The effect of immediate dentin sealing

on the marginal adaptation and bond

strengths of total-etch and self-etch
adhesives
Sillas Duarte, Jr, DDS, MS, PhD,a Claudia Regina Buanain de
Freitas, DDS, MS,b José Roberto Cury Saad, DDS, MS, PhD,c
and Avishai Sadan, DMDd
School of Dental Medicine, Case Western Reserve University,
Cleveland, Ohio; Araraquara School of Dentistry, São Paulo State
University (UNESP), Araraquara, São Paulo, Brazil

Statement of problem. Sealing ability and bond strengths of total-etch and self-etch dentin adhesives used for imme-
diate dentin sealing have not been assessed and established.

Purpose. The purpose of this study was to determine the effectiveness of immediate dentin sealing (IDS) using total-
etch or self-etch dentin adhesives on microleakage and microtensile bond strength.

Material and methods. Twenty recently extracted molars were selected, and standard MOD inlay preparations were
made with the gingival margins located below the cemento-enamel junction. The teeth were assigned to 4 experi-
mental groups (n=5) according to the indirect composite restoration cementation technique used: (1) immediate
dentin sealing with Adper Single Bond (TEBI); (2) conventional adhesive cementation technique using Adper Single
Bond (TEAI); (3) immediate dentin sealing using Adper Prompt L-Pop (SEBI); or (4) conventional adhesive cementa-
tion technique using Adper Prompt L-Pop (SEAI). The restored teeth were thermal cycled 1,000 times between 5°
and 55°C and then immersed in 50% ammoniacal silver nitrate. Three specimens per restoration were evaluated for
microleakage, according to predefined scores, and submitted to Friedman’s test (α=.05). The specimens were then
sectioned to obtain 0.8 ±0.2-mm-thick sticks (with n ranging from 32 to 57 specimens) and submitted to microtensile
bond strength (µTBS) testing. The obtained data were submitted to 2-way ANOVA test (α=.05).

Results. None of the experimental groups demonstrated complete elimination of marginal microleakage. There were
significant differences in microleakage of the tested adhesives (P>.001). IDS microleakage scores were similar to those
obtained using the conventional cementation technique (CCT) for both adhesives. The highest mean bond strengths
were obtained with TEBI (51.1 MPa), whereas SEAI showed the lowest mean bond strengths (1.7 MPa). IDS resulted
in significantly higher bond strengths than CCT (P<.001).

Conclusions. Total-etch and self-etch adhesives have a significant effect on IDS. IDS resulted in high bond strengths
for both adhesives; however, the microleakage was similar to that obtained with CCT. (J Prosthet Dent 2009;102:1-9)

Clinical Implications
Despite immediate dentin sealing that resulted in high bond
strengths for both adhesives, the marginal microleakage was
not improved. The total-etch and self-etch adhesives evaluated
have a significant effect on immediate dentin sealing.

a
Associate Professor, Department of Comprehensive Care, Case Western Reserve University.
b
PhD student, Department of Operative Dentistry, São Paulo State University.
c
Associate Professor, Department of Operative Dentistry, São Paulo State University.
d
Professor and Chairman, Department of Comprehensive Care, Case Western Reserve University.
Duarte et al
2 Volume 102 Issue 1
Tooth-colored posterior direct ent study was to evaluate the effect gival extension, 6.0 mm. The gingival
esthetic restorations are affected by of immediate dentin sealing (IDS) walls were placed below the cemento-
polymerization shrinkage,1 which on microtensile bond strengths and enamel junction (CEJ) (Fig. 1). All
may result in postoperative sensitivity microleakage using a total-etch and preparations were examined under
and also in disruption of the bonded a self-etch dentin adhesive. The null x20 magnification for possible cracks
interface.2,3 To overcome these prob- hypotheses tested in this study were: or fissures. A digital caliper (Mitutoyo
lems, indirect restoration has been (1) different adhesives used for IDS Corp, Kawasaki, Japan) and a peri-
advocated, especially to restore deep do not influence marginal microleak- odontal probe were used to examine
preparations with gingival margins lo- age, and (2) there is no difference in the preparation dimensions, and if
cated in dentin.4,5 Unfortunately, the microtensile bond strength when dif- any deviation from the standard prep-
need to form a path of insertion with ferent adhesives are used for IDS. aration design occurred, the tooth
divergent preparation walls for indi- was discarded and another specimen
rect restorations exposes more dental MATERIAL AND METHODS was prepared.
tissue. In addition, the bond to the The preparations were assigned to
gingival walls was found to be less pre- Twenty freshly extracted caries- 4 experimental groups (n=5), accord-
dictible than the bond to axial walls in free human third molars were selected ing to the hard tissue hybridization
both in vitro6-8 and in vivo investiga- for the present study after examina- and cementation technique used.
tions.7 The bonding system used also tion with a stereomicroscope (Carl That is, the internal hard tissues of the
can positively or negatively affect the Zeiss Microimaging, Inc, Thornwood, preparations were immediately sealed
adhesion to dentin margins.9 NY) at x20 magnification to detect before impressions and before ce-
Immediate dentin sealing (IDS) possible enamel cracks or fissures, mentation using a total-etch adhesive
has been reported to increase and stored in 0.5% chloramine (Fish- (TEBI, Adper Single Bond; 3M ESPE,
the bond strengths of indirect er Scientific, Pittsburg, Pa) at 4°C. St. Paul, Minn) or self-etch adhe-
restorations.10,11-15 Freshly prepared Twenty standardized MOD Class II sive (SEBI, Adper Prompt L-Pop; 3M
dentin is more permeable16,17; thus, preparations for indirect compos- ESPE), while in groups TEAI and SEAI,
it is more susceptible to bacterial ite restorations were prepared with the preparations were sealed only be-
contamination.18-22 The application 15-degree gingival-occlusal diver- fore the cementation with total-etch
of a dentin adhesive to freshly pre- gence.38 Standardized preparations and self-etch adhesives, respectively.
pared dentin might seal and protect were completed with a diamond rota- All materials were used according to
dentin against bacterial leakage.23-25 ry cutting instrument (#3131; KG So- the manufacturer’s instructions (Ta-
However, as the weak link of a bond- rensen, Barueri, São Paulo, Brazil) in ble I).
ed indirect restoration is located a high-speed handpiece with copious
at the adhesive layer-dentin inter- water cooling. After every 5 prepara- TEBI group: Total-etch adhesive, Ad-
face,26-31 microleakage remains a con- tions, the diamond rotary cutting in- per Single Bond, before impression
cern,10,25,32-37 especially under thermal strument was discarded and replaced
or occlusal stress.38,39 with a new one. Each standardized The preparations were acid-etched
Sealing ability and bond strengths preparation had the following dimen- with 35% phosphoric acid for 15 sec-
of total-etch and self-etch dentin ad- sions: buccal-lingual extension, 6.0 onds (ScotchBond Etchant; 3M ESPE),
hesives used for IDS have not been mm; pulpal floor depth, 2.5 mm; axial rinsed with water for 10 seconds, blot
established. The objective of the pres- wall extension, 2.5 mm; occlusal-gin- dried using a cotton pellet to leave the

