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Acta Odontológica Latinoamericana
versão On-line ISSN 1852-4834
Acta odontol. latinoam. vol.22 no.3 Buenos Aires dez. 2009
ARTÍCULOS ORIGINALES
24 hours and 3-months bond strength between dual-cured resin cements and simplified adhesive systems
Thaiane R. Aguiar1, Andrea N. Cavalcanti2, Céres M. Fontes2, Giselle M. Marchi1, Leonardo Muniz3, Paula Mathias2
1 Department of Restorative Dentistry, Piracicaba Dental School, Campinas State University.
2 Department of Restorative Dentistry, Federal University of Bahia.
3 Bahiana Foundation for Science Development.
CORRESPONDENCE Dra. Paula Mathias. Faculdade de Odontologia da Universidade Federal da Bahia. Av. Araujo Pinho, # 62, Canela, Salvador, BA, 40110-150. Brazil. Tel (+5571) 33365776 / Fax (+5571)33550081. e-mail: pmathias@yahoo.com
ABSTRACT
This study evaluated the bonding compatibility between dualcured resin cements and simplified adhesive systems (one-step self-etch and two-step etch & rinse), measured after 24 hours and 3 months. The occlusal dentin surfaces of 24 human third molars were exposed and flattened. Teeth were randomly assigned to 3 groups and treated with different combinations of adhesive system and resin cement [G1 - Single Bond/Rely X ARC (SB/RX); G2 - Excite DSC/Variolink II (EX/VR); G3 - Adper Prompt/Rely X ARC (AD/RX)]. Indirect composite restorations were cemented on flattened surfaces, and sectioned to obtain multiple bonded beams for the microtensile bond strength test. The beams from each tooth were tested under tension after 24 hours and 3 months (ANOVA/ Tukey’s test, α=5%). Failure patterns were evaluated with scanning electron microscopy. After 24h, AD/RX presented the lowest bond strength mean values. AD/RX specimens did not withstand three months storage. SB/RX and EX/VR presented similar bond strengths in both periods tested. The association AD/RX resulted in low bond strength mean values, especially after storage. Cementing indirect restorations using one-step self-etch adhesive systems and dual-cured resin cements would be clinically unreliable.
Key words: Dentin bonding; Resin cements; System adhesive; Bond strength.
RESUMO
Avaliacao da resistencia de uniao de cimentos resinosos de dupla polimerizacao associados a sistemas adesivos simplificados apos 24 horas e 3 meses
Este estudo avaliou a compatibilidade de uniao entre cimentos resinosos de dupla polimerizacao e sistemas adesivos simplificados (adesivo autocondicionante - 1 passo- e adesivo total-each - 2 passos), apos 24h e 3 meses. A superficie oclusal de 24 terceiros molares humanos foi exposta e planificada. Os dentes foram aleatoriamente divididos em 3 grupos usados de acordo a seguinte combinacao entre sistema adesivo/cimento resinoso [G1 - Single Bond/Rely X ARC (SB/RX); G2 - Excite DSC/Variolink II (EX/VR); G3-Adper Prompt/Rely X ARC (AD/RX)]. Restauracoes indiretas em resina composta foram cimentadas na superficie dentinaria, e seccionados em multiplos palitos para a realizacao do teste de resistencia de uniao atraves do ensaio de microtracao. Os palitos obtidos por dente foram submetidos ao teste apos 24 horas e 3 meses (ANOVA/ Tukey test, α=5%). O padrao de fratura foi observado no microscopio eletronico de varredura. Apos 24 horas, AD/RX apresentou menor valor medio de resistencia de uniao. Os corpos-de-prova do grupo AD/RX nao resistiram ao armazenamento de 3 meses. SB/RX e EX/VR demonstraram similar resistencia de uniao em ambos os periodos avaliados. A associacao AD/RX resultou em menores valores medios de resistencia de uniao, especialmente apos o armazenamento. A cimentacao de restauracoes indiretas utilizando sistemas autocondicionantes (1 passo) e cimentos resinosos de dupla polimerizacao nao foi considerada clinicamente confiavel.
Palavras chaves: Dentina; Cimentos resinosos; Sistemas adesivos; Resistencia de uniao.
INTRODUCTION
The effectiveness of adhesive techniques has expanded the range of clinical applications1. For example, the positive results obtained using adhesive cementation in indirect restorations have increased the frequency of metal-free restoration procedures, allowing sound dental tissue to be preserved with more conservative tooth preparations2,3. However, the clinical success of adhesive cementation is highly dependent on the bonding properties of adhesive systems and resin cements 4.
