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AIM: The aim of this study was to compare the microtensile bond strength (µTBS) and failure mode of 4 different universal adhesive systems (UAs) on human dentin. MATERIALS AND METHODS: The study sectioned the occlusal thirds of 32 human third molars and divided them into 4 groups based on the adhesive system used. Group A: Palfique Universal Bond, Group B: Single Bond Universal, Group C: All-Bond Universal, and Group D: One Coat 7 Universal. The specimens underwent a 10,000-cycle thermocycling ageing process prior to testing (n = 32). Afterwards, 8 beams were obtained per group and subjected to µTBS testing using a digital universal testing machine at a speed of 1 mm/min. The microtensile bond strength values were analysed in Megapascals (MPa), and the failure mode was evaluated using a stereomicroscope. Welch's parametric ANOVA with robust variance and the Games-Howell post hoc test were used for µTBS comparisons, and Fisher's exact test was used to determine the association between adhesive type and failure mode. The significance level was set at P < .05. RESULTS: Group D showed a significantly higher µTBS than groups A (P < .001) and B (P < .001), but no significant difference was observed with group C (P= .075). Furthermore, groups B and C showed significantly higher µTBS than group A (P< .001 and P < .001, respectively), but there was no significant difference between groups B and C (P = .132). Additionally, group A exhibited a significant association with an adhesive failure mode (P < .05), whereas groups B, C, and D were significantly associated with a mixed failure mode (P < .05). CONCLUSION: The One Coat 7 Universal adhesive system showed higher microtensile bond strength values and higher chemical interaction with dentin compared to Palfique Universal Bond and Single Bond Universal. However, no significant differences were observed compared to All-Bond Universal.

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Objective: To evaluate the effect of saliva contamination and different decontamination protocols on the microshear bond strength of a universal adhesive to dentin. Material and Methods: 84 bovine teeth were divided into three groups according to bonding stage at which salivary contamination occurred; before curing of the adhesive, after curing of the adhesive, and a control group with no salivary contamination. Each group was further subdivided into four subgroups according to the decontamination protocol used (n=7): no decontamination protocol, rinsing then reapplication of the adhesive, grinding with sandpaper silicon carbide grit 600 then reapplication of the adhesive and finally ethanol application then reapplication of the adhesive. Specimens were tested in micro-shear mode. Results: All the decontamination protocols used in this study to reverse effect of salivary contamination before curing significantly improved the bond strength to contaminated dentin (p<0.001). Meanwhile, after curing, ethanol decontamination protocol recorded highest bond strength followed by rinsing and grinding compared to no decontamination (p<0.001). Conclusion: Saliva contamination led to significant deterioration in the bond strength regardless of the bonding stage at which saliva contamination occurred. All decontamination protocols improved the immediate microshear bond strength when contamination occurred before curing of the adhesive, while ethanol seemed to be the most effective both before curing and after curing (AU)

Objetivo: Avaliar o efeito da contaminação por saliva e de diferentes protocolos de descontaminação na resistência de união ao microcisalhamento de um adesivo universal à dentina. Material e Métodos: 84 dentes bovinos foram divididos em três grupos de acordo com o passo operatório do protocolo adesivo em que ocorreu a contaminação por saliva: antes da polimerização do adesivo, ou após a polimerização do adesivo e um grupo controle sem contaminação por saliva. Cada grupo foi subdividido em quatro subgrupos de acordo com o protocolo de descontaminação utilizado (n=7): sem protocolo de descontaminação; lavagem seguida da reaplicação do adesivo; lixar a região com lixa de carbeto de silício de granulação 600 e reaplicar o adesivo; aplicar etanol e reaplicar o adesivo. Os espécimes foram testados no modo de micro-cisalhamento. Resultados: Todos os protocolos de descontaminação utilizados neste estudo em busca de reverter o efeito da contaminação do adesivo por saliva melhoraram significativamente a resistência de união à dentina contaminada (p<0,001). Enquanto isso, após a polimerização, o protocolo de descontaminação com etanol resultou na maior resistência de união, seguido pela lavagem, e depois pelo lixamento, em comparação com nenhum protocolo de descontaminação (p<0,001). Conclusão: A contaminação por saliva levou a uma deterioração significativa na resistência de união, independentemente do passo operatório do protocolo adesivo em que ocorreu a contaminação por saliva. Todos os protocolos de descontaminação melhoraram a resistência de união ao microcisalhamento imediato quando a contaminação ocorreu antes da polimerização do adesivo, enquanto o etanol pareceu ser o protocolo mais eficaz nos dois tipos de contaminação (antes e depois da polimerização).

