Ó

Operative Dentistry, 2013, 38-1, 63-72

Effect of Different
Adhesion Strategies on
Bond Strength of Resin
Composite to Composite-
dentin Complex
M Özcan  G Pekkan

Clinical Relevance
When composite materials are to be repaired next to dentin, preferably the substrate
composite and repair composite should be of the same type. Conditioning the substrate
composite with silica coating and silanization after etching the dentin add to the repair
strength of the composite-dentin complex when compared to the success of silane
application only.

ABSTRACT using some surface conditioning methods, but

the most effective adhesion protocol for re-
Service life of discolored and abraded resin
layering is not known when the composite
composite restorations could be prolonged by restorations are surrounded with dentin. This
repair or relayering actions. Composite-com- study evaluated the effect of three adhesion
posite adhesion can be achieved successfully strategies on the bond strength of resin com-
posite to the composite-dentin complex. Intact
*Mutlu Özcan, professor, Dr.med.dent., PhD, University of
maxillary central incisors (N=72, n=8 per
Zürich, Head of Dental Materials Unit, Center for Dental and
Oral Medicine, Clinic for Fixed and Removable Prosthodon- subgroup) were collected and the coronal
tics and Dental Materials Science, Zürich, Switzerland. parts of the teeth were embedded in autopoly-
Gurel Pekkan, associate professor, DDS, PhD, Dumlupinar merized poly(methyl tfr54methacrylate) sur-
University, Facultyof Dentistry, Department of Prosthodon- rounded by a polyvinyl chloride cylinder.
tics, 43270 Kutahya, Turkey; Oral and Dental Health Center, Cylindrical cavities (diameter: 2.6 mm; depth:
Cumhuriyet Mahallesi, Haymeana Caddesi, No:26, Kutahya, 2 mm) were opened in the middle of the labial
Turkey. surfaces of the teeth using a standard dia-
*Corresponding author: University of Zürich, Head of mond bur, and the specimens were randomly
Dental Materials Unit, Center for Dental and Oral divided into three groups. Two types of resin
Medicine, Clinic for Fixed and Removable Prosthodontics
composite, namely microhybrid (Quadrant An-
and Dental Materials Science, Plattenstrasse 11, CH-8032,
Zürich, Switzerland; e-mail: [email protected]
terior Shine; AS) and nanohybrid (Grandio;
G), were photo-polymerized incrementally in
DOI: 10.2341/11-482-L
the cavities according to each manufacturer’s
64 Operative Dentistry