Adhesive systems can be classified according to their adhesion strategies, i.e. etch & rinse or self-etch techniques5. The simplified etch & rinse technique involves two steps: acid conditioning followed by application of a mixture of primer and adhesive monomers 6. When bonding to dentin, the rinsing and drying steps make this technique more susceptible to operator error, reducing adhesive performance7.Onestep self-etch or all-in-one systems, as they are commonly referred to, involve only one procedure5. These systems use acidic monomer solutions that etch, prime, and bond simultaneously8. They eliminate critical steps, such as rinsing and drying9 that decrease the technique’s sensitivity8. Consequently, these systems are being increasingly used6, even for adhesive cementation in indirect restorations. Adverse interactions between simplified adhesives and chemical/dual-cured resin cements have been reported2,6,10,11. An incompatible acid-base reaction occurs between acidic monomers present in simplified systems and the tertiary amines present in the catalyst paste of resin cements, resulting in incomplete polymerization of resin cements. The higher concentration of ionic and hydrophilic groups in adhesive systems may allow the movement of water and ions from the underlying dentin even after polymerization, compromising the hermetic sealing of the dentin interface2. Moreover, one-step self-etch systems usually have a pH of 1.0 or lower, resulting in considerably deep demineralization effects, and thus more hydrophilic interfaces that are more prone to hydrolytic degradation12 . In vitro bond strength evaluations are usually performed 24h after specimen preparation9,13. This period of time may not be long enough to verify the efficiency of restorative and adhesive materials, both in terms of bond stability and durability13,14.
Thus, the aim of this study was to evaluate the compatibility, after 24h and 3 months, between simplified adhesives systems (two etch & rinse systems and one one-step self-etch system) and dual-cured resin cements using a microtensile bond strength test (μTBS). Additionally, the morphological characteristics of the fractured surfaces were evaluated using scanning electron microscopy (SEM). The null hypothesis tested was that combinations of simplified adhesive systems and resin cements present similar bond strength to dentin and long-term performance.
MATERIAL AND METHODS
This study was approved by the Ethical Committee in Research at the Federal University of Bahia. Twenty-four non-carious human third molars were disinfected with 0.5% chloramine T solution. Their roots were mounted in self-curing acrylic resin cylinders (2.5 cm diameter). The occlusal enamel was removed using 180-grit silicon carbide paper under running water, and the smear layer was standardized with 600-grit silicon carbide papers under water cooling during 1 minute. Teeth were randomly allocated to 3 groups according to the following treatments (n=8): SB/RX (Single Bond (3M ESPE, St. Paul, MN, USA)/ Rely X ARC (3M ESPE, St. Paul, MN, USA); EX/VR (Excite DSC (Ivoclar Vivadent, Schaan, Liechtenstein)/Variolink II (Ivoclar Vivadent, Schaan, Liechtenstein); AD/RX (Adper Prompt (3M ESPE, St. Paul, MN, USA)/ RelyX ARC). The composition of the materials and manufacturers are shown in Table 1. The adhesive systems and resin cements were manipulated and applied according to manufacturers’ instructions. The same manufacturer was used for all groups to avoid chemical bias. Rectangular indirect restorations (4x4x6 mm) were fabricated using composite resin (Tetric Ceram, Ivoclar Vivadent, Schaan, Liechtenstein). The composite was inserted in 2.0 mm thick increments and each increment was light-activated for 20 seconds. The light output of the light curing unit (Optilight 600, Gnatus, Ribeirao Preto, SP, Brazil) was tested (500 to 600 mW/cm2) with a radiometer (Curing Radiometer, model 100, Kerr Corporation, Orange, USA).
Table 1: Materials used in the present study, with the corresponding manufacturers, batch numbers and composition.
The indirect composite was bonded to dentin with adhesive systems and resin cements in accordance with the manufacturer’s instructions. Visible-light activation of each surface was applied for 20 s (Optilight 600). After cementation, specimens were stored in artificial saliva at 37°C for 24h. Next, they were sectioned on the mesio-distal and bucco-lingual planes using a low-speed, watercooled diamond saw (Isomet, Buehler, Lake Bluff, IL, USA). The boundaries of the restoration were discarded, six beams were obtained per tooth and the cross-sectioned area was measured with a digital caliper (727, Starrett Ind., Itu, SP, Brazil) to the nearest 0.01 mm. Beams obtained from each tooth were divided into 2 groups: half specimens were tested after 24h; the other half specimens were stored in artificial saliva (37°C) and tested after 3 months. Throughout the storage process, the artificial saliva was changed every five days.
To carry out microtensile testing, specimens were attached to the flat grips of a μTBS device with cyanoacrylate glue (Super Bonder; Henckel Loctite, Itapevi, SP, Brazil) and tested under tension in a Universal Testing Machine (EMIC DL 500, Sao Jose dos Pinhais, SC, Brazil) at a cross-head speed of 0.5 mm/min, until failure. Means and standard deviations were calculated and expressed in MPa. No bond strength value was attributed for premature debonding during specimen preparation. The μTBS data were analyzed using Repeated Measures ANOVA and Tukey’s test (α=5%).
After testing, each specimen was gold-sputter coated (Balzers-SCD 050 Sputter Coater, Germany) and observed by SEM (JSM 2900, JEOL, Scanning Electron Microscopy Peabody, MA, USA) to assess the failure pattern. Failure modes were classified in three types: type 1 - failure between adhesive system and dentin, and partial cohesive failure in adhesive resin; type 2 - total cohesive failure in the adhesive resin; type 3 - cohesive failure in the cement resin.
