight extracted non-carious human molar teeth (< 2 days from extraction and maintained at
Cell proliferation was determined on days 1, 7, 14 and 21 with the WST-1 test. Odontogenic -80C) were removed using a low-speed diamond saw. A cavity (2 x 4 x 2 mm) was prepared
differentiation was evaluated by determination of alkaline phosphatase (ALP) activity on on the dentinal surface leaving surrounding dentinal walls of 1 mm thickness. Cavity walls were
days 14 and 21. Odontogenic gene expression was determined via real time PCR on days 7 and then acid-etched with 38% phosphoric acid and samples were pulverized using an analytic mill
14 to evaluate early stage differentiation. ELISA test were performed on day 14 to determine with liquid nitrogen, and demineralized in 1% phosphoric acid for 10 min at 4C. Demineralized
the amounts of osteocalcin and osteopontin produced by the cells. In addition, at the end of dentin samples were rinsed 3x with water and suspended at 1:2 ratio in extraction buffer (100
the odontogenic differentiation culture, on day 28, SEM was performed to examine the bone mM Tris-HCl pH 7.6, 0.1 mM ZnCl2, 100 mM CaCl2, 200 mM NaCl, 1% Triton X-100) containing a
nodule formation by the cells in presence of different PCMs. RESULTS: Higher cell proliferation protease inhibitor cocktail, and centrifugally concentrated approximately 2x. Total protein
rate was obtained in the wells containing ProRoot and DiaRoot discs. Although no difference was concentration was determined via Modified Lowry assay. MMP-8 concentration was determined
observed between control and odontogenic experimental groups on day 14 in terms of calcium using a human ELISA kit and activity by release of a fluorescent substrate. RESULTS:
phosphate deposition, primary bone nodule formation was evidenced in the odontogenic wells
MMP-8 Molar1 Molar2 Molar3 Molar4 Average Minus
on day 21 through positive Alizarin red staining. Calcium phosphate mineral deposition by the Outliers
cells cultured under odontogenic conditions for 28 days in presence of ProRoot and DiaRoot discs pg/mg dentin 0.179 0.465 0.1036 0.2036 0.2380.157 0.1620.052
Activity (M fluorescence) 2.1988 2.7494 1.4895 2.5841 2.255 -
was shown via scanning electron microscopy. ELISA tests carried out on day 14 revealed the
highest osteocalcin and osteopontin values in the DiaRoot group. CONCLUSIONS: MTA-containing CONCLUSIONS: This study demonstrates a reliable and consistent method of extracting and
PCMs have positive effects on DP-MSCs proliferation and odontogenic differentiation. CLINICAL assaying MMP-8 from a single-tooth dentin sample consisting of dentinal cavity walls. CLINICAL
SIGNIFICANCE: The use of MTA-containing PCMs in the direct pulp capping treatment can play SIGNIFICANCE: This novel method will contribute toward determining endogenous activity
an important role in the repair of dentin. of MMPs present in dentinal cavity walls and establishment of a reliable extraction method
to investigate selective inhibition of host-derived MMPs using dentin adhesive systems in
clinical situations.
DENTAL MATERIALS
Core Thickness and Compression Surface Effects on Strength of All-ceramic Materials

SINMAZIIK G*, DEMIRBA B, ZER F, GLMEZ T.
*Marmara University School Vocational School of Health Services, Turkey
OBJECTIVES: The aim of this study was to assess the effects of zirconia core thickness and zirconia and porcelain compression surfaces on the flexural strength of bi-layered dental ceramic specimens.
MATERIALS AND METHODS: A total of 48 disks with variable thicknesses, i.e., 0.3 mm (n=16, group 1), 0.4 mm (n=16, group 2), 0.5 mm (n=16, group 3) were obtained from a fully sintered zirconia
block. A layer of dentin porcelain 1.5 mm in thickness was fired on the zirconia specimens of each group according to the instructions of the manufacturer. Biaxial flexural strength tests were
carried out on the bilayer disks. The test surface was the overlaying porcelain in half of the specimens and the zirconia surface in the other half (n=8). The flexural test results were analyzed with
one-way ANOVA test. RESULTS: The porcelain test surface exhibited significantly higher flexural strength values than the zirconia test surface. Comparing the flexural strength values between the
different thicknesses, 0.3 mm (253 MPa) and 0.5 mm (297 MPa) zirconia core groups were significantly different (p0.05) for the porcelain test surface and 0.3 mm (85 MPa), 0.4 mm (99 MPa) and
0.5 mm (145 MPa) were significantly different from each other (p0.05) for the zirconia test surface. CONCLUSIONS: Increasing zirconia core thickness contributes to higher flexural strength values
of bilayer zirconia-dentin porcelains regardless of the test surfaces. CLINICAL SIGNIFICANCE: The thickness of the zirconia core should be taken into consideration when fabricating high-strength
ceramic restorations.
Effect of a Polymerizable Cationic Non-Protein Thiols Inhibit Dentinal MMPs and