recommendations. The composite-enamel sur- and 3, respectively). When the substrate and
faces were ground finished to 1200-grit sili- the adherend are of the same type, greater
cone carbide paper until the dentin was repair strength could be expected. In the
exposed. The surfaces of the substrate com- repair of composites next to the dentin, de-
posites and the surrounding dentin were con- pending on the composite type, conditioning
ditioned according to one of the following the composite with silica coating and silaniza-
adhesion protocols: protocol 1: acid-etching tion after etching the dentin adds to the repair
(dentin) + silica coating (composite) + silani- strength compared to the results obtained
zation (composite) + primer (dentin) + bonding with silane application only.
agent (dentin + composite); protocol 2: silica
coating (composite) + acid-etching (dentin) + INTRODUCTION
silanization (composite) + primer (dentin) + Resin-based composite materials (hereafter referred
bonding agent (dentin + composite); and pro- to as composites) are widely used in restorative
tocol 3: acid-etching (dentin) + primer (dentin) dentistry.1–3 Composites are becoming more durable
+ silanization (composite) + bonding agent with advances in the filler particles, monomer
(dentin + composite). Applied primer and matrices, improved adhesive systems, and polymer-
bonding agents were the corresponding mate- ization devices.4 However, failures of composite
rials of the composite manufacturer. Silica restorations are still being reported in clinical
coating (CoJet sand, 30 lm) was achieved studies,5–7 with failure rates ranging between 5%
using a chairside air-abrasion device (dis- and 45% during an observation period of up to five
tance: 10 mm; duration: four seconds in circu- years. Ageing of such materials is often a conse-
lar motion). After conditioning protocols, the quence of mechanical/physical degradation mecha-
repair resin was adhered to the substrate nisms such as wear, abrasion, and fatigue or is due
surfaces using transparent polyethylene to chemical degradation mechanisms such as enzy-
molds (diameter: 3.6 mm) incrementally and matic, hydrolytic, acidic, or temperature-related
photo-polymerized. The substrate-adherend breakdown.6,8–10 While physical and chemical deg-
combinations were as follows: AS-AS, G-G, radation phenomena occur as a function of time and
AS-G. Shear force was applied to the adhesive are considered to represent late failures, early
interface in a Universal Testing Machine failures could occur as a result of mishandling of
(crosshead speed: 1 mm/min). The types of the material, failure to master the matrix technique,
failures were further evaluated and catego- improper finishing and polishing procedures, or a
rized as follows: 1) cohesive in the composite mismatch between the restored tooth and the
substrate and 2) adhesive at the interface. adjacent one.1,11
Bond strength values (MPa) were statistically
analyzed using two-way analysis of variance Complete replacement of failed restorations is
and least significant difference post hoc tests usually costly and time consuming.1,10–14 Moreover,
(a=0.05). Significant effects of the adhesion removing tooth-colored restorations may lead to
strategy (p=0.006) and the composite type removal of intact dental tissues and induce destruc-
(p=0.000) were found. Interaction terms were tive changes in odontoblasts.15,16 When composite
not significant (p=0.292). Regardless of the restorations fail as a result of discoloration, micro-
substrate-adherend combination, protocol 1 leakage, ditching at the margins, delamination, or
(17–22 MPa) showed significantly higher re- simple fracture, restorations need to be repaired or
sults than did protocols 2 (15–17 MPa) and 3 replaced.3,7,15,16 Partial replacement is often prefer-
(11–17 MPa) (p=0.028, p=0.002, respectively). able when possible. This can be achieved by adding a
The highest results were obtained from the G- new layer of composite onto an existing one.
G combination after all three protocols (17–22 High bond strength is desired between the pre-
MPa). The incidence of cohesive failures was polymerized and the new composite layer for clinical
more common when the substrate and the durability.1,2,4,9 Adhesion between two composite
adherend were the same composite type (AS- layers is achieved in the presence of an oxygen-
AS: 87.5%, 87.5%, 75%; G-G: 100%, 75%, 50% for inhibited layer of the unpolymerized resin.17,18 Since
protocols 1, 2, and 3, respectively). When prepolymerized composites contain fewer free radi-
substrate and adherend were used inter- cals on their surfaces, several methods have been
changeably, adhesive failures were more fre- suggested1,2,4,10–12,19,20 to improve the composite-
quent (25%, 50%, and 100% for protocol 1, 2, composite adhesion through surface roughening
Özcan & Pekkan: Effect of Different Adhesion Strategies on Composite Repair 65

