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Blunck/Zaslansky a. 21 days of WS vs. 1st TC multi-bottle adhesives all-in-one adhesiv es w ith mixing all-in-one adhesiv es w ithout mixing -25 -20 -15 -10 -5 0 * * * * * * * * * * * * * AQ Bond Clearfil SE Bond Xeno III / Tetric Ceram iBond Xeno III / Quixfil OptiBond FL Syntac Xeno III / Dyract eXtra Adper Prompt L-Pop / Filtek Z250 Futurabond NR G-Bond Hybrid Bond Prompt L-Pop 1999 tri-S Bond Adper Prompt L-Pop / Tetric Ceram One-up Bond F Plus Prompt L-Pop 2000 b. 1st TC vs. 2nd TC multi-bottle adhesives all-in-one adhesiv es w ith mixing all-in-one adhesiv es w ithout mixing -25 -20 -15 -10 -5 0 * * * * * * * * * * * * * Xeno III / Dyract eXtra Syntac OptiBond FL Futurabond NR Hybrid Bond Xeno III / Tetric Ceram AQ Bond Xeno III / Quixfil iBond tri-S Bond Adper Prompt L-Pop / Filtek Z250 Prompt L-Pop 2000 Clearfil SE Bond G-Bond Adper Prompt L-Pop / Tetric Ceram One-up Bond F Plus Prompt L-Pop 1999 Fig 4 Ranked slopes of regression lines through MQ1 values in dentin for each product (a) after 21 days of water storage vs 1 st TC (column A in Table 3) and (b) 1 st TC vs 2 nd TC (column C in Table 3). * denotes stopes that were determined between MQ1 median values that are statistically different with p < 0.05 (Wilcoxon test). OptiBond FL and Syntac in combination with the etch-andrinse technique and the multi-step self-etching adhesive Clearfil SE Bond are reliable adhesives even after long-term usage. For this reason, these three products were used as reference materials in this study. They also provide to some extent a means to calibrate the present results with other studies. With the quasi-dynamic trends, it is possible to rank the different adhesives according to their rate of deterioration (as shown for mainly after TC) after 21 days or 1 year in water (see example Figs 4a and 4b). This ranking differs for the two water storage periods, which can be attributed to the specific properties of each adhesive, which lead to differences in bond quality and rates of degradation. The working assumption of this study was that better performance of any adhesive group would be associated with the highest (least negative) slope of MQ1 deterioration (column I in Table 3). These slope values are different from the slopes of the individual segments 1st WS vs 1st TC and 1st vs 2nd TC, and thus the rate of deterioration of the bonds might vary substantially over time. As seen in Figs 4a and 4b, 238 The Journal of Adhesive Dentistry
Blunk/Zaslansky many of the products, change the rank between the initial water storage period, as compared with the rank after the first year . We are aware that such ranking might be of limited use for predicting clinical performance; therefore, clinicians and manufacturers might need to define criteria for “adequate performance”, not “better performance”. Clearly such long-term effects need to be considered in addition to operation skill and experience, 15,21 both of which are difficult to account for, therefore consequences of these findings necessitate further investigations. The marginal analysis centered on the quantitative evaluation of MQ1 (“excellent” or “continuous” margin) as a measure for marginal integrity. It has recently been shown that such an evaluation provides a good indicator for the ability of an adhesive system to compensate for the shrinkage of composite resins during polymerization, as compared to bond strength tests. 17 The extent to which the present in vitro results correspond to in vivo data of quantitative marginal analysis of Class V fillings is not obvious, especially as there are reports showing that such data are unable to predict clinical outcome. 17 Nevertheless, results of this study and trend analysis provide an additional means of determining objective and standard measures of the physical attributes of any combination of adhesive system and composites. It therefore remains to be seen just how such details match the outcomes of clinical investigations. It is worthwhile to note that other studies have evaluated the marginal quality using stress induced by mechanical loading. 12,13 The method employed in this study has the advantage that TC induces precise and repeatable stress (assuming the coefficient of thermal expansion of the composites stays constant), and this concept was used to provide more information about the effects of water storage at short and long intervals. The present results are based on SEM evaluation of the percentage of the different marginal qualities, calculated in relation to the entire margin length in dentin or enamel independently. It has been shown that when the same operator evaluates the same specimens twice, the difference between the results is in the range of 4%, 26 whereas when two trained operators evaluate the same specimens, the differences can reach 10% to 20%. 