RESULTS
Bond strength results are shown in Table 2. All specimens from the AD/RX group aged for 3 months debonded at the cement/dentin interface during specimen storage. Therefore, this combination could not be included in the statistical analysis. SB/RX and EX/VR presented similar bond strength in both periods and were not significantly affected by storage. The failure mode distribution is described in Fig. 1. In both periods tested, SB/RX presented mainly type 3 failures (Fig. 2: SEM photomicrograph illustrating a cohesive failure in the resin cement). The most frequent type of failure in EX/VR was type 1 after 24 hours (Fig. 3: SEM photomicrograph illustrating the dentin side of a fractured specimen presenting an adhesive failure between adhesive resin and dentin); and type 2 after the 3-months period (Fig. 4: SEM photomicrograph illustrating the dentin side of a fractured specimen with a total cohesive failure in the adhesive resin). AD/RX presented mainly cohesive failures within the adhesive after 24 hours. After 3-months, both type 1 and type 3 failures were observed.
Table 2: Mean values (standard deviations) of μTBS (MPa).
Fig. 1: Failure mode distribution according to the combination between adhesive system and resin cement.
Fig. 2: SEM photomicrograph illustrating a cohesive failure in the resin cement.
Fig. 3: SEM photomicrograph illustrating the dentin side of a fractured specimen presenting an adhesive failure between adhesive resin and dentin.
Fig. 4: SEM photomicrograph illustrating the dentin side of a fractured specimen with a total cohesive failure in the adhesive resin.
DISCUSSION
The present study was conducted to evaluate the μTBS of dual-cured resin cements bonded to simplified adhesive systems, after 24 hours and 3 months storage. Early bond strength measurements might provide an important reference regarding the bonding capability of adhesive materials9. Nevertheless, it is widely accepted that long-term clinical studies provide more realistic results with respect to the efficiency of restorative materials14, but the drawbacks of such studies are the high cost and extensive length of time15. To overcome these limitations, in vitro methods, such as artificial aging, were developed to simulate aging conditions in an effort to provide information about bonding durability. In this study, specimens were stored in artificial saliva to simulate aging. However, other clinically-related factors, such as chewing stress, pH and temperature variations, were not simulated in this study. The storage method and the solution used are important variables in this study. Storage solutions have a significant effect on the leachability of filler particles, and artificial saliva might promote a greater degradation of resin-based materials than distilled water16. Thus, it can better simulate the intraoral conditions. The interfacial bonding area exposed to the storage period may also play an important role in specimen degradation14. In the present study, specimens with 1 mm2 interfacial bonding areas were stored in artificial saliva. This method was chosen to accelerate the degradation of the interfaces between resin cements, adhesive systems and dentin.
The etch & rinse systems (SB/RX and EX/VR) showed statistically similar bond strength values, irrespective of length of storage period. Therefore, the 3-months period may not be long enough to age restorative materials with improved bonding performance, such as the two-step etch & rinse systems. On the other hand, the bond created using the one-step self-etch system was incapable of withstanding 3 months of storage, suggesting that this adhesive system does not present a reliable longterm capacity for cementing indirect restorations. The relatively high dentin permeability found in simplified self-etch systems results from the increased concentration of acidic monomers 6,17. The faster hydrolytic degradation of these systems in humid environments might justify the incidence of premature failures in the AD/RX group 12,18. Similar incidences of premature failure have previously been reported1.
Type 2 failure mode was frequently noted in the non-aged group AD/RX. It can be hypothesized that the higher permeability and incomplete light activation of the one-step self-etch system promoted a faster hydrolytic degradation, premature failure and, consequently, the loss of specimens. On the other hand, SB/RX groups demonstrated fewer failures involving the hybrid layer, since mainly cohesive failures in the cement resin were observed. In addition to hydrolytic degradation, the chemical incompatibility between chemical/dual-cured resin cements and simplified adhesive systems can negatively influence the adhesive cementation of indirect restorations6,8,19. The result of this adverse reaction is the incomplete polymerization of resin-based materials2. Since the degree of conversion of resin-based materials is directly related to their me chanical properties11, an adequate polymerization of the resin cement is a fundamental prerequisite for restoration stability20. Although simplified etch & rinse systems might also present a chemical incompatibility with dual cure cements, the results of this study indicate that this effect might be less pronounced than with one-step self-etch systems (AD/RX group).
Within the limitations of this study, it could be concluded that there is no satisfactory evidence to justify the use of simplified self-etch systems and dual-cured composites for cementing indirect restorations. Findings showed that this association resulted in low bond strength mean values, especially after storage. However, bonding of indirect composite using two-step etch & rinse adhesive systems and chemical/dual-cured resin cement was not significantly affected by storage.
ACKNOWLEDGMENTS
This study was supported by Federal University of Bahia (PIBIC/CNPq grant # 117951/2004-8).
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