Monomer on Dentin MMPs HEMA Toxicity
LI F*, LIU N, ZHANG L, CHEN JH. NASSAR M*, HIRAISHI N, SHIMOKAWA H, TAMURA Y, OTSUKI M, OHYA K, TAGAMI J.
*Fourth Military Medical University School of Stomatology, China *Tokyo Medical and Dental University, Japan
OBJECTIVES: This study examined the use of methacryloxylethyl cetyl dimethyl ammonium OBJECTIVES: Phosphoric acid (PA) etching used in etch-and-rinse adhesives is known to activate
chloride (DMAE-CB) as a potential matrix metalloproteinases (MMPs) inhibitor on both soluble host-derived dentinal matrix-metalloproteinases (MMPs) and increase dentin permeability.
recombinant MMPs and dentine matrix-bound endogenous MMPs. It also examined the effective These two phenomena will result, respectively, in degradation of dentin-adhesive bonds and
anti-MMP group of quaternary ammonium methacrylates (QAMs). MATERIALS AND METHODS: leaching of some monomers especially 2-hydroxyethyl methacrylate (HEMA) into the pulp
The possible inhibitory effects of DMAE-CB (concentrations of 0.1%, 0.5%, 1%, 3% and 5%) on that might negatively affect the vitality of pulpal cells. This study is the first to investigate
soluble rhMMP-9 were measured using a colorimetric assay kit. Methyl methacrylate (MMA) the inhibitory effect of non-protein thiols (NPSH), namely reduced glutathione (GSH) and
and [2-(Methacryloyloxy)ethyl] trimethylammonium chloride (METMAC) were also screened N-acetylcysteine (NAC), on dentinal MMPs and on HEMA cytotoxicity. Chlorhexidine (CHX) will
against rhMMP-9 to compare the inhibitory effect with DMAE-CB. Matrix-bound endogenous be use for comparison. MATERIALS AND METHODS: Dentin powder was prepared from human
MMP-activity was evaluated in completely demineralized dentin beams. Thirty beams were teeth, demineralized with 1% PA and then treated with 2% GSH, 2% NAC or 2% CHX for 1 min.
randomly divided into three groups and placed into 500 L of calcium- and zinc-containing Zymographic analysis of extracted proteins was performed. To evaluate the effect of GSH, NAC
media (CM, control), 0.2% chlorhexidine or 3% DMAE-CB in CM aged for 30 days. The changes in and CHX on HEMA cytotoxicity, solutions of these compounds were prepared with or without
modulus of elasticity, loss of dry mass and solubilization of collagen peptides were measured HEMA and rat pulpal cells were treated with the tested solutions for 6 and 24 h. Cells viability was
via three-point bending, precision weighing and hydroxyproline assay, respectively. RESULTS: measured by means of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)
0.5%-5% mass concentrations of DMAE-CB were highly effective (P<0.05) in inhibiting rhMMP-9 assay. Cytotoxicity data were analyzed by one-way ANOVA and Tukey post-hoc tests (P<0.05).
(range 76.6%-97.1%). The inhibitory effect of MMA was lower than that of METMAC and DMAE-CB RESULTS: The inhibitory effect of GSH and NAC on dentinal MMPs was confirmed. GSH, NAC and
at the same concentration (P<0.05). Dentin beams incubated in 3% DMAE-CB showed a 26.3% CHX inhibited pro- and active forms of MMP-2. GSH had similar effectiveness to NAC regarding
decrease in the modulus of elasticity (75.7% decrease in control), a 1.7% loss of dry mass HEMA cytotoxicity inhibition while CHX did not show this protective effect. CONCLUSIONS: NPSH
(29.7% loss in control), and less solubilized hydroxyproline when compared with the control used in this study were effective inhibiting dentinal MMPs and HEMA cytotoxicity. CLINICAL
(P<0.05). CONCLUSIONS: DMAE-CB is effective at inhibiting both soluble recombinant MMPs and SIGNIFICANCE: The two properties of the NPSH studied provide promising clinical use, which
matrix-bound dentine MMPs. Quaternary ammonium group is the effective anti-MMP group may enhance dentin-bond durability and decrease post-operative sensitivity. This work was
of QAMs. CLINICAL SIGNIFICANCE: The incorporation of DMAE-CB into dental adhesives has the supported by a grant from the Japanese Ministry of Education and Global Center of Excellence
potential to enhance the durability of dentin bonding. This study was financially supported by program, International Research Center for Molecular Science in Tooth and Bone Diseases.
grants from the Natural Science Foundation of China (No. 81100772, No. 81130078) and Natural
Science Foundation of Shanxi Province, China (No. 2011JQ4020).