A B
1 A, Occlusal view of inlay preparation. B, Cross-sectioned view of inlay preparation.

The Journal of Prosthetic Dentistry Duarte et al

July 2009 3
Table I. Restorative materials used
Material Composition Manufacturer Application Technique

Adper Single Bis-GMA, HEMA, 3M ESPE, 1. Apply Scotchbond Etchant to dentin. Wait 15 s and rinse
Bond dimethacrylates, ethanol, St. Paul, Minn for 10 s. Blot excess water using cotton pellet without
water, photoinitiator system, dehydrating dentin. Surface should appear glistening
methacrylate functional without pooling of water.
copolymer of polyacrylic
and polyitaconic acids, 2. Immediately after blotting, apply 2-3 consecutive coats of
5-nm silica particles adhesive for 15 s with gentle agitation using fully saturated
(batch #3HT) applicator. Gently air thin for 5 s to evaporate solvent.
Light polymerize for 10 s.

Adper Prompt Methacrylate phosphoric 3M ESPE 1. Apply adhesive to entire surface of cavity, rubbing in
L-Pop ester, bis-GMA, solution with moderate finger pressure for 15 s. Use gentle
camphorquinone, stream of air to thoroughly dry adhesive to thin film.
2-hydroxyethyl
methacrylate (HEMA), 2. Apply second coat of adhesive that does not need to be
water, polyalkenoic acid massaged into surface. Again, use gentle stream of air to
copolymer stabilizers thoroughly dry adhesive to thin film. Light polymerize for 10 s.
(batch #133511)

RelyX ARC Bis-GMA, TEGDMA 3M ESPE 1. Dispense cement onto mixing pad and mix for 10 s.
Adhesive polymer, zirconia/ Apply thin layer of cement onto preparation.
Cement silica filler,
benzoyl peroxide 2. Slowly seat inlay/onlay. While holding in place, remove
(batch #CWCX) excess cement immediately after seating.

3. Light polymerize margins for 40 s.

Targis UDMA, decanediol Ivoclar Vivadent, 1. Incrementally add Targis onto stone cast in 4 layers.
Ceromer dimethacrylate, Schaan, Prepolymerize each layer with halogen light source (Targis
System bis-GMA, barium glass, Liechtenstein Quick; Ivoclar Vivadent) for 10 s.
mixed oxide,
silicon dioxide 2. Apply layer of Targis Gel (Ivoclar Vivadent) onto definitive
(batch #D34837) restoration to inhibit oxygen layer formation.

3. Postpolymerize (Targis Power Oven; Ivoclar Vivadent)

definitive restoration at 90°C for 25 min.

