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Microtensile Bond Strength To Enamel Affected by Hypoplastic Amelogenesi
Microtensile Bond Strength To Enamel Affected by Hypoplastic Amelogenesi
Microtensile Bond Strength To Enamel Affected by Hypoplastic Amelogenesi
PhD Student, Department of Operative Dentistry, Faculty of Dentistry, Istanbul University, Istanbul, Turkey. Contributed to application of bond strength
tests.
Correspondence: Dr. Batu Can Yaman, Department of Operative Dentistry, Faculty of Dentistry, Istanbul University, Istanbul, Turkey. Tel: +902124142020/30369, Fax: +90-2125250075. e-mail: batucan@istanbul.edu.tr
or batucanyaman@hotmail.com
Yaman et al
Yaman et al
Table 1
Materials and
Lot Numbers
Composition
Manufacturers
3M ESPE; St Paul,
MN,USA
Clearfil SE Bond
Lot# 061538
Kuraray Medical;
Kurashiki, Japan
Filtek Supreme XT
Lot# 20070714
3M ESPE; Seefeld,
Germany
MESIAL
DISTAL
MESIAL
DISTAL
Table 2 The distribution of failed sticks during cutting and failure modes after microtensile bond testing
(%)
c
Group 1
(ER-Control)
60
25
10
Group 2
(ER-HPAI)
Group 3
(SE-Control)
72.5
15
12.5
Group 4
(SE-HPAI)
28.5
7.1
35.7
42.8
D
35.7
28.5
35.7
Failure modes: a: cohesive failure within the resin composite or resin adhesive; b: adhesive failure at resin/enamel interface; c: cohesive failure
within dentin; d: mixed failure with a and b; e: mixed failure with b and c;
f: prematurely failed sticks.
C
d
Fig 1 Diagrammatic representation of specimen preparation.
a) Cutting slabs from the tooth. b) Obtaining sticks from the
slabs. c) Long sticks ready to cut into two parts. d) Microtensile test sticks. D: dentin, C: composite resin, E: enamel.
Yaman et al
Table 4 Microtensile bond strengths of adhesive systems to the enamel affected by HPAI and control groups
Df
Sum of
squares
Mean
square
Groups
Interaction
17.01
17.01
0.6754
Group 1 (ER-Control)
41
31.59 7.78b
Adhesives
107.8
107.8
4.279
Group 2 (ER-HPAI)
45
19.63 8.16a
Enamel
2978
2978
118.2
Group 3 (SE-Control)
40
29.24 7.17b
Residual
80
2015
25.18
Group 4 (SE-HPAI)
47
18.21 5.72a
35
ER
30
SE
MPa
25
20
15
10
5
0
Sound
HPAI
failure within the resin composite and/or resin adhesive; (b) adhesive failure at the resin/enamel interface;
(c) cohesive failure within dentin; (d) mixed failure of (a)
and (b); and (e) mixed failure of (b) and (c). Each type of
failure mode was expressed as a percentage of the total
number of specimens in that group.
Statistical Analysis
Numerical (quantitative) data were presented as means
and standard deviation. Two-way ANOVA and Tukeys
multiple comparison tests were used to compare the
means of the two adhesives. The significance level was
set at p 0.05. Statistical analysis was performed with
GraphPad Prism4 (GraphPad Software; La Jolla, CA,
USA) for Windows.
Enamel
Fig 2 Bar graph showing means and standard deviations of
of the microtensile bond strength (two-way ANOVA).
RESULTS
The results of two