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Frankenberger et al Fig 1 Fractured μTBS specimen at the resin composite aspect with Syntac not separately cured. Short resin tags have been pulled out of the dentin at the cavity floor. Fig 2 Fractured μTBS specimen with XP Bond + SCA at the dentin side. The interface is ruptured at the bottom of the hybrid layer at the transition to the funnel-shaped orifices of dentinal tubules. RESULTS The results of the study are displayed in Table 2. Contamination with temporary cement reduced dentin bond strengths (p < 0.05). Removing remnants of cements with Prophypearls air-polishing significantly decreased dentin bond strengths (p < 0.05). Separate light curing of the adhesives did not produce higher dentin bond strengths (p > 0.05). The dual-cured adhesive exhibited significantly higher bond strengths in control groups without IDS (p < 0.05). Immediate dentin sealing (resin coating) prior to temporizing increased internal bond strength for all adhesives under investigation (p < 0.05). Fractographic analysis exhibited insufficient interface formation when light-cured adhesives were cured together with the luting resin composite (Fig 1). Fractured interfaces of XP Bond showed characteristic positive features of typical etch-and-rinse adhesives (Fig 2). DISCUSSION The survival of ceramic inlays is fundamentally dependent on durable enamel bonding; also when the dentin aspects were covered with a cement lining, long-term success was reported to be good. 4,14-16 However, the present study exclusively focussed on internal dentin bond strength beneath adhesive inlays. Due to easier processing, direct resin composite inlays were chosen, because they reveal the same dentin-resin composite interface as ceramic inlays. 12,13,16,29 Hikita et al 11 evaluated enamel and dentin bond strengths of luting systems for adhesive inlays. It was remarkable that Syntac and Variolink II without separate light curing of the adhesive obtained the lowest dentin bond strengths in that investigation. This may be surprising, because especially this combination of light-curing adhesive and dual-curing luting resin composite has been repeatedly reported to be clinically effective. 4,14,15 This clearly demonstrates that the clinical success of ceramic inlays as well as of direct resin composite restorations may be primarily dependent on good and durable marginal adaptation to enamel. The present results also clearly confirm the theory that solely light-cured adhesives do not receive enough light energy through 3-mm-thick adhesive inlays, not even under laboratory conditions. To elucidate the problem of insufficient light curing through ceramic inlays as demonstrated in vitro, marginal quality assessment alone is not sufficient. A previous and often cited study with conical ceramic inserts luted into standardized dentin cavities showed good bond strengths and marginal adaptation in vitro, even when the light-curing adhesive was not light cured separately. 5 However, in the course of push-out investigations, in most of the cases, enough light energy passes through the specimens, being considerably thinner than inlay cavities. Previous results showed that enough light intensity was always transported to the marginal areas of the luted ceramic inays, even in proximal margins below the CEJ. 1 Nevertheless, this does not necessarily mean that the light-curing adhesives under investigation revealed a complete cure in all areas beneath the ceramic inlays. The present results clearly show that results of marginal analyses may produce results which are not representative for what is happening deeper inside the restored tooth. In this context, it has often been discussed in the past whether a light-cured adhesive has to be separately light cured prior to the application of a luting resin composite. This study indicates that a separate light-curing step of lightcured adhesives was not beneficial for dentin bond strength. This may be attributed to the fact that heavily air-thinned layers of bonding agents are subjected to severe oxygen inhibition and are therefore almost not cured despite the presence of light energy for 40 s. Finally, due to reasons of contamination and oxygen inhibition, immediate dentin sealing 272 The Journal of Adhesive Dentistry
Frankenberger et al or resin coating may be the method of choice to pretreat dentin surfaces being chosen for adhesive luting, because contamination with temporary cements is avoided and appropriate polymerization of the resin-dentin interface is guaranteed. 12,13,17,21,23,29 This is given even more credence, because the present study was able to demonstrate that any contamination with temporary cements is crucial, and removal methods such as air polishing are sometimes disadvantageous, as proven in a previous investigation conducted with the effect of air-polishing alone. 