Effect of Polishing Procedures on Color Stability of Composite Resins
ESENER EZ*, CAN SAY E.
*Yeditepe University Faculty of Dentistry, Turkey
OBJECTIVES: The purpose of this study was to evaluate the effect of different polishing procedures on color stability of nanohybrid (Clearfil Majesty Esthetic, Kuraray), nanofil (Filtek Ultimate,
3M ESPE), and microhybrid (G-aenial, GC) composite resins. MATERIALS AND METHODS: A total of 120 composite resin discs, 40 from each material, 8 mm in diameter and 2 mm in thickness were
polymerized under Mylar matrix (Optilux 501, Kerr). Surface finish of the specimens was accomplished with tungsten carbide burs and then each composite resin group was randomly divided
into four subgroups (n=10) according to the polishing procedure: 1) Sof-Lex (3M ESPE), 2) Sof-Lex + Diamond polish (Ultradent), 3) PoGo (Dentsply), 4) PoGo + Diamond polish. Following storage
in artificial saliva for 24 h at 37C, initial color measurements were performed with a spectrophotometer (CM-2600d, Konica Minolta). Then the specimens were immersed in tea with the staining
cycle being repeated for 14 days. Color differences (E) were then evaluated. Data were analyzed using one-way ANOVA and post hoc Tukeys tests (p<0.05). RESULTS: All the test composite
resins showed statistically significant changes in E during the 14-day period (p<0.05), which was greater than the clinically acceptable value of 3.3. When the same polishing procedures were
compared, Clearfil Majesty Esthetic showed less color change than Filtek Ultimate (p<0.05). The differences between Filtek Ultimate, G-aenial, and Clearfil Majesty Esthetic compared to G-aenial
were not significant (p>0.05). Except for the G-aenial/PoGo group, combination of the polishing system with a polishing paste showed significantly less color change than the polishing system
alone (p<0.05). CONCLUSIONS: The type of composite resin and polishing procedure affect color stability. CLINICAL SIGNIFICANCE: The use of a diamond polishing paste in combination with polishing
system can be beneficial in reducing discoloration of nanohybrid, nanofil, and microhybrid composite resins.
Evaluation of Radiopacity of Flowable Bulk-Fill Effect of Polymer-based Coating Materials on