Bis-GMA: bisphenol-A-diglycidylether dimethacrylate; HEMA: 2-hydroxyethyl methacrylate; TEGMA: triethylene glycol dimethacrylate;
UDMA: urethane dimethacrylate

surfaces moist (glistening), and then all groups), an acrylic resin (Duralay; vinyl polysiloxane impression mate-
2-3 layers of Adper Single Bond (3M Reliance Dental Mfg Co, Worth, Ill) rial (Aquasil ULV; Dentsply De Trey
ESPE) were applied. The applied ad- custom tray was fabricated to facili- GmbH, Konstanz, Germany) was ap-
hesive was gently agitated for 15 sec- tate impression procedures. The cus- plied to both the cavity preparation
onds using a fully saturated applica- tom tray was coated with a thin layer and the custom tray. The specimens
tor. The solvent was evaporated for 5 of tray adhesive (Caulk Tray Adhesive; were immediately inserted into the
seconds and light polymerized for 10 Dentsply Caulk, Milford, Del) and al- custom acrylic tray. After the impres-
seconds. For each prepared tooth (in lowed to air dry for 5 minutes. Mixed sion material had polymerized, the
Duarte et al
4 Volume 102 Issue 1
specimens were removed from the resin cement (RelyX ARC; 3M ESPE) seconds under a pressure of 50 psi at a
tray and thoroughly rinsed in running was dispensed, mixed, and applied to 10-mm distance, rinsed with distilled
water for 1 minute. The teeth were re- both the internal surface of the res- water, air dried, and silanated. A thin
stored with a provisional restorative toration and the cavity preparation layer of the dentin adhesive (Adper
material (Fermit; Ivoclar Vivadent, before seating the inlay. The ceromer Single Bond; 3M ESPE) was applied
Schaan, Liechtenstein) and stored in inlay was seated in the preparation to the internal surface of the restora-
distilled water at 37°C for 7 days (un- under a 1-kg weight, while the excess tions, without light polymerization
til the cementation of the inlays). cement was carefully removed from before the cementation.24
The impressions were vacuum the margins with disposable sponges. The preparations were acid etched
poured in type IV die stone (GC Fu- All of the margins were polymerized with 35% phosphoric acid for 15
jirock EP; GC America, Alsip, Ill). The for 40 seconds with a light-polymer- seconds (ScotchBond Etchant; 3M
stone casts were coated with 2 layers ization unit (XL3000 light; 3M ESPE) ESPE), rinsed with water for 10 sec-
of separator (Targis Model Separator; with a light output of 600 mW/cm2 onds, blot dried using a cotton pellet
Ivoclar Vivadent). The indirect cer- constantly monitored with a radiom- to leave the surfaces moist (glisten-
omer inlays (Targis system; Ivoclar Vi- eter (Demetron Halogen Radiometer; ing), and then 2-3 layers of Adper
vadent) were fabricated as described Kerr Corp, Orange, Calif ). The mar- Single Bond (3M ESPE) were applied.
in Table I. The inlay finishing and pol- gins of the restorations were finished The applied adhesive was agitated
ishing procedures were performed with aluminum-oxide discs (Sof-Lex for 15 seconds using a fully saturated
with aluminum-oxide discs (Sof-Lex XT; 3M ESPE) under x10 magnifica- applicator. The solvent was allowed
XT; 3M ESPE). After 7 days, the in- tion. The restored teeth were stored to evaporate for 5 seconds and light
terim restorations were removed and in 37°C distilled water for 24 hours. polymerized for 10 seconds. The resin
the sealed dentin was cleaned with cement (RelyX ARC; 3M ESPE) was
pumice and water. The ceromer inlays TEAI group: Total-etch adhesive, Ad- dispensed, mixed, and applied to
were placed into the preparations and per Single Bond, after impression both the intaglio surface of the res-
the marginal adaptation was evaluat- toration and the cavity preparation
ed with a stereomicroscope under x10 The preparations were neither before seating the inlay. The ceromer
magnification (Carl Zeiss Microimag- immediately acid etched nor resin inlay was seated in the preparation as
ing, Inc). sealed, and were instead cemented described previously, and all the mar-
The intaglio surface of the resto- with the conventional cementation gins were polymerized for 40 seconds
rations was treated with airborne- technique (CCT). Vinyl polysiloxane (XL3000 light; 3M ESPE). The mar-
particle abrasion with 50-μm Al2O3 impressions were made as described gins of the restorations were finished
particles (Microetcher II; Danville previously. After the impression mate- with aluminum-oxide discs (Sof-Lex
Engineering, San Ramon, Calif ) for rial had polymerized, the specimens XT; 3M ESPE) under x10 magnifica-
10 seconds under a pressure of 50 were removed from the tray and thor- tion. The restored teeth were stored
psi at a 10-mm distance, rinsed with oughly rinsed in running water for 1 in 37°C distilled water for 24 hours.
distilled water, and air dried. Subse- minute. The teeth were restored with
quently, a silane coupling agent (Ce- a provisional restorative material (Fer- SEBI group: Self-etch adhesive, Adper
ramic Primer; 3M ESPE) was applied mit; Ivoclar Vivadent) and stored in Prompt L-Pop, before impression
to the restoration’s intaglio surface, distilled water at 37°C for 7 days (un-
allowed to evaporate for 3 minutes, til the cementation of the inlays). The Dry, smear layer-covered dentin
and air dried for 30 seconds.40 A thin impressions were vacuum poured, die was immediately sealed with self-etch
layer of the dentin adhesive (Adper spacer was added, and the ceromer adhesive (Adper Prompt L-Pop; 3M
Single Bond; 3M ESPE) was applied inlays were fabricated. Next, the inter- ESPE). The adhesive was applied to
to the intaglio surface of the restora- im restorations were removed and the the entire surface of the cavity while
tions without light polymerization be- preparation was cleaned with pumice being agitated with moderate finger
fore the cementation. 24 and water. The ceromer inlays were pressure for 15 seconds. A gentle
The preparations were acid etched placed into the preparations, and the stream of air was applied to thor-
with 35% phosphoric acid for 15 marginal adaptation was evaluated oughly dry the adhesive to a thin film.
seconds, rinsed with water for 10 with a stereomicroscope under x10 A second coat of adhesive was ap-
seconds, blot dried before the appli- magnification (Carl Zeiss Microimag- plied, followed by a gentle stream of
cation of 2-3 layers of Adper Single ing, Inc). air to thoroughly dry the adhesive to a
Bond, agitated for 15 seconds, then The intaglio surface of the restora- thin film. The adhesive was then light
the solvent was allowed to evaporate tions was airborne-particle abraded polymerized for 10 seconds (XL3000
for 5 seconds, and the preparation was with 50-μm Al2O3 particles (Micro- light; 3M ESPE). Impressions were
light polymerized for 10 seconds. The etcher II; Danville Engineering) for 10 made, and then the teeth were pro-
The Journal of Prosthetic Dentistry Duarte et al
July 2009 5
visionally restored and stored in dis- performed as described previously.
tilled water at 37°C for 7 days. The SEAI group: Self-etch adhesive, Adper All of the specimens were cycled
casts were made, die spacer was Prompt L-Pop, after impression for 1000 thermal cycles between
added, and the inlays were fabricated water baths held at 5oC/55oC, using
as described previously. The intaglio Dry, smear layer-covered dentin a 30-second dwell time. Next, the
surface of the restoration was treated was not previously sealed with Adper specimens were coated with 2 layers
with airborne-particle abrasion with Prompt L-Pop (3M ESPE). Instead, of nail polish (Vinyl shine nail polish;
50-μm Al2O3 particles (Microetcher impressions were made, casts were Rimmel London, London, UK), except
II; Danville Engineering) for 10 sec- made, die spacer was added, and the for a 2.0-mm rim around the restora-
onds, rinsed with distilled water, air inlays were fabricated. The teeth were tion, to allow contact of the leakage-
dried, and silanated. No adhesive was restored with a provisional restorative tracing agent with the margins of the
applied to the intaglio of the restora- material (Fermit; Ivoclar Vivadent) restoration. The specimens were then
tion because of the acidic pH of the and stored in distilled water at 37°C immersed in an aqueous solution of
self-etch adhesive. for 7 days. 50 wt% ammoniacal silver nitrate
The interim restoration was re- The provisional restoration was (pH=9.5) for 24 hours, followed by 8
moved, and the preparations were removed, and the preparations were hours in a photo-developing solution
resealed with the self-etch adhesive sealed with self-etch adhesive (Adper (Eastman Kodak Co, Rochester, NY)
(Adper Prompt L-Pop; 3M ESPE) and Prompt L-Pop; 3M ESPE). The adhe- to permit reduction of the diammine
light polymerized for 10 seconds. The sive was applied to the entire surface silver ions to metallic silver grains.41
resin cement (Rely X ARC; 3M ESPE) of the cavity, rubbing in the solution The specimens were retrieved from
was dispensed, mixed, and applied to with moderate finger pressure for 15 the photo-developing solution and
both the internal surface of the res- seconds. A gentle stream of air was washed in running water for 1 minute.
toration and the cavity preparation applied to thoroughly dry the adhe- The nail polish was carefully removed
before seating the inlay. The ceromer sive to a thin film. A second coat of with a #15 scalpel (Miltex Instruments
inlay was seated in the preparation adhesive was applied, followed by a Co, York, Pa) and the specimens were
under a 1-kg weight, and the excess ce- gentle stream of air to thoroughly dry sectioned through the restoration
ment was carefully removed from the the adhesive to a thin film. The ad- with a precision, water-cooled, slow-
margins with disposable sponges. All hesive was then light polymerized for speed diamond saw (IsoMet 1000;
of the margins were polymerized for 10 seconds. The resin cement (Rely X Buehler Ltd, Lake Bluff, Ill). Three 0.8
40 seconds (XL3000 light; 3M ESPE), ARC; 3M ESPE) was dispensed, mixed, ±0.2-mm-thick slabs from the center
and the margins of the restorations and applied to both the intaglio sur- of the restoration were generated (Fig.
were finished with aluminum-oxide face of the restoration and the cavity 2, A). The slabs were analyzed with a
discs (Sof-Lex XT; 3M ESPE). The re- preparation before seating the inlay. stereomicroscope at x30 magnifica-
stored teeth were stored in 37°C dis- The cementation and finishing were tion and scored by 2 examiners for
tilled water for 24 hours.