2 Finally, both null hypotheses had to be rejected. CONCLUSIONS The dual-cured adhesive provided higher internal bond strengths to dentin beneath adhesive inlays. Contamination of dentin with temporary cements is a hazard for excellent dentin adhesion of adhesive inlays. Therefore, immediate dentin sealing is promising. Among temporary cement cleaning techniques, polishing air abrasion with Prophypearls severely reduces dentin bond strengths. REFERENCES 1. Frankenberger R, Lohbauer U, Schaible BR, Nikolaenko SA, Naumann M. Luting of ceramic inlays in vitro: marginal quality of self-etch and etch-andrinse adhesives vs. self-etch cements. Dent Mater 2006;submitted. 2. Frankenberger R, Lohbauer U, Tay FR, Taschner M, Nikolaenko SA. Air-polishing powders differently affect dentin bonding. J Adhes Dent 2007; accepted for publication. 3. Frankenberger R, Pashley DH, Reich SM, Lohbauer U, Petschelt A, Tay FR. Characterisation of resin-dentine interfaces by compressive cyclic loading. Biomaterials 2005;26:2043-2052. 4. Frankenberger R, Petschelt A, Krämer N. Leucite-reinforced glass ceramic inlays and onlays after six years: clinical behavior. Oper Dent 2000;25:459-465. 5. Frankenberger R, Sindel J, Krämer N, Petschelt A. Dentin bond strength and marginal adaptation: direct composite resins vs ceramic inlays. Oper Dent 1999;24:147-155. 6. Fuzzi M, Rappelli G. Ceramic inlays: clinical assessment and survival rate. J Adhes Dent 1999;1:71-79. 7. Hayashi M, Tsubakimoto Y, Takeshige F, Ebisu S. Analysis of longitudinal marginal deterioration of ceramic inlays. Oper Dent 2004;29:386-391. 8. Hayashi M, Tsuchitani Y, Kawamura Y, Miura M, Takeshige F, Ebisu S. Eightyear clinical evaluation of fired ceramic inlays. Oper Dent 2000;25:473- 481. 9. Hayashi M, Wilson NH, Yeung CA, Worthington HV. Systematic review of ceramic inlays. Clin Oral Investig 2003;7:8-19. 10. Hayashi M, Yeung CA. Ceramic inlays for restoring posterior teeth. Aust Dent J 2004;49:60. 11. Hikita K, Van MB, De MJ, Ikeda T, Van LK, Maida T, Lambrechts P, Peumans M. Bonding effectiveness of adhesive luting agents to enamel and dentin. Dent Mater 2006. 12. Islam MR, Takada T, Weerasinghe DS, Uzzaman MA, Foxton RM, Nikaido T, Tagami J. Effect of resin coating on adhesion of composite crown restoration. Dent Mater J 2006;25:272-279. 13. Jayasooriya PR, Pereira PN, Nikaido T, Tagami J. Efficacy of a resin coating on bond strengths of resin cement to dentin. J Esthet Restor Dent 2003;15:105-113. 14. Krämer N, Ebert J, Petschelt A, Frankenberger R. Ceramic inlays bonded with two adhesives after 4 years. Dent Mater 2006;22:13-21. 15. Krämer N, Frankenberger R. Clinical performance of bonded leucite-reinforced glass ceramic inlays and onlays after eight years. Dent Mater 2005;21:262-271. 16. Krämer N, Lohbauer U, Frankenberger R. Adhesive luting of indirect restorations. Am J Dent 2000;13:60D-76D. 17. Magne P, Kim TH, Cascione D, Donovan TE. Immediate dentin sealing improves bond strength of indirect restorations. J Prosthet Dent 2005; 94:511-519. 18. Manhart J, Chen H, Hamm G, Hickel R. Buonocore Memorial Lecture. Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition. Oper Dent 2004;29:481-508. 19. Martin N, Jedynakiewicz NM. Clinical performance of CEREC ceramic inlays: a systematic review. Dent Mater 1999;15:54-61. 20. Mehl A, Kunzelmann KH, Folwaczny M, Hickel R. Stabilization effects of CAD/CAM ceramic restorations in extended MOD cavities. J Adhes Dent 2004;6:239-245. 21. Nikaido T, Cho E, Nakajima M, Tashiro H, Toba S, Burrow MF, Tagami J. Tensile bond strengths of resin cements to bovine dentin using resin coating. Am J Dent 2003;16 Spec No:41A-46A. 22. Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Frankenberger R. Influence of c-factor and layering technique on microtensile bond strength to dentin. Dent Mater 2004;20:579-585. 23. Ozturk N, Aykent F. Dentin bond strengths of two ceramic inlay systems after cementation with three different techniques and one bonding system. J Prosthet Dent 2003;89:275-281. 24. Pallesen U, van Dijken JW. An 8-year evaluation of sintered ceramic and glass ceramic inlays processed by the Cerec CAD/CAM system. Eur J Oral Sci 2000;108:239-246. 25. Posselt A, Kerschbaum T. Longevity of 2328 chairside Cerec inlays and onlays. Int J Comput Dent 2003;6:231-248. 26. Reiss B. Clinical results of Cerec inlays in a dental practice over a period of 18 years. Int J Comput Dent 2006;9:11-22. 27. Schulz P, Johansson A, Arvidson K. A retrospective study of Mirage ceramic inlays over up to 9 years. Int J Prosthodont 2003;16:510-514. 28. Sjögren G, Molin M, van Dijken JW. A 10-year prospective evaluation of CAD/CAM-manufactured (Cerec) ceramic inlays cemented with a chemically cured or dual-cured resin composite. Int J Prosthodont 2004;17:241- 246. 29. Stavridakis MM, Krejci I, Magne P. Immediate dentin sealing of onlay preparations: thickness of pre-cured dentin bonding agent and effect of surface cleaning. Oper Dent 2005;30:747-757. Clinical relevance: Dual-cured adhesives are beneficial for adhesive luting. Sealing dentin prior to temporizing improves dentin bond strength. Vol 9, Supplement 2, 2007 273
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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
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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
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Page 57 and 58: Raffaelli et al Table 2 Bond streng
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