Composites Using Digital Radiography Root Caries Prevention
GMR B*, TARIN B, PEKER S, VEOLU HS. OSHIMA M*, HAMBA H, NIKAIDO T, TAGAMI J.
*Marmara University Faculty of Dentistry, Turkey *Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan
OBJECTIVES: New flowable composites that may be bulk-filled in layers up to 4 mm are indicated OBJECTIVES: Development of professional and simple methods for prevention of primary root
as base beneath posterior composite restorations. Radiopacity is among the several important caries is very important in the aging societies. Two coating materials, MS Coat One (MSO, Sun
requirements that such material should meet. The aim of this study was to evaluate the Medical) and MS Coat F (MSF, Sun Medical), containing a tooth-reactive polymer and oxalic
radiopacity of flowable bulk-fill composites and to compare it with conventional flowable acid (OA), which were developed as dentin desensitizing agents were used. In addition, MSF
composites using digital imaging. MATERIALS AND METHODS: Ten standard specimens (5 mm contains 3000 ppm F, which is expected to prevent dentin demineralization. The purpose of
in diameter, 1 mm in thickness) were prepared from four different flowable bulk-fill composites this study was to evaluate the effects of the polymer-based coating materials on prevention
(SDR, Dentsply; Filtek Bulk Fill, 3M ESPE; X-tra Base, Voco; Venus Bulk Fill, Kulzer) and nine of root caries using micro-computed tomography (micro-CT) non-destructively. MATERIALS AND
different conventional flowable composites. Radiographs of the specimens were taken together METHODS: Bovine root dentin surfaces were ground with #1500-grit SiC. The dentin surfaces were
with 1-mm-thick tooth slices and an aluminum (Al) stepwedge using Drr VistaScan Mini digital then treated with MSO, MSF, or OA for 30 s. Untreated dentin surfaces served as control. After
imaging system (Drr Dental). For the radiographic exposures, a storage phosphor plate (size strongly air-drying, the roots were coated with nail varnish with exception of the treated areas.
4, 5.7 x 7.6 cm) and a dental x-ray unit at 70 kVp and 7 mA were used. The object-to-focus The specimens were then immersed in a demineralizing solution (pH 4.5) for 5 h. Following
distance was 30 cm, and the exposure time was 0.2 s. The grey values of the materials were demineralization, they were scanned using micro-CT (InspeXio SMX-100 CT, Shimadzu, Japan)
measured using the histogram function of the system own software (DBSWIN 5.2.0) and the and analyzed by using a 3D image software (TRI/3D-BON, RATOC, Japan). Mean mineral loss (ML)
radiopacity was calculated as equivalent thickness of Al. The data were analyzed statistically after demineralization was calculated from the mineral density profiles. The specimens were
(p<0.05). RESULTS: Venus Bulk Fill (Heraeus Kulzer) showed the highest radiopacity value, observed under scanning electron microscopy (SEM). The collected ML data were statistically
whereas Arabesk Flow (Voco) showed the lowest. The radiopacity comparison for the flowable analyzed using one-way ANOVA and Tukeys test (=0.05). RESULTS: MeanSD are shown in
bulk-fill composites was Venus Bulk Fill X-tra Base > SDR Filtek Bulk Fill. CONCLUSIONS: All the table. Different letters show significant differences. N=21.
test materials have radiopacity values greater than the radiopacity of dentin and all flowable Treatment Control OA MSO MSF
bulk-fill composites have radiopacity values greater than that of enamel. CLINICAL SIGNIFICANCE: ML % 99.413.0 a 91.110.9 a,b 89.19.2 b 80.410.6 c
As the radiopacity values of flowable bulk-fill composite materials are greater than dentin and
enamel, it is not possible to misinterpret them as secondary caries lesions. For the SEM observations, dentinal tubules were not found after the treatments, while tubular
orifices were opened after demineralization in all the groups. CONCLUSIONS: MS Coat F demon-
strated the highest reduction of demineralization of the root dentin. CLINICAL SIGNIFICANCE:
Application of a polymer-based coating material may become an effective strategy for root
caries prevention.
DENTAL MATERIALS
Inhibition of MMP Activity in Acid-Etched Dentin by Gluma Treatment