A B
2 A, Specimen preparation for microleakage evaluation. B, Microleakage scores.
Duarte et al
6 Volume 102 Issue 1
the degree of dye penetration along lowed by Wilcoxon post hoc tests. millimeters. The load (in newtons, N)
the dentin walls (mesial and distal After microleakage evaluation, and the bonding surface area of the
gingival margins), according to the each slab was again attached to a phe- specimen were recorded, and micro-
following scores42: score 0, no mar- nolic ring (Buehler Ltd), and a second tensile bond strengths were calculat-
ginal leakage; score 1, silver nitrate set of sections, 0.8 ±0.2 mm thick, ed in MPa. The fractured specimens
penetrates up to half the length of were cut perpendicular to the adhe- were observed under a stereoscopic
the gingival wall; score 2, silver nitrate sive interface. Stick-shaped specimens microscope under x40 magnification
penetrates beyond half the gingival with a rectangular sectional area of to classify the mode of failure as: (A)
wall length, without reaching the axial 0.8 ±0.2 mm were obtained from gin- adhesive failure, (C) cohesive failure,
wall; score 3, silver nitrate penetrates gival and pulpal walls. Specimens with or (M) mixed failure. Statistical analy-
along the gingival and axial walls to- either inappropriate dimensions or sis was performed using the same
wards the pulp (Fig. 2, B). uneven bonded interfaces that could statistical software. Bond strength
There were 5 teeth per group. Each not be aligned perpendicular to the data obtained from the 4 experimen-
tooth yielded 3 slabs for the scoring tensile load were discarded; thus, the tal groups were analyzed with a 2-way
of microleakage. The marginal mi- number of specimens for each group analysis of variance (ANOVA), with
croleakage of each slab was assessed ranged from 32 to 57. The specimens each tooth (mean microtensile bond
for the mesial and distal margins of were tested individually by attaching strength testing from the number of
the restorations. Therefore, repeated them to a microtensile jig using cyano- beams retrieved from each tooth)
measurements of microleakage scores acrylate glue (Zapit; Dental Ventures used as a single measurement, yielding
were obtained from each tooth (3 of America, Inc, Corona, Calif ).43 The 5 measurements per group (α=.05). A
slabs and measurements on the me- specimens were then submitted to a 2-way ANOVA was computed with ad-
sial and distal margins, for 6 measure- tension load using a universal test- hesive type and immediate or delayed
ments per molar). Statistical analysis ing machine (MTS 810; MTS Systems sealing as the 2 factors (α=.05).
was performed with statistical soft- Corp, Eden Prairie, Minn) at 1.0 mm/
ware (SPSS 15; SPSS, Inc, Chicago, min crosshead speed. A digital caliper RESULTS
Ill). The data were analyzed with the (Mitutoyo Corp) with an accuracy of
Friedman’s test (α=.05) to evaluate 0.001 mm was used to measure the Table II represents repeated mea-
different techniques of hybridization depth and width of the bonded inter- surements of microleakage scores on
for indirect ceromer restorations, fol- face and calculate the bonding area in each tooth (3 slabs and measurements