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PURPOSE: The efficacy of etch-and-rinse, selective enamel-etching, and self-etching protocols for universal adhesives in follow-ups of over 12 months was compared in a network meta-analysis. STUDY SELECTION: Randomized controlled trials (RCTs) published from 1998 to 2022 that compared marginal staining, marginal adaptation, retention and fractures, post-operative sensitivity, or recurrence of caries that took place over 12-months post-restoration were selected. A network meta-analysis determined the performance of each adhesive protocol. RESULTS: After screening 981 articles, 16 RCTs were subjected to data extraction. Of which, 674 patients with 2816 restorations, were included in the network meta-analysis. The pooled risk of marginal discoloration following self-etching was significantly higher than that following etch-and-rinse at over 12, 24, and 36 months, which was time-dependent. The pooled risks of unfavorable marginal adaptation and unfavorable retention and fractures following self-etching were also significantly higher than that following etch-and-rinse, with the rates of unfavorable retention and fractures in non-carious cervical lesions increasing in a time-dependent manner. The pooled risks of marginal discoloration, unfavorable marginal adaptation, retention and fractures were similar between etch-and-rinse and selective enamel-etching protocols. Post-operative hypersensitivity and recurrence of caries were not significantly different among etch-and-rinse, selective enamel-etching, and self-etching protocols. CONCLUSIONS: In follow-ups over 12 months, esthetic and functional outcomes of restorations completed with an etch-and-rinse adhesive protocol were superior to the ones achieved with a self-etching strategy without selective enamel-etching. Selective enamel etching is recommended for self-etching systems. Biological responses were similar for all three adhesive strategies.

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OBJECTIVE: The aim of this double-blind, randomized clinical trial was to evaluate the 6- and 18-month clinical performances of a new universal adhesive applied in the "no-waiting" (NW) technique to non-carious cervical lesions (NCCLs) using two evaluation criteria. MATERIALS AND METHODS: One hundred and seventy-six restorations were assigned to four groups according to the adhesive system, adhesive strategy, and application mode: Prime&Bond Active (PB) applied using the etch-and-rinse (ER) and self-etch (SE) strategies with 20 s applications and Clearfil Universal Bond Quick (CQ) applied using the ER and SE strategies with the NW technique. The composite resin restorations were evaluated at baseline and after 6 and 18 months using the World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. The Friedman repeated measures analysis of variance and Wilcoxon test were used for statistical analyses (α = 0.05). RESULTS: No significant differences were observed among any of the groups or criteria after 6 months (p > 0.05). After 18 months, 10 restorations were lost (p > 0.05) (2 with PB-ER [95.5%; 95%CI: 92-100%], 4 with PB-SE [90.9%; 95%CI: 82-98%], 0 with CQ-ER [100%; 95%CI: 92-100%], and 4 with CQ-SE [90.9%; 82-98%]). The restorations performed with the SE strategy showed more marginal discrepancies than those performed with the ER strategy, mainly when the FDI criteria were used (p < 0.05). Those that used the PB-SE showed fewer marginal discrepancies than those that used the CQ-SE (FDI; p < 0.05). A few restorations showed marginal discrepancies after the USPHS analysis (p > 0.05). CONCLUSIONS: The results when using the CQ-SE and -ER strategies with the NW technique were similar to those when using the PB-SE and -ER strategies in standard applications to non-carious cervical lesions after 6 and 18 months of clinical evaluation. CLINICAL RELEVANCE: After 6 and 18 months, the application of Clearfil Universal Bond Quick with the "no-waiting" technique showed similar clinical performance compared to the standard application of Prime & Bond Active applied using the standard application time (20 s). TRIAL REGISTRATION: ClinicalTrials.gov identifier RBR-5f9gps.