18 Therefore, all specimens in this study were prepared and evaluated by the same operator. It is interesting to note that for most of the products not displaying a large discrepancy between the initial and intermediate MQ1 values, the first-year data provide only a moderate predictor for the longer term trend of deterioration. Therefore, initial predictors of restorative success have limited applicability, and more data over long periods of time are needed. This is unavoidable even in an in vivo setting, and is important especially when both manufacturers and clinicians want to know as early as possible which is the best product. It is, of course, conceivable that storage at higher temperatures might allow faster answers to these questions. All-in-one adhesives are rather user friendly; however, certain indicators have suggested reduced performance that might be associated with their usage. Compared with twostep self-etching or etch-and-rinse adhesive systems, lower bond strength values were reported. 5,14,19,20 It has also been shown that permeable membranes develop after curing due to a high hydrophilicity, which allows water movements through the all-in-one adhesive layer. 30 Sites of incomplete water removal and subsequent suboptimally polymerized resins 31 have been described and termed “water trees”. All these might contribute to extensive degradation of the adhesive layer, 7,32 but conclusive findings have not been confirmed. The most recent (to date) one-bottle all-inone adhesives appear to be susceptible to phase separation after dispensing the complex mixture of hydrophobic and hydrophilic components, 34 and this also is assumed to contribute to bond degradation. 33 This study has presented preliminary results of short- and long-term water storage effects combined with thermocycling for control and 14 all-in-one adhesive/composite treatments. The results show that overall, few if any differences are found in vitro between the tested products and the reference materials. Furthermore, based on a quality estimate associated with the marginal integrity, it has been shown that early deterioration rates (up to 1 year) can only sometimes be used as estimates for the rate of bond degradation over a period of 3 years. Indeed, it seems that deterioration rates due to storage in water are not dependent on the class (or generation) of the adhesive: large differences in deterioration rates seem to exist between different products, and these are probably associated with the details of the specific chemistry. Additional studies are still needed in order to elucidate to what extent – and in which product – deterioration is critical. These should then be correlated with clinical studies so that decisive conclusions can be drawn . It appears that the effects of long-term water storage may not be as detrimental as usually assumed, if indeed the marginal integrity estimates are appropriate measures of the quality and effectiveness of recent generations of dental adhesives. A statistically significant decrease in the amount of MQ1 was only found in 3 out of 14 tested all-in-one adhesives after 1 year water storage. However, in enamel, the marginal analysis revealed fewer “continuous margins” than the control groups for G-Bond, AQ Bond, Hybrid Bond, and One-up Bond F Plus, and this was already observed after 1 year of water storage. As new results of clinical evaluations emerge, and with a growing body of data from in vitro measurements, it is hoped that a clearer understanding of the long-term effects of the use of these systems will emerge, thus providing an improved guide for clinical judgement. REFERENCES 1. Anusavice KJ. Criteria for selection of restorative materials: properties versus technique sensitivity. In: Anusavice KJ (ed). Quality evaluation of dental restorations. Chicago: Quintessence, 1989:15-56. 2. Armstrong SR, Vargas MA, Fang Q, Laffoon JE. Microtensile bond strength of a total-etch 3-step, total-etch 2-etch, self-etch 2-step, and a self-etch 1- step dentin bonding system through 15-month water storage. J Adhes Dent 2003;5:47-56. 3. Armstrong SR, Vargas MA, Chung I, Pashley DH, Campbell JA, Laffoon JE, Qian F. Resin-dentin interfacial ultrastructure and microtensile dentin bond strength after five-year water storage. Oper Dent 2004;29-26:705-712. Vol 9, Supplement 1, 2007 239
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Page 3 and 4: Guest Editorial Satellite Symposium
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Page 7 and 8: Dental Adhesives …. How it All St
Page 9 and 10: Söderholm resulted in a new genera
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Page 21 and 22: Clinical Bonding of a Single-step S
Page 23 and 24: van Dijken et al DISCUSSION The rap
Page 25 and 26: Shear Bond Strength and Physicochem
Page 27 and 28: Latta Fig 1 Representative spectra
Page 29 and 30: Microshear Fatigue Testing of Tooth
Page 31 and 32: Braem Fig 1 Positioning of the dent
Page 33 and 34: Braem the number of steps but also
Page 35 and 36: Microleakage of Class V Composite R
Page 37 and 38: Rosales-Leal Fig 1 Percentage of ca
Page 39 and 40: Rosales-Leal fect the occlusal seal
Page 41 and 42: Microleakage of XP Bond in Class II
Page 43 and 44: Manhart/Trumm heim, Germany), resul
Page 45 and 46: Six-month Clinical Evaluation of XP
Page 47 and 48: Blunck et al Table 2 Results of the
Page 49 and 50: Adhesive Luting Revisited: Influenc
Page 51 and 52: Frankenberger et al Table 2 Results
Page 53 and 54: Frankenberger et al or resin coatin
Page 55 and 56: XP BOND in Self-curing Mode used fo
Page 57 and 58: Raffaelli et al Table 2 Bond streng
Page 59 and 60: XP BOND in Self-curing mode used fo
Page 61 and 62: Ferrari et al Table 2 Performance c
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