Table II. Microleakage scores

TEBI TEAI SEBI SEAI

Tooth Specimen Mesial Distal Mesial Distal Mesial Distal Mesial Distal

1 1 0 3 2 3 3 3 3
1 2 1 1 3 3 3 3 3 3
3 1 0 3 3 3 3 3 3

1 3 3 3 3 3 3 3 3
2 2 1 2 1 3 3 3 3 3
3 3 2 3 3 3 3 3 3

1 3 3 2 3 3 3
3 2 3 3 2 2 3 3 3 3
3 3 3 2 2 3 3 3 3
2 3
1 1 1 2 2 3 3 3 3
4 2 3 3 2 3 3 3 3 3
3 3 3 3 1 3 3 3 3

1 1 2 2 1 3 3 3 3
5 2 3 1 2 1 3 3 3 3
3 3 1 2 2 3 3 3 3

The Journal of Prosthetic Dentistry Duarte et al

July 2009 7
Table III. Mean microtensile bond strengths (SD) in MPa
Tooth TEBI TEAI SEBI SEAI

1 49.4 (13.7) 33.1 (11.8) 8.7 (12.1) 2.0 (4.2)

2 46.0 (15.1) 41.0 (12.2) 13.6 (9.0) 1.7 (3.6)

3 56.0 (11.0) 44.9 (18.2) 21.1 (9.6) 2.5 (5.5)

4 47.0 (12.7) 35.7 (18.3) 12.3 (17.8) 2.8 (8.4)

5 57.1 (12.1) 18.8 (16.1) 9.8 (15.4) 0.0 (0.0)

Total 51.1 (5.1)a 40.7 (6.4)b 13.0 (5.0)c 1.7 (1.1)d

PTF/n 0/32 0/45 27/56 42/49

Means followed by different superscript letter are statistically different at P<.05.

PTF/n: Number of pretest debond failures/total number of sticks prepared.

Table IV. Two-way analysis of variance (ANOVA) for cementation technique (immediate
or delayed sealing) and adhesive type (total etch or self etch)