SABATINI C*, SCHEFFEL DL, AGEE KA, PASHLEY DH.
*University at Buffalo School of Dental Medicine, USA
OBJECTIVES: The objective of this study was to determine if Gluma Desensitizer (composed of 5% glutaraldehyde and 35% HEMA in water, Heraeus Kulzer) inhibits the endogenous MMPs of dentin
matrix. MATERIALS AND METHODS: Human coronal dentin from extracted third molars was prepared by removing roots and enamel. Dentin beams of 1 x 1 x 6 mm were prepared. To measure the
influence of Gluma treatment time on total MMP activity on dentin, beams were dipped in 37% phosphoric acid (PA) for 15 s and rinsed in water. The acid-etched beams were then dipped in
Gluma for 5, 15, 30 or 60 s, rinsed in water and dropped into SensoLyte generic MMP substrate (AnaSpec, Inc.) for 60 min. Controls were dipped in water for 60 s. Additional beams were completely
demineralized in 37% PA for 18 h, rinsed and used to measure modulus of elasticity (E) after 60 s of Gluma treatment followed by incubation in buffer for 0, 1 or 4 weeks. E was measured by 3-point
flexure. RESULTS: Gluma treatment inhibited total MMP activity of acid-etched dentin by 44, 50, 84 and 86 % after 5, 15, 30 and 60 s of exposure, respectively. All completely demineralized dentin
beams lost stiffness after 1 and 4 weeks. There were no significant differences between controls and Gluma-treated dentin. CONCLUSIONS: Treatment of acid-etched dentin by Gluma for 30 and
60 s produced 84 and 86% inhibition of total MMP activity. CLINICAL SIGNIFICANCE: The use of Gluma Desensitizer may help in the preservation of adhesive interfaces by inhibiting endogenous
dentin MMPs. Supported, in part, by R01DE015306 from the NIDCR.
Comparative Evaluation of Fracture-resistance

and Biomechanics of Post-restored Teeth
BELLI S*, CELIK K, AKBULUT B, GUNESER B, ERASLAN O, ESKITASCIOGLU G.
*Seluk University, Turkey
OBJECTIVES: The goal of this laboratory and Finite Elemental Stress Analysis (FEA) study was
to compare the fracture resistance of endodontically treated teeth restored with metal, glass
fiber and dentin posts and to evaluate stresses occurring within the remaining tooth structure
under loading. MATERIALS AND METHODS: Forty extracted single-rooted teeth were decoronated
and divided into four groups (n=10). The first group was kept as control (without post) and the
others were restored using prefabricated metal post (ParaPost, Whaledent); glass fiber-post
(i-TFC, Sun Medical) and dentin-posts, which were prepared from extracted bovine teeth. The
posts were luted (Clearfil SA Cement, Kuraray), composite-resin cores (Clearfil Majesty, Kuraray)
were created and the specimens loaded obliquely until failure (1.0 mm/min). The data were
analyzed using ANOVA. Three-dimensional (3D) FEA models simulating the same test conditions
were created. A 300-N static load was applied to the models to calculate stress distributions.
SolidWorks/Cosmosworks structural analysis programs were used for FEA analysis. RESULTS: Post
restorations increased fracture strength of the roots (p<0.05). Glass fiber-post group showed
the highest while dentin post group showed the lowest fracture strength values (p<0.001).
ParaPost treated samples showed more catastrophic failures. The analysis of the von Mises
and tensile stresses revealed that maximum stresses occurred within the composite cores in
all models. ParaPost created more stress at the root dentin and inside the post material when
compared to the glass fiber and dentin posts. CONCLUSIONS: Restoration of roots with glass
fiber post and dentin post reduce stresses within the core material and the remaining root.
However, a fracture resistant post-core restoration cannot be achieved using a dentin post.
CLINICAL SIGNIFICANCE: Considering their biomechanical properties, clinicians may use glass
fiber posts for the restoration of endodontically treated teeth, when needed.