using airborne particle abrasion and etching agents the same type of composite as the substrate and
such as acidulated phosphate fluoride, hydrofluoric adherent materials. This may not always be possible
acid, phosphoric acid or through the use of interme- given the clinical situation since often the underly-
diate adhesive resins (IARs). Although promising ing composite type is not known unless the operator
results were obtained with some of these surface registers the type of the composite in the patient
conditioning methods in earlier studies, adhesion file.
tests were often performed on composite surfaces Composite formulations have changed constantly
only.1,2,4,18,20–23 In fact, in clinical situations, except over the years, and numerous brands of composites
in the complete relayering of a composite veneer, have been introduced in the dental market. The
composite restorations such as Class IV, V, or improvements in filler technology led to the devel-
occlusal composite fillings are surrounded with opment of the nanohybrid or nanofilled composites.
enamel and/or dentin.1,14,24 Typically some amount As a result of their higher degree of conversion, as
of composite and the surrounding enamel are opposed to hybrid or microhybrid composites,39
removed to create space for the new layering repair bond strength could be impaired for nano-
composite. hybrid composites.
The success of composite-composite adhesion The objectives of this study, therefore, were to
depends on the chemical composition of the surface, compare the effect of three adhesion strategies on
surface roughness,25,26 wettability of the IARs or the the bond strength of resin composites to the
new composite layer,27 and the surface conditioning composite-dentin complex and to evaluate the failure
procedures applied.28–31 During layering, composite types. The null hypotheses tested were that different
materials are exposed to atmospheric oxygen, creat- 1) adhesion strategies and 2) substrate-adherent
ing an oxygen-enriched surface layer that remains combinations would not affect the bond strength.
unpolymerized.2,18 Though the oxygen-inhibited
layer is viscous, it contains unreacted C=C
MATERIALS AND METHODS
bonds.32–34 The unreacted C=C bonds of the func-
tional groups on the surface of the polymerized resin The brands, manufacturers, chemical compositions,
matrix enables the monomer of the new resin and batch numbers of the materials used in this
composite to bond to it.35 While authors of some study are listed in Table 1.
studies28,36 reported enhanced repair bond strength
with the use of an IAR, others25,32,36,37 claimed Specimen Preparation
better results with physico-chemical conditioning of Intact maxillary central incisors (N=72, n=8 per
the composite surface. One example of the latter is subgroup) were collected and the roots of the teeth
the chairside tribochemical silica coating that cre- were removed under coolant water. The coronal
ates both micromechanical and chemical reaction parts of the teeth were embedded in autopolymerized
sites on the composite surfaces. In this technique, poly(methyl methacrylate) (PMMA, Autoplast, Can-
the surface is air-abraded with silica-coated alumina dulor AG, Altstätten, Switzerland) surrounded by a
particles; this is followed by the application of a polyvinyl chloride (PVC) cylinder. The enamel
silane coupling agent and an IAR.25,32,36,37 The surfaces were ground finished to 1200-grit silicone
application of silane on the composite was suggest- carbide paper under water until dentin was exposed.
ed29 to improve the wettability of the fillers on the Cylindrical cavities (diameter: 2.6 mm; depth: 2 mm)
composite surface and, consequently, adhesion of the were opened in the middle of the labial surfaces of
composite. the teeth using a standard bur, and the specimens
Successful adhesion to dentin has been estab- were randomly divided into three groups. Two types
lished over the last two decades.5 When composite of resin composites, namely, microhybrid (Quadrant
repairs are performed next to dentin, it can be Anterior Shine; AS) and nanohybrid (Grandio; G),
anticipated that the adhesion to the dentin could be were photo-polymerized incrementally in the cavi-
sufficient such that additional conditioning of the ties according to each manufacturer’s recommenda-
composite may not be required. On the other hand, tions. Each increment was photo-polymerized with a
initial conditioning of the composite may impair the halogen polymerization unit (Demetron LC, SDS
adhesion to the dentin. Hence, the detrimental Kerr, Orange, CA, USA) for 40 seconds from a
effects of the conditioning sequence on the compos- constant distance of 2 mm from the surface. Light
ite-dentin complex is not known. Furthermore, intensity was 800 mW/cm2 as verified by a radiom-
earlier studies11,21,30,38 were often performed using eter (Demetron LC, Kerr).
66 Operative Dentistry

Table 1: The Brands, Manufacturers, Chemical Compositions, and Batch Numbers of the Materials Used in This Study

Brand Manufacturer Chemical Composition Batch

Number

Resin composites

Quadrant Anterior Shine (AS) (Microhybrid) Cavex GmbH & Co KG, bis-GMA, diurethane dimethacrylate, silica, 010100
Haarlem, The Netherlands silicate glass, and fluoride-containing fillers
(63 v%)