Sum of Mean
Source Squares df Square F P

Cementation technique 585 1 585 25.0 <.001

Adhesive 7426 1 7426 317.6 <.001

Cementation technique x adhesive 1.053 1 1.05 0.45 .84

Error 374 16 23

Corrected total 8387 19

on the mesial and distal margins, for 6 gle Bond (P=.287) and Prompt L-Pop etch adhesives, regardless of the ce-
measurements per molar). The analy- (P=1.00) adhesives. However, differ- mentation technique (SEBI, 13.0
sis of microleakage scores was con- ent adhesive systems resulted in sig- MPa; SEAI, 1.7 MPa).
ducted for mesial and distal margins nificant differences in microleakage at Most of the failures observed in
separately. Significant differences in dentin margins (P<.001). The total- the total-etch groups were cohesive
marginal microleakage were observed etch adhesive (Adper Single Bond) (TEBI, 58.1%; TEAI, 64.4%), whereas
for all experimental groups in both produced less microleakage than the self-etch adhesive groups showed
mesial (χ2=17.48, P<.001) and dis- all-in-one self-etch adhesive (Adper more adhesive failures (SEBI, 67.9%;
tal margins (χ2=21.26, P<.001), and Prompt L-Pop). SEAI, 87.8%). Spontaneous pretest
Wilcoxon tests were used to follow up Table III lists the microtensile bond debonding failures (PTF) were ob-
this finding. A Bonferroni correction strengths and standard deviations for served only for the groups in which
was applied and so all of the effects the experimental groups. The highest self-etch adhesive was used. In those
are reported at a 0.0125 level of sig- mean bond strengths were obtained 2 groups (SEBI and SEAI), the pretest
nificance. None of the experimental when a total-etch adhesive (Adper failures represented 48% and 86% of
groups was capable of completely Single Bond) was used (TEBI, 51.1 the total, respectively (Table III). Any
eliminating marginal microleakage. MPa; TEAI, 40.7 MPa). The use of specimen exhibiting PTF was counted
The immediate dentin sealing (IDS) a self-etch adhesive (Adper Prompt as 0 MPa. When means were pooled
microleakage scores were similar to L-Pop) for cementation of ceromer for the cementation technique, im-
those obtained from the conventional inlays resulted in significantly lower mediate dentin sealing resulted in sig-
cementation technique for both Sin- bond strengths (P<.001) than total- nificantly higher bond strengths than
Duarte et al
8 Volume 102 Issue 1
those obtained with the conventional may not be completely removed by total-etch adhesive (Table III). Im-
cementation technique (P<.001) (Ta- solvent evaporation. As a result, wa- mediate dentin sealing (IDS) is pur-
ble IV). Therefore, there were signifi- ter becomes trapped in the micro- ported to protect the exposed dentin
cant differences between the tested channels among the collagen fibrils, after preparation.12,15,33 The appli-
cementation techniques. The interac- resulting in incomplete polymeriza- cation of total-etch adhesive12,23,33
tion effect of cementation technique tion.28 The hybrid layer might show or dentin adhesive associated with
versus adhesive systems was not sig- areas with minimal conversion inside low-viscosity resin10,13,15 has been ad-
nificant (P=84). The differences in of the polymeric matrix, with conse- vocated to enhance bond strengths.
overall bond strengths which related quent nanoleakage.26 In addition, ad- Most of the studies are consistent in
to the cementation techniques did verse chemical interaction was found showing that IDS produces higher
not depend on the adhesive system; when 1-step self-etch adhesives were bond strengths than do conventional
that is, the same cementation tech- bonded to dual-polymerizing com- cementation techniques, with mean
nique differences were found for both posite resins.29,35 Therefore, the in- bond strength values ranging from 15
the total-etch adhesive group and the compatibility of acidic adhesive and to 60 MPa.10,11,13-15,33 One possible ex-
self-etch adhesive group. dual-polymerizing composite resin planation for the high bond strengths
may explain not only the high micro- observed is that the first dentin hy-
DISCUSSION leakage scores obtained for Adper bridization occurs in a stress-free en-
Prompt L-Pop, but also the low bond vironment. The repeated application
This study shows that while imme- strengths. of dentin adhesive, after preparation
diate dentin sealing enhanced bond The total-etch adhesive (Adper and prior to cementation, might form
strengths for both tested adhesives, it Single Bond; 3M ESPE) showed a a more uniform interface with the
did not improve the marginal micro- more favorable behavior than the resin cement than that produced by
leakage for indirect restorations. self-etch adhesive (Adper Prompt L- the conventional cementation tech-
Thus, both hypotheses were rejected, Pop). Aging has been shown not to nique.33 Hashimoto et al25 showed
since different adhesives produced sig- influence bond strengths of Adper that multiple coatings of adhesive
nificantly different scores for marginal Single Bond, regardless of the bonded result in improved quality of resin-
microleakage and differences in bond walls (axial or gingival).9 However, dentin bonds, due to increased bond
strengths. Marginal sealing is impera- this outcome should be interpreted strengths and reduced nanoleakage.