CLINICAL STUDIES
Seven-year Clinical Evaluation of Restorations Repaired by Composite Resin

ISHIZAKI H*, FUKUSHIMA M.
*Niigata University Medical and Dental Hospital, Japan
OBJECTIVES: To evaluate the long-term clinical performance of repaired restorations based on the minimal intervention concept. MATERIALS AND METHODS: Thirty-eight restorations in 16 patients
were repaired with: Composite materials - Filtek Supreme and Filtek Flow (3M ESPE); Clearfil AP-X, Clearfil ST, and Clearfil Opaquer (Kuraray Medical); and Palfique Estelite (Tokuyama Dental).
Adhesive materials used were Mega Bond, K-etchant, and Clearfil Porcelain Bond Activator (Kuraray Medical); and Metal primer II (GC). Restorations were evaluated using USPHS criteria at baseline
(immediately after polishing) and 7 years after repair. No statistical analysis was performed. Observations are reported. RESULTS: Thirty-one teeth (32 repaired restorations in 12 patients) were
recalled at 7 years (recall rate=84%). Reasons for repair at baseline were secondary caries (20), abrasion (5), new caries (3), and others (4). Types of restorations to be repaired were composite
resins (17), metal crowns (7), porcelain fused to metal crowns (7), and metal inlay (1). Locations of repairs were root surface (18), Class V (6), wedge-shaped defect (5), and Class III (3). One tooth
was excluded from the evaluation because of root fracture (tooth survival rate=97%). Seven teeth were re-repaired during the 7 years (re-repair rate=23%). Reasons for re-repair were problem of
repaired portion - secondary caries (1), bulk fracture of composite resin (1); new caries (2); problem with primary restoration - secondary caries (1), failure of restoration (1); and other (1). Four of
seven re-repaired cases occurred in high caries-risk patients. CONCLUSIONS: The long-term durability of repaired restorations was affected by several reasons with 77% success at 7 years. CLINICAL
SIGNIFICANCE: The majority of the repairs were done because of secondary caries and performed on root surfaces. Within the limitations of this study, that suggests that material selection is
critical for restorative treatment success. Repairs may extend the survival of teeth.
Seven-year Clinical Evaluation of Short-term Follow-up of