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Objetivo: Analizar la resistencia de unión a dentina sana y desmineralizada, en forma inmediata y a los 6 meses, utilizando un pretratamiento de clorhexidina (CHX) 2%. Método: 40 terceros molares sanos con desarrollo radicular incompleto se desgastaron exponiendo dentina. Las piezas fueron sometidas a ciclado de pH. Se dividieron aleatoriamente en 2 grupos: con y sin CHX. En dentina se crearon 4 botones de resina utilizando adhesivo universal mediante autoacondicionamiento. Las muestras se almacenaron en agua destilada a 37ºC hasta su análisis. El microcizallamiento se ejecutó a las 24 horas y a los 6 meses de envejecimiento. Resultados: El grupo de dentina sana, sin CHX inmediato presentó mayor resistencia adhesiva (23,37±1,84). El grupo de dentina desmineralizada, sin CHX, envejecido presentó la menor resistencia adhesiva (8,87±1,51). Conclusiones: La CHX al 2% previo a la aplicación del adhesivo no mejora los valores de resistencia de unión a dentina sana ni desmineralizada a corto o largo plazo.

Objetivo: Analisar a resistência de união à dentina hígida e desmineralizada, imediatamente e após 6 meses, utilizando um pré-tratamento com (CHX) a 2%. Método: 40 terceiros molares hígidos com desenvolvimento radicular incompleto foram desgastados expondo a dentina. As peças foram submetidas a ciclagem de pH. Eles foram divididos aleatoriamente em 2 grupos: com e sem CHX. Em dentina, foram criados 4 botões de resina utilizando adesivo universal em modo autocondicionante. As amostras foram armazenadas em água destilada a 37ºC até a análise. O microcisalhamento foi realizado às 24 horas e aos 6 meses de envelhecimento. Resultados: O grupo de dentina saudável, sem CHX imediata apresentou maior resistência adesiva (23,37±1,84). O grupo de dentina desmineralizada, sem CHX , envelhecida apresentou a menor resistência adesiva (8,87±1,51). Conclusões : A CHX antes da aplicação do adesivo não melhoraria os valores de resistência de união em dentina saudável ou desmineralizada a curto ou longo prazo.

Objective: To analyze the bond strength to healthy and demineralized dentin, immediately and after 6 months, using a 2% chlorhexidine (CHX) pretreatment. Method : 40 healthy third molars with incomplete root development were abraded exposing dentin. The pieces were subjected to pH cycling. They were randomly divided into 2 groups: with and without CHX. In dentin, 4 resin buttons were created using universal adhesive in self-etching mode. The samples were stored in distilled water at 37ºC until analysis. Micro shearing was carried out at 24 hours and at 6 months of aging. Results: Healthy dentin group, without immediate CHX presented higher bond strength (23.37±1.84). (Demineralized dentin group, without CHX, aged) presented the lowest bond strength (8.87±1.51). Conclusions : CHX prior to adhesive application doesn't improve bond strength values to healthy or demineralized dentin in short nor long term.