tive for long-term success of any in- with caution, since in vivo, the bond However, when the dentin adhesive
direct restoration. In contrast, adhe- to gingival walls is significantly more is applied for the second time (before
sive failure at the restoration margins subject to failure than the other prep- cementation), both layers of dentin
can compromise the longevity of a aration walls.7 Adper Single Bond has adhesive are subjected to polymeriza-
restoration.18,39 If an adhesive failure been reported to produce adequate tion shrinkage of the luting cement.
occurs, the patient might experience dentin sealing30 and reduce dentin If the shrinkage stress surpasses the
postoperative sensitivity,20 recurrent permeability,17 but marginal micro- bond strength, a gap will be formed,
caries,22 and pathologic alterations leakage was not completely eliminat- resulting in microleakage.3,32
of the pulp.37 Two adhesive systems ed. Some porosity within the hybrid In vitro studies provide important
were evaluated in the present study: layer created by Single Bond recently information when assessing new tech-
a total-etch (Adper Single Bond; 3M was observed.25 In addition, out- niques to improve bonding to dental
ESPE) and a self-etch (Adper Prompt ward fluid flow is expected to occur tissues. However, they have limita-
L-Pop; 3M ESPE) adhesive system. with total-etch adhesives, even after tions and do not replace clinical tri-
There was a significant difference in bonding.36 The inward and outward als. Clinical studies are needed prior
the performance of the tested adhe- fluid shifts create water trees, which to making clinical recommendations.
sive systems for microleakage and can contribute to degradation of the The findings of the present study
microtensile bond strength (Tables II resin-bonded interfaces.31 demonstrate the need for further in-
and III). No difference was observed in mi- vestigations, especially those measur-
Adper Prompt L-Pop is consid- croleakage scores if the dentin was hy- ing cyclical load and long-term effec-
ered a strong all-in-one self-etch ad- bridized immediately after preparation tiveness of IDS.
hesive.19 Its monomer initially has a or just before cementation, for both
pH as low as 1.0.26 After application tested adhesives (Table II). However, CONCLUSIONS
of the adhesive, collagen fibers are significant differences were found for
exposed, and the hydroxyapatite is µTBS when immediate dentin sealing Immediate dentin sealing result-
partially removed, but traces of the was used. The findings showed high- ed in high bond strengths for both
smear layer remain.27 The water pres- er bond strengths with IDS for both adhesives; however, the microleak-
ent within dentin and in the adhesive adhesive systems, particularly for the age observed was similar to that ob-
The Journal of Prosthetic Dentistry Duarte et al
July 2009 9
tained with the conventional adhesive 14.Nikaido T, Cho E, Nakajima M, Tashiro 32.Hilton TJ, Ferracane JL. Cavity prepara-
H, Toba S, Burrow MF, et al. Tensile bond tion factors and microleakage of Class II
cementation technique. This study strengths of resin cements to bovine dentin composite restorations filled at intraoral
showed that cementation techniques using resin coating. Am J Dent 2003;16 temperatures. Am J Dent 1999;12:123-30.
currently in use for indirect restora- Spec No:41A-46A. 33.de Andrade OS, de Goes MF, Montes MA.
15.Okuda M, Nikaido T, Maruoka R, Foxton Marginal adaptation and microtensile bond
tions are not capable of producing RM, Tagami J. Microtensile bond strengths strength of composite indirect restorations
complete sealing of the exposed den- to cavity floor dentin in indirect composite bonded to dentin treated with adhesive
tin, in effect, leaving a potential path- restorations using resin coating. J Esthet and low-viscosity composite. Dent Mater
Restor Dent 2007;19:38-46. 2007;23:279-87.
way for bacterial infiltration. 16.Pashley DH, Pashley EL. Dentin permeabil- 34.Guzmán-Armstrong S, Mitchell RJ. Surface
ity and restorative dentistry: a status report coating and leakage of dentin-bonded
REFERENCES for the American Journal of Dentistry. Am J resin composite restorations. J Dent
Dent 1991;4:5-9. 2002;30:113-8.
1. Versluis A, Tantbirojn D, Pintado MR, De- 17.Grégoire G, Joniot S, Guignes P, Millas A. 35.Cheong C, King NM, Pashley DH, Ferrari
Long R, Douglas WH. Residual shrinkage Dentin permeability: self-etching and one- M, Toledano M, Tay FR. Incompatibility
stress distributions in molars after compos- bottle dentin bonding systems. J Prosthet of self-etch adhesives with chemical/dual-
ite restoration. Dent Mater 2004;20:554- Dent 2003;90:42-9. cured composites: two-step vs one-step
64. 18.Pashley DH, Pashley EL, Carvalho RM, Tay systems. Oper Dent 2003;28:747-55.
2. Loguercio AD, Reis A, Schroeder M, Balduc- FR. The effects of dentin permeability on 36.Hashimoto M, Ito S, Tay FR, Svizero NR,
ci I, Versluis A, Ballester RY. Polymerization restorative dentistry. Dent Clin North Am Sano H, Kaga M, Pashley DH. Fluid move-
shrinkage: effects of boundary conditions 2002;46:211-45. ment across the resin-dentin interface
and filling technique of resin composite 19.Pashley DH, Tay FR. Aggressiveness of con- during and after bonding. J Dent Res
restorations. J Dent 2004;32:459-70. temporary self-etching adhesives. Part II: 2004;83:843-8.