Grandio (G) (Nanohybrid) Voco GmbH, Cuxhaven, bis-GMA dimethacrylate, UDMA, TEGDMA, 621332
Germany glass-ceramic, SiO2-containing filler (71.4
v%)

Tribochemical silica coating kit

CoJet-Sand 3M ESPE AG, Seefeld, Aluminum trioxide particles coated with silica, 165092
Germany particle size: 30 lm

ESPE-Sil 3M ESPE AG 3-Methacryloxypropyltrimethoxysilane, 152745

ethanol

Intermediate adhesive resins

Quadrant Unibond (for AS) Cavex bis-GMA, TEGDMA, silicate glass fillers, 10049
silica, polycarboxylic acid, camphorquinone

Solobond Plus (for G) Voco bis-GMA, TEGDMA, HEMA, camphorquinone 591583

Abbreviations: bis-GMA, bisphenol A diglycidyl ether dimethacrylate; HEMA, 2-hydroxyethyl methacrylate; TEGDMA, triethylene glycol dimethacrylate; UDMA,
urethane dimethacrylate or 1,6-di(methacryloyloxyethylcarbamoyl)-3,30,5-trimethylhexaan.

Surface Conditioning Protocols sand particles were gently air-blown. After condi-
The surfaces of the substrate composites and the tioning protocols, the repair resin was adhered to the
substrate surfaces using transparent polyethylene
surrounding dentin were conditioned according to
molds with an inner diameter of 3.6 mm and a height
one of the following adhesion protocols: protocol 1:
of 5 mm and photo-polymerized. The same operator
acid-etching (dentin) þ silica coating (composite) þ
carried out the bonding procedures in accordance
silanization (composite) þ primer (dentin) þ bonding
with the manufacturers’ instructions throughout the
agent (dentin þ composite); protocol 2: silica coating
experiments. The composite was packed against the
(composite) þ acid-etching (dentin) þ silanization substrate incrementally with a hand instrument,
(composite) þ primer (dentin) þ bonding agent and each layer was photo-polymerized for 40 sec-
(dentin þ composite); and protocol 3: acid-etching onds. After polymerization, the polyethylene molds
(dentin) þ primer (dentin) þ silanization (composite) were gently removed from the test specimens. The
þ bonding agent (dentin þ composite). substrate-adherent combinations were as follows:
The primer and the bonding agents were the AS-AS, G-G, and AS-G.
materials of the corresponding composite manufac-
turers. Silica coating was achieved using a chairside Testing Procedure and Failure Analysis
air-abrasion device (Dento-Prep, RØNVIG A/S, Dau- Specimens were mounted in the jig of the Universal
gaard, Denmark) filled with 30-lm alumina particles Testing Machine (Zwick ROELL Z2.5 MA 18-1-3/7,
coated with silica (CoJet-Sand, 3M ESPE AG, Ulm, Germany), and the shear force was applied to
Seefeld, Germany) from a distance of approximately the adhesive interface until failure occurred. The
10 mm at a pressure of 2.5 bars for four seconds. load was applied to the adhesive interface, as close as
Following surface conditioning, the remnants of possible to the surface of the substrate. The
Özcan & Pekkan: Effect of Different Adhesion Strategies on Composite Repair 67

Table 2: Results of Two-way Analysis of Variance for the Composite Types, Adhesion Protocols, and the Interaction Terms
According to Bond Strength Data (* p,0.05)

Source of Variation DF SS MS F p

Composite type 2 466.312 233.156 9.758 0.000*

Adhesion protocol type 2 267.545 133.772 5.599 0.006*

Interaction (composite*protocol) 4 121.139 30.285 1.267 0.292

Error 1505.315 1505.315 23.894

Total 22,234.509 22,234.509

* Statistically significant difference at the level of a=0.05.