Two One-step Self-etch Adhesives Anterior Aesthetic Restorations
KUBO S*, YOKOTA H, YOKOTA H, HAYASHI Y. KAZAK M*, GUNAL S.
*Nagasaki University Hospital, Japan *Istanbul Aydin University Faculty of Dentistry, Turkey
OBJECTIVES: This randomized controlled clinical trial evaluated the 7-year clinical performance OBJECTIVES: One of the most challenging tasks in restorative dentistry is to restore teeth with
of resin composite restorations in non-carious cervical lesions (NCCL). MATERIALS AND METHODS: adhesive materials and make them aesthetically appealing. The search for the lost or desired
One hundred and eight NCCLs in 23 patients (mean age of 61.8 years) were placed. Enamel aesthetic, especially in anterior teeth, by patients is increasing day after day and clinicians
bevels were placed and dentin walls were lightly roughened, and the teeth were restored with must be able to supply this demand. To do this, restorative dentists not only need to return
HEMA-contained S3 Bond (S3, Kuraray Medical) or HEMA-free G-Bond (GB, GC) in conjunction the tooth back to its normal function but also promote aesthetic excellence. The aim of this
with a hybrid resin composite (Clearfil AP-X, Kuraray). Each patient randomly received at least study is to report 6-month follow-ups of 12 anterior teeth that were restored with adhesive
one restoration from each restorative protocol. All restorations (53 restorations for S3 and 55 materials. Reasons for the restorations were dental caries, hypoplasia, fractures, developmental
restorations for GB) were placed by one dentist. The restorations were blindly evaluated at abnormalities, and closure of diastemas. MATERIALS AND METHODS: The cases of six patients
baseline, 6 months, and every year up to 7 years using modified USPHS criteria by two examin- treated for direct aesthetic restorations on their maxillary anterior teeth in the Department of
ers. The data were statistically analyzed using the Fishers exact test, the Kaplan-Meier method, Restorative Dentistry at the Istanbul Aydin University Faculty of Dentistry are described. Ten teeth
and the Cox proportional hazards model. RESULTS: All except one patient with five restorations were restored with Filtek Ultimate and Adper Single Bond 2 (3M ESPE); one tooth was restored
were examined at the 7-year recall. In addition, three restorations were not evaluated due with Enamel Plus HRi (Micerium SPA) and Adper Single Bond 2 (3M ESPE); and one tooth was
to tooth extraction. One restoration of each material was lost within 2 years. No secondary restored with Enamel Plus HRi and IntegraBond (Premier). Direct restorations were performed
caries was detected on any tooth. The only significant clinical problem was related to enamel according to the manufacturers instructions with two increments of the respective composite
marginal integrity. Small defects were detected at the margins of many restorations, regardless resin being placed to replace dentin and enamel. Clinical performance was evaluated using
of the adhesive system. The incidence of marginal staining increased with time. Marginal Modified USPHS criteria by two independent examiners. RESULTS: At the 6-month follow-up,
discoloration (minor) occurred adjacent to 21 S3 and 27 GB restorations. There was no significant teeth still presented natural appearance with proper shape, marginal integrity, function, and
difference in the clinical performance between S3 and GB for each variable. CONCLUSIONS: Under color. CONCLUSIONS: The success of natural tooth-like restorations for the anterior teeth has
the protocol used in this study, the one-step self-etch adhesives demonstrated acceptable always posed an aesthetic challenge for dentists. Adhesive restorations can be successful and
clinical performance after 7 years of clinical service. CLINICAL SIGNIFICANCE: Both S3 and GB reliable in the restoration of anterior teeth. CLINICAL SIGNIFICANCE: When compared to prosthetic
demonstrated acceptable clinical performance during the 7-year follow-up period. This study crown restorations, minimally invasive treatments with adhesive restorative materials may be
was supported by JSPS Grant-in Aid for Scientific Research (C) 2359802. preferred considering the lower cost and acceptable aesthetic result.
Preparation of a Lingual Rest Seat Using Clinical Success of Zirconia-based RBFPDs:
Adhesive Composite Resin A Literature Review
OHKUBO C*, KURIHARA D, SHIMPO H, SAKURAI T, NAKATA T. TAKEICHI T*, BLATZ MB, ITO Y.
*Tsurumi University School of Dental Medicine, Japan *Aichi Gakuin University School of Dentistry, Japan
OBJECTIVES: To improve the support of removable partial dentures (RPD), lingual rests are OBJECTIVES: The aim of this review was to report on the clinical success of Y-TZP (yttria-
prepared on anterior teeth and canines. In our removable prosthodontic treatment, cingulum stabilized tetragonal zirconia polycrystals)-based resin-bonded fixed partial dentures (RBFPDs).
rest seats have been provided with minimal removal of tooth structure and using adhesive MATERIALS AND METHODS: A literature search was conducted in PubMed using key words
procedures and composite resins. MATERIALS AND METHODS: Lingual rest seat preparations resin-bonded fixed partial denture AND zirconia to identify literature in English referring to
in enamel are rarely satisfactory on anterior teeth because the enamel lacks the necessary in vivo studies published from January 2000 through April 2013, following specific inclusion/
thickness. Thus, a cingulum rest seat has been provided using the following procedure: 1) A small exclusion criteria. Inclusion criteria: (1) Human in vivo, (2) conducted on Y-TZP, (3) RBFPDs,
groove is prepared as the floor of the rest seat on the lingual surface of an incisor or canine; 2) (4) natural teeth abutments, (5) followed-up data available, (6) written in English. Exclusion
Final impression is taken; 3) The form for the supportive rest seat is waxed above the groove criteria: (1) In vitro, (2) animal studies. RESULTS: The search identified 29 matches resulting
on the lingual surface of the working cast; 4) After duplicating the cast, the framework is cast in four studies after application of inclusion/exclusion criteria. Only one was a randomized
and the RPD is completed; 5) After the RPD is delivered and adjusted, composite resin is used control trial. Other studies that met the inclusion/exclusion criteria were three clinical reports
as filling material between the lingual surface and the inner surface of the lingual rest of the involving Y-TZP-based RBFPDs. According to one randomized controlled clinical trial, three-year
framework; and 6) The composite resin is cured under occlusal force. RESULTS: Advantages of survival rate was 93.1%. According to three clinical reports, which included seven Y-TZP-based
this method are as follows: 1) The lingual rest seat can be prepared with minimal cutting of the RBFPDs, no debonding was observed after observation periods varying from six to 20 months.
tooth; 2) An adequate rest seat can be formed by the laboratory technician; 3) Functional fitting CONCLUSIONS: There are only a small number of studies available on the clinical survival of
can be obtained by curing the composite resin under occlusal force; and 4) Veneer crowns or Y-TZP-based RBFPDs, which do not allow solid conclusions and clinical recommendations.
brackets are not necessary. CONCLUSIONS: An adequate rest seat form can be prepared on the CLINICAL SIGNIFICANCE: Y-TZP-based resin-bonded fixed partial dentures may be an option
working cast and a cingulum rest can be provided with minimal sacrifice of tooth structure. for the restoration of missing teeth. Additional well-designed long-term clinical studies are
CLINICAL SIGNIFICANCE: Using composite resin, an appropriate cingulum rest can be prepared necessary to provide reliable evidence.
not only for mandibular canines but also for maxillary central incisors.