3. Uno S, Shimokobe H. Contraction stress etching effects on unground enamel. Dent 37.Pashley DH. Clinical considerations of
and marginal adaptation of composite Mater 2001;17:430-44. microleakage. J Endod 1990;16:70-7.
restorations in dentinal cavity. Dent Mater J 20.Cox CF. Evaluation and treatment of bacte- 38.Dietschi D, Herzfeld D. In vitro evaluation
1994;13:19-24. rial microleakage. Am J Dent 1994;7:293-5. of marginal and internal adaptation of
4. Duquia Rde C, Osinaga PW, Demarco FF, 21.Warfvinge J, Dahlén G, Bergenholtz G. class II resin composite restorations after
de V Habekost L Conceição EN. Cervical Dental pulp response to bacterial cell wall thermal and occlusal stressing. Eur J Oral
microleakage in MOD restorations: in vitro material. J Dent Res 1985;64:1046-50. Sci. 1998;106:1033-42.
comparison of indirect and direct compos- 22.Mjör IA. Clinical diagnosis of recurrent car- 39.Going RE. Microleakage around dental
ite. Oper Dent 2006;31:682-7. ies. J Am Dent Assoc 2005;136:1426-33. restorations: a summarizing review. J Am
5. Hasegawa EA, Boyer DB, Chan DC. Micro- 23.Paul SJ, Schärer P. The dual bonding Dent Assoc 1972;84:1349-57.
leakage of indirect composite inlays. Dent technique: a modified method to improve 40.Filho AM, Vieira LC, Araújo E, Monteiro
Mater 1989;5:388-91. adhesive luting procedures. Int J Periodon- Júnior S. Effect of different ceramic surface
6. Purk JH, Dusevich V, Glaros A, Eick JD. tics Restorative Dent 1997;17:536-45. treatments on resin microtensile bond
Adhesive analysis of voids in Class II 24.Guzmán-Ruiz S, Armstrong SR, Cobb DS, strength. J Prosthodont 2004;13:28-35.
composite resin restorations at the axial Vargas MA. Association between micro- 41.Tay FR, Pashley DH, Yoshiyama M. Two
and gingival cavity walls restored under in tensile bond strength and leakage in the modes of nanoleakage expression in single-
vivo versus in vitro conditions. Dent Mater indirect resin composite/dentin adhesively step adhesives. J Dent Res 2002;81:472-6.
2007;23:871-7. bonded joint. J Dent 2001;29:145-53. 42.Peris AR, Duarte S Jr, de Andrade MF. Eval-
7. Purk JH, Dusevich V, Glaros A, Spencer P, 25.Koshiro K, Inoue S, Tanaka T, Koase K, uation of marginal microleakage in class
Eick JD. In vivo versus in vitro microtensile Fujita M, Hashimoto M, et al. In vivo deg- II cavities: effect of microhybrid, flowable,
bond strength of axial versus gingival cavity radation of resin-dentin bonds produced by and compactable resins. Quintessence Int
preparation walls in Class II resin-based a self-etch vs. a total-etch adhesive system. 2003;34:93-8.
composite restorations. J Am Dent Assoc Eur J Oral Sci 2004;112:368-75. 43.Perdigão J, Geraldeli S. Bonding charac-
2004;135:185-93. 26.Duarte S Jr, Perdigão J, Lopes MM. Effect of teristics of self-etching adhesives to intact
8. Cavalcanti AN, Mitsui FH, Silva F, Peris dentin conditioning time on nanoleakage. versus prepared enamel. J Esthet Restor
AR, Bedran-Russo A, Marchi GM. Effect of Oper Dent 2006;31:500-11. Dent 2003;15:32-41.
cyclic loading on the bond strength of class 27.Perdigão J, Duarte S Jr, Lopes MM. Advanc-
II restorations with different composite es in dentin adhesion. Compend Contin Corresponding author:
materials. Oper Dent 2008;33:163-8. Educ Dent 2003;24:10-6. Dr Sillas Duarte, Jr.
9. Cavalcanti AN, Mitsui FH, Ambrosano GM, 28.Tay FR, King NM, Chan KM, Pashley DH. Department of Comprehensive Care
Mathias P, Marchi GM. Dentin bonding on How can nanoleakage occur in self-etching Case School of Dental Medicine
different walls of a class II preparation. J adhesive systems that demineralize and Case Western Reserve University
Adhes Dent 2008;10:17-23. infiltrate simultaneously? J Adhes Dent 10900 Euclid Ave
10.Jayasooriya PR, Pereira PN, Nikaido T, 2002;4:255-69. Cleveland, OH 44106-4905
Tagami J. Efficacy of a resin coating on 29.Tay FR, Pashley DH, Yiu CK, Sanares AM, Fax: 216-368-3204
bond strengths of resin cement to dentin. J Wei SH. Factors contributing to the incom- E-mail: [email protected]
Esthet Restor Dent 2003;15:105-13. patibility between simplified-step adhe-
11.Kitasako Y, Burrow MF, Nikaido T, Tagami sives and chemically-cured or dual-cured Acknowledgments
J. Effect of resin-coating technique on composites. Part I. Single-step self-etching The authors thank Dr Bernard Tandler for
dentin tensile bond strengths over 3 years. J adhesive. J Adhes Dent 2003;5:27-40. editorial assistance. In addition, Drs Avishai
Esthet Restor Dent 2002;14:115-22. 30.Prati C, Chersoni S, Mongiorgi R, Pashley Sadan and Sillas Duarte, Jr, disclose a financial
12.Magne P. Immediate dentin sealing: DH. Resin-infiltrated dentin layer forma- interest/arrangement with 3M ESPE (hono-
a fundamental procedure for indirect tion of new bonding systems. Oper Dent raria and special customer preference).
bonded restorations. J Esthet Restor Dent 1998;23:185-94.
2005;17:144-54. 31.Tay FR, Pashley DH. Water treeing--a Copyright © 2009 by the Editorial Council for
13.Nikaido T, Nakaoki Y, Ogata M, Foxton potential mechanism for degradation of The Journal of Prosthetic Dentistry.
R, Tagami J. The resin-coating technique. dentin adhesives. Am J Dent 2003;16:6-12.
Effect of a single-step bonding system
on dentin bond strengths. J Adhes Dent
2003;5:293-300.

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