Abbreviations:DF, degrees of freedom; SS, sum of squares; MS, mean square.

specimens were loaded at a crosshead speed of 1 mm/ bond strength results. Interaction terms were not
min, and the stress-strain curve was analyzed with significant (p=0.292) (Table 2). Regardless of the
the software program (Zwick ROELL). Subsequent- substrate-adherent combination, protocol 1 (17–22
ly, digital photos (Canon Ixus 40, Canon Inc, Tokyo, MPa) showed significantly higher results than did
Japan) were taken from the substrate surfaces, and protocol 2 (15–17 MPa) (p=0.028) and 3 (11–17 MPa)
specimens were evaluated under optical microscope (p=0.002). Protocol 3 presented the lowest results
(MP 320, Carl Zeiss, Jena, Germany). The types of (11–17 MPa). The highest results were obtained from
failures were categorized as 1) cohesive failure in the the G-G combination for all three protocols (17–22
composite substrate and 2) adhesive failure at the MPa) (Table 3; Figure 1). The power of the study was
interface. calculated to be 82% (confidence interval, 95%).
From four separate specimens, cold field emission The incidence of cohesive failures was more
scanning electron microscope (SEM; JSM-6301F, common when the substrate and the adherent were
Jeol Instruments, Tokyo, Japan) images were taken the same composite type (AS-AS: 87.5%, 87.5%, 75%;
at 25 kV at a magnification of 10,0003. Surfaces G-G: 100%, 75%, 50% for protocols 1, 2, and 3,
were first sputter-coated with a 3-nm-thick layer of respectively) (Figure 2). When substrate and adher-
ent composites were used interchanged (AS-G),
gold/palladium (80/20) prior to examination.
adhesive failures were more frequent (72.5%,
12.5%, 100% for protocols 1, 2, and 3, respectively)
Statistical Analysis
(Table 4).
Statistical analysis was performed using SPSS 11.0 Figure 3a-d shows SEM images of the composites
software for Windows (SPSS Inc, Chicago, IL, USA). before (left panel) and after (right panel) silica
Bond strength data (MPa) were submitted to two- coating. The microfilled composite, AS, clearly
way analysis of variance. Multiple comparisons were showed larger filler particles than did nanohybrid
made with the least significant difference (LSD) post G. It should be noted that these regions need not
hoc test (a=0.05), with the shear bond strength as necessarily be at the surface but may also be slightly
the dependent factor and adhesion protocols and the underneath the surface, covered by a thin resin
composite material types as the independent factors. matrix layer. After silica coating, similarly rough
Values of p,0.05 were considered to be statistically surfaces were evident in all composites.
significant in all tests. Power analysis was per-
formed using a statistical software package (Stata, DISCUSSION
StataCorp, College Station, TX, USA).
This study was undertaken in order to investigate
the effect of different repair protocols on the
RESULTS
adhesion of composites to composite-dentin complex-
Significant effects of the adhesion strategy (p=0.006) es using the shear bond strength test. This type of
and the composite type (p=0.000) were found on the test produces a combination of shear, tensile, and
68 Operative Dentistry

Table 3: The Mean Bond Strength Values (MPa) With Standard Deviations (6SD) for Composite Combinations After Adhesion
Protocolsa

Adhesion Protocol AS-AS G-G AS-G

aA aA aA
Protocol 1 17.5 6 4.8 22.3 6 6.8 17.7 6 4.1

abA aA abA
Protocol 2 15.3 6 3.2 17.6 6 5.4 15.1 6 6.7

bA aB bA
Protocol 3 11.7 6 3.2 17.7 6 4.1 11.4 6 3.0

Abbreviations: AS, Quadrant Anterior Shine; G, Grandio.

a
The same uppercase superscripted letters in the column (least significant difference [LSD] test, a=0.05) and capital letters in the row indicate no significant
differences (LSD test, a=0.05). For group abbreviations see Table 1.