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Background: The bond capacity of universal adhesives should be comparable to a specific primer for zirconia. Thus, this study evaluated the bond strength to zirconia of four universal adhesives and a zirconia primer over long-term storage. Materials and Methods: The surfaces of 75 samples of zirconia were sandblasted with 50 µm aluminum oxide particles and then divided into groups (n = 15): G1 - Single Bond Universal (SBU); G2 - All Bond Universal; G3 - Peak Universal Bond; G4 - Ambar Universal (AU), and G5 - Z-Prime Plus (ZP). A cone of resin composite was constructed on the applied materials. The samples were submitted to a tensile bond strength test after 24 h using a universal testing machine. Then, the remaining materials were removed from the sample surfaces, and the surfaces were polished and sandblasted again as previously described to obtain the same groups. These new samples were stored in distilled water at 37°C for 12 months and then submitted to a tensile bond strength test. The data were analyzed by two-way analysis of variance and Tukey's test (α =0.05). Results: The material factor (P = 0.001) and the storage factor (P = 0.001) were significant, and the interaction was not significant (P = 0.117). According to Tukey's test, bond strength mean values (in MPa) followed by distinct letters were significantly different. After 24 h, G5 = 21.12 A, G1 = 20.55 A, G4 = 19.19 AB, G2 = 14.22 B, and G3 = 8.44 C. After 12 months, G1 = 7.37 A, G5 = 5.61 AB, G4 = 4.97 B, G2 = 3.32 C, and G3 = 1.93 D. After 12 months of storage, all groups' bond strength significantly decreased. Conclusions: SBU and AU had bond strengths comparable to ZP after 24 h. No material resisted water degradation.

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This in vitro study aimed to evaluate the effect of different bonding strategies on the micro-shear bond strength (µSBS) of luting agents to CAD−CAM composites. Surface scanning electron microscopy (SEM) and spectroscopy by energy-dispersive X-ray spectroscopy (EDS) were performed to analyze the surfaces of the composite before and after bonding treatment. Three CAD−CAM composites were evaluated: Lava Ultimate restorative (LU), Brava Blocks (BR), and Vita Enamic (VE). The LU and BR surfaces were sandblasted using aluminum oxide, while the VE surfaces were etched using a 5% hydrofluoric acid gel according to the manufacturers' recommendations. All surfaces were subjected to the following bonding strategies (n = 15): adhesive with silane and MDP (ScotchBond Universal, 3M Oral Care, St Paul, MI, USA); adhesive with MDP (Ambar Universal, FGM, Joinville, Brazil); adhesive without silane or MDP (Prime&Bond Elect, Dentsply Sirona, Charlotte, NC, USA), pure silane without MDP (Angelus, Londrina, Brazil), and pure silane with MDP (Monobond N, Ivoclar Vivadent, Schaan, Liechtenstei). Afterwards, tygons were filled with RelyX Ultimate (3M Oral Care), AllCem (FGM), or Enforce (Dentsply Sirona), which were light-cured and subjected to the µSBS test. Data were analyzed using two-way ANOVA and Bonferroni's post hoc test (α = 0.05). Additional blocks (n = 15) were subjected to scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) before and after the surface treatment. The µSBS values on VE surfaces were higher than those observed on LU and BR surfaces (p < 0.001). Silane without MDP (Allcem) promoted the highest µSBS values, while silane with MDP (RelyX Ultimate) provided the highest values among all bonding strategies (p < 0.001). Enforce promoted no significant difference in µSBS values. SEM and EDS analyses detected noticeable changes to the surface morphology and composition after the surface treatment. The effectiveness of the bonding strategy may vary according not only to the CAD−CAM composite but also to resin cement/bonding agent/silane used.