PHOTO GALLERY
5th International Congress on Adhesive Dentistry IAD 2013

Friday, June 14, 2013 to Saturday, June 15, 2013
(1) Dr. Markus B Blatz, President of the 5th IAD and Head of the
organizing committee during his welcome address with Drs.
Lorenzo Breschi (Italy, left) and Jean-Francois Roulet (USA, right).
(2) Dr. Lorenzo Breschi (Italy) speaks about the long-term durability
of current adhesive systems. (3) First Place Scientific Award Winner
Dr. Alireza Sadr with Drs. Ricardo Walter (Scientific Committee
Chair, left) and Markus Blatz (IAD President, right). (4) Dr. Jorge
1 Perdigao (USA) discusses his research findings with the audience.
3 4
Presenters and Moderators Markus B. Blatz, IAD PRESIDENT
Luiz Baratieri BRAZIL Satoshi Imazato JAPAN Jean-Francois Roulet USA

Stephen Bayne USA Fatma Koray TURKEY Hidehiko Sano JAPAN
Lorenzo Breschi ITALY Yasuko Momoi JAPAN Gottfried Schmalz GERMANY
Ji-Hua Chen CHINA Mutlu Ozcan SWITZERLAND Edward J. Swift, Jr. USA
William Cheung HONG KONG Jeong-won Park KOREA Junji Tagami JAPAN
Didier Dietschi SWITZERLAND David Pashley USA Bart Van Meerbeek BELGIUM
Sillas Duarte USA Jorge Perdigao USA Nairn Wilson UNITED KINGDOM
Jack Ferracane USA Patricia Pereira BRAZIL ...and others
Naoki Hayashi USA Andre Ritter USA
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Non-destructive Non-staining 3D Analysis of Marginal and Internal Microgaps

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Antimicrobial Activity and Dentin Bond Strength of Adhesive Systems

Incorporation of Proanthocyanidin into a Effects of Dentin Treatments on Bond Strength

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Microleakage-free Restorations to Dentin: Bond Strengths of Self-etch Adhesives

Comparison of a Universal Adhesive with Contemporary Adhesives

Dentin Bonding Efficacy of HEMA-containing Bond Strengths and Microleakage of Composites

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An All-in-one Adhesive for Dry Bond Strength of Newly Developed

Elemental Analysis of the Resin-Dentin Interface Using TOF-SIMS

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Adhesion of HEMA-free Adhesive Systems to Dentin

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Remineralization Assessment of Adhesive with Polymerization Shrinkage and Bond Strength of

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Resin-dentin Bond Strength of an Influence of Oxygen-inhibited Layer on

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Bonding of Flowable Composites to Cavity-floor Influence of Irradiation Distance on

G2: FLB+BII 18.64 4.5a 0 mm 5 mm 10 mm 20 mm 30 mm

Dentin Bonding Durability of Resin Cements in Self-curing Mode

Dentin Bond Strength of an A New Ion-releasing Core Build-up

22 November/December 2013 Volume 34 Special Issue 9

Ultra-high-speed Fracture Observation in Resin-dentin Interface under Microtensile Load

Bonding Performance of a Resin Cement in Effects of Application Mode and

24 November/December 2013 Volume 34 Special Issue 9

Effect of Storage Conditions on Microleakage and Bond Strength of

Effect of Antioxidant Following Bleaching on Bond Strength to Enamel