compressive stresses that often occurs during chew- surfaces are coated with silane that makes the
ing function.14 Since it is technically impossible to surface more reactive for the methacrylate groups
study adhesion on complex assemblies of dentin- of the repair resin.
composite or enamel-composite using tensile or The results of this study showed a significant
microtensile tests,40 the shear test was employed. influence of the adhesion protocol. Therefore, the
The surface conditioning methods indicated for first hypothesis—that the different adhesion strate-
composite repairs are often based on mechanical gies would not affect the bond strength—could be
roughening with burs,9,10,37 airborne particle abra- rejected. The highest mean bond strength was
sion,1,4 or use of etching agents9,10,13 followed by obtained using protocol 1, in which the dentin was
application of adhesive systems.1,4,20 Particle depo- etched and the composite was then silica-coated.
sition techniques increase the surface area, and After etching the dentin, dentinal tubules could be
adhesion of the adherent composite is achieved expected to be closed by the sand particles, and as a
through mechanical interlocking.1,4,32 This retentive consequence, the bond strength would be impaired
surface texture also favors the surface wettability of when compared to the bond strength associated with
the composite.5,19 Based on previous favorable the other protocols. Since this was not the case, an
findings,1,4,20,22,25,29,40 in this study, composite spec- adverse effect of air-abrasion could not be confirmed,
imens were conditioned using silica coating and but it must be also noted that in this current study,
silanization. In this method, after air-abrasion with the dentin surrounding the composite was limited.
30-lm alumina particles coated with silica,4,22 the The reason for the choice of 0.5 mm of dentin
surrounding the composite was that it imitated the

Figure 2. Distribution of failure types in percentage analyzed after

Figure 1. The mean shear bond strength values (MPa) of compos- shear bond strength test depending on the substrate-adherent
ites to composite-dentin complex after three adhesion protocols. combinations after three adhesion protocols.
Özcan & Pekkan: Effect of Different Adhesion Strategies on Composite Repair 69

Table 4: Distribution and Frequency of Failure Types per

Considering the adhesion protocols regardless of
Experimental Group Analyzed After Bond the composite type, it can be stated that physico-
Strength Test chemical conditioning the composite surface adds to
the adhesive strength of the adherent. When the
Adhesion Failure AS-AS G-G AS-G composite surfaces were only silane-coated but not
Protocol Type physico-chemically conditioned (protocol 3), the
mean bond strength was lower. This is in contrast
1 A 87.5 100 37.5 to the results of two previous studies19,41 in which
silane application was found to be sufficient for
B 12.5 0 72.5
composite repairs. Silanes are molecules with two
functional groups. While silanol groups react with
2 A 87.5 75 87.5
the inorganic filler particles of the resin, organo-
functional groups react with the methacrylate
B 12.5 25 12.5
groups in the adhesive system. A covalent bond
may be established between the monomers in the
3 A 75 50 0
adhesive system and the inorganic filler particles in
B 25 50 100
the composite using the silanes.42 When no fillers
are exposed on the substrate surface, the silane has
Abbreviations: [Failure Type] A, cohesive failure in the composite substrate; to react with the monomer matrix only, which could
AS, Quadrant Anterior Shine; [Failure Type] B, adhesive failure at the
interface; G, Grandio. be the situation in previous studies. Furthermore,
the wettability capacity of the substrate-adherent
combinations as well as IAR types could also have
tooth surface after beveling, since clinical over- played a role in the variation seen in the results. The
contouring of the enamel/dentin surfaces during existence of the surrounding dentin did not increase
repairs is avoided. However, in the case of ceramic the adhesion of the composite. In this group, the
inlay, onlay, or overlay fractures, the exposed dentin results were lower than in a previous report40 in
surfaces may be wider. This aspect requires further which only composites were repaired without any
investigation in situations in which the surrounding approximating dentin. Nevertheless, considering the
dentin is wider than 0.5 mm. high incidence of adhesive failures after using