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OBJECTIVES: This review evaluated the effects of the acidic composition of self-etch (SE) adhesives at the long-term bond strengths to dentin and enamel. DATA: The review followed the PRISMA Extension Statement for network meta-analysis. Studies were identified by a systematic search in PubMed, Web of Science, and Scopus databases. STUDY SELECTION: The inclusion criteria were in vitro studies that evaluated bond strength data of samples analyzed at both immediate and long-term (after aging simulation) periods and that were bonded to sound dentin/enamel using SE adhesives, with at least one group of adhesives being based on 10-MDP (10-methacryloyloxy-decyl-dihydrogen-phosphate; control) and the other group being comprised of alternative acidic monomers. Statistical analyses were conducted using two methods: standard pairwise meta-analysis (SPMA) and Bayesian network meta-analysis (NMA). Heterogeneity was assessed by using the Cochran Q test and I2 statistics. RESULTS: From 5220 studies identified, 87 met the eligibility criteria and 83 were meta-analyzed. Seventeen adhesives were based on 10-MDP and 44 systems were based on alternative acids. The resin-dentin/enamel bonds were predominantly reduced after aging (∼84% of cases). From the SPMA findings, the following acidic compositions showed lower bond strength values (effect size: mean difference [MD] with 95% confidence interval [95% CI]) than 10-MDP: 4-META (MD -4.99, 95% CI: -7.21, -2.78; p<0.001); sulfonic acids (MD -9.59, 95% CI -12.19, -6.98; p<0.001); unspecified phosphate esters (MD -8.89, 95% CI -17.50, -0.28; p = 0.04); or mixed acids (MD -11.0, 95% CI -13.62, -8.38; p<0.001). The dental bonds were benefited from the presence of 10-MDP upon longer aging (>6 months). From the NMA probabilistic findings, adhesives based on 10-MDP and phosphonic acids ranked as having the best and the worst bonding potential to dentin, respectively. More than one composition (phosphonic acids and mixed acids) ranked similarly to 10-MDP in enamel. The studies scored as having moderate risk of bias (58.6%), followed by low (39.1%) and high (2.3%) risk of bias. CONCLUSION: 10-MDP is an outstanding acidic monomer that contributes to higher bonds to dentin at the long-term. In enamel, there is no evidence that one acidic composition prevails over the other. CLINICAL SIGNIFICANCE: The acidic composition of SE adhesives affects the resistance of dental bonds after simulated aging, with 10-MDP playing a significant role in the adhesion to dentin but not to the enamel. REGISTRATION NUMBER: This report is registered at the Open Science Framework (osf.io/urtdf).

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Abstract This study evaluated the effects of alternative self-etch application modes on resin-dentin microtensile bond strength (µTBS) of three commercially available "no wait" concept universal adhesives. In this study extracted impacted non-carious human third molars were used. The flat surfaces were prepared in mid-coronal dentin and prepared with a 600-grit SiC paper. The three universal adhesives that were used are as follows: Clearfil Universal Bond Quick (CUQ, Kuraray Noritake, Japan), G-Premio Bond (GPB, GC Corp, Japan), and a self-curing universal adhesive "Tokuyama Universal Bond" (TUB; Tokuyama Dental, Japan). The following three different application procedures were used for the dentin surfaces: the adhesives were applied and immediately subjected to air-dry; the adhesives were applied followed by a 10-second wait; or the adhesives were rubbed for 10 seconds. Then composite resin was applied to the dentin surface and light cured. After storage in 37°C distilled water for 24 h, all the bonded teeth were cut into 1mm² sections using a low-speed diamond saw (Micracut 125 Low Speed Precision Cutter, Metkon, Bursa, Turkey) under running water (n=15). The sections were subjected to a tensile force at a crosshead speed of 1mm/min in a testing apparatus (Microtensile Tester, Bisco, IL, USA) and µTBS values were measured. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test. Failure modes were analyzed under a stereomicroscope. Prolonged application time significantly affected the µTBS (p<0.005). A significant increase of µTBS on active application was observed for CUQ and GPB. The TUB with an active application had a significantly lower µTBS value compared with the other adhesives. Prolonged application time caused significant improvement of bond strength in all adhesives. The active application is effective at increasing the dentin bond strength except for TUB.

Resumen Este estudio evaluó los efectos de los modos alternativos de aplicación de adhesivos de autograbado en la resistencia de la unión microtensil entre resina y dentina (µTBS) de tres adhesivos universales de concepto "no espera" disponibles en el mercado. En este estudio se utilizaron terceros molares humanos impactados que fueron extraídos. Las superficies planas se prepararon en la dentina coronal media y se prepararon con un papel SiC de 600 granos. Los tres adhesivos universales que se utilizaron son los siguientes: Clearfil Universal Quick Bond (CUQ, Kuraray Noritake, Japón), G-Premio Bond (GPB, GC Corp, Japón), y un adhesivo universal autopolimerizable "Tokuyama Universal Bond" (TUB; Tokuyama Dental, Japón). Se utilizaron los tres procedimientos de aplicación siguientes para las superficies dentinarias: se aplicaron los adhesivos y se sometieron inmediatamente a un secado al aire; se aplicaron los adhesivos y se esperó 10 segundos; o se frotaron los adhesivos durante 10 segundos. Luego se aplicó resina compuesta a la superficie dentinaria y se fotopolimerizó. Después de su almacenamiento en agua destilada a 37°C durante 24 h, todos los dientes unidos se cortaron en secciones de 1mm² utilizando una sierra de diamante de baja velocidad (Micracut 125 Low Speed Precision Cutter, Metkon, Bursa, Turquía) bajo agua corriente (n=15). Las secciones fueron sometidas a una fuerza de tracción a una velocidad de cruceta de 1mm/min en una máquina de prueba universal (Microtensile Tester, Bisco, IL, USA) y se midieron los valores de µTBS. Los datos fueron analizados utilizando la prueba de Kruskal-Wallis y la prueba U de Mann-Whitney. Los modos de falla fueron analizados bajo un estereomicroscopio. El prolongado tiempo de aplicación afectó significativamente a los µTBS (p<0,005). Se observó un aumento significativo de µTBS en la aplicación activa para el CUQ y el GPB. El TUB con una aplicación activa tuvo un valor de µTBS significativamente más bajo comparado con los otros adhesivos. El tiempo de aplicación prolongado causó una mejora significativa de la fuerza de adhesión en todos los adhesivos. La aplicación activa es efectiva para aumentar la fuerza de adhesión de la dentina, excepto para el TUB.

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OBJECTIVES: This study aimed at evaluating the microtensile bond strength (µTBS) and the resin-dentine ultramorphology (24 h and 10 months ageing) of contemporary universal adhesives applied in self-etch (SE) or etch-and-rinse (ER) mode. MATERIALS AND METHODS: Sixty-four sound human molars were collected and randomly allocated in 4 main experimental groups (n = 16) according to the adhesive system employed and subsequently divided into two subgroups depending on their application mode SE or ER (n = 8): ZipBond X (ZBX-SE; ZBX-ER), Prime and Bond Active (PBA-SE; PBA-ER), Clearfil Universal Bond Quick (CBQ-SE; CBQ-ER) or Scotchbond Universal (SCH-SE; SCH-ER). The specimens were cut into sticks with a cross-sectional area of approximately 0.9 mm2 and subjected to µTBS testing at 24 h or after 10 months of ageing in artificial saliva (AS). Five representative fractured specimens from each group were analysed using field-emission scanning electron microscopy (FE-SEM). Resin-dentine slabs (Ø 0.9mm2) from each experimental group were immersed in Rhodamine B and subsequently analysed using confocal microscopy analysis (CLSM). The µTBS results were analysed using a two-way ANOVA and Newman-Keuls multiple-comparison test (α = 0.05). RESULTS: ZBX, PBA and SCH exhibited greater µTBS values than CQB at 24 h in both SE and ER modes (p < 0.05). CQB showed a significant decrease in µTBS values after ageing both when used in SE and ER mode (p < 0.05). ZBX-ER exhibited no significant differences in the µTBS test after ageing (p > 0.05), while a significant drop in µTBS was seen in SCH-ER and APB-ER after 10-month ageing (p < 0.05). Clear signs of degradation were evident in the resin-dentine interface created with CQB regardless of the application mode or the ageing time. In APB-ER and SCH-ER groups, such signs of degradation were evident after ageing in AS. ZBX showed slight dye infiltration both when used in ER and SE mode. CONCLUSIONS: The long-term bonding performance of modern universal adhesives is usually influenced by the adhesive strategy employed; self-etching application should be prioritised during dentine bonding. Moreover, the use of shortened bonding protocols may compromise the quality of the resin-dentine interface and the bonding performance of most modern universal adhesives. CLINICAL RELEVANCE: The use of etch-and-rinse bonding procedures, as well as "shortened" application protocols should be eluded when using modern universal adhesives in dentine. However, new generation universal adhesives based on innovative chemical formulations may probably allow clinicians to achieve long-term bonding performance with such simplified system also when employed in ER mode.

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