Figure 3. (a-d) SEM micrographs (10,0003) of the two composites Quadrant Anterior Shine (a) before and (b) after silica-coating and Grandio (c)
before and (d) after silica-coating. Bar marker indicates 1 lm.
70 Operative Dentistry

protocol 3, there seems to be a need for surface was not practically possible to avoid the effect of air-
conditioning for micromechanical retention. abrasion on the dentin. Similarly, when dentin was
The composite type also significantly affected the etched, during washing and rinsing the composite
results of this study. Therefore, the second hypoth- surface also received some phosphoric acid. This
esis—that the different substrate-adherent combi- cross-contamination might have decreased the bond
nations would not affect the bond strength—was results. There is certainly a needfor adhesives that
also rejected. In clinical practice, the type of could condition multiple surfaces with different
composite for immediate repairs is usually the same natures (ie, tooth-restoration surfaces) at the same
time. The obtained results need to be verified in
substrate. However, in some cases, as a result of
clinical studies.
better color choices, another type of composite may
be chosen for relayering. In this case, the substrate Substrate-adherent combinations were not aged,
and the adherent composites would be different. In which could be considered a limitation of this study.
addition, in some situations, if the patient already Polymeric materials tend to absorb water and
has a composite restoration, the information on the degrade when they are exposed to hydrothermal
substrate type may not be traced. In such situations, aging conditions.29,34 Therefore, the effect of the
a different repair composite is used. The results of studied protocols may vary when the composite
this study showed that adhesion of different sub- combinations are aged. This aspect needs to be
strate-adherent combination (AS-G) resulted in the further investigated.
highest incidence of adhesive failures. This indicates
that the adhesion did not reach the cohesive CONCLUSIONS
strength of the substrate composite. Since both From this study, the following can be concluded:
composites are basically methacrylate-based mate-
rials, one reason for the adhesive failures could be  Increased repair strength was obtained with a high
the variation between the surface wettability prop- incidence of cohesive failures in the substrate when
erties of the AS (microhybrid) and G (nanohybrid) the substrate and the repair composite are of the
composites.1 During the experiments, it was noted same type.
that the G composite was less viscous than AS. It is  The nanohybrid composite tested presented higher
likely that surface contact was not ideal between AS repair strength compared to the microhybrid
and G. On the other hand, the high mean repair composite.
strength could be due to better compatibility or a  For durable repair of the composite-dentin com-
greater number of free radicals available on the G plex, after etching the dentin, neighboring com-
substrate in the G-G combination. In future studies, posite surfaces need to be activated with air-
the degree of conversion in correlation with the abrasion and silanization. This procedure present-
repair bond strength needs to be evaluated using ed better results than did silane-only application
Raman spectroscopy. on the composite.
The bond strength values for clinically durable
repairs are not known to date, but adhesion to Acknowledgements
enamel is usually considered the gold standard.5,7 In The authors would like to thank Cavex GmbH & Co KG
all groups, the results ranged between 11 and 22 (Haarlem, The Netherlands) and Voco GmbH (Cuxhaven,
MPa. These values were comparable to or lower than Germany) for the generous provision of the composite
materials and adhesive resins used.
those of previous studies1,2,4,10,40 in which composite-
composite adhesion was tested. Rinastiti and others3
Conflict of Interest
found shear bond strengths for AS and G using IARs
The authors of this article certify that they have no
for immediate repairs of 15.0 6 6.6 MPa and 15.8 6 proprietary, financial, or other personal interest of any nature
5.9 MPa, respectively. Similar to the findings of this or kind in any product, service, and/or company that is
study, tribochemical silica coating increased the presented in this article.
immediate repair strength of AS and G to 25.0 6
8.5 MPa and 26.3 6 7.9 MPa, respectively. The (Accepted 19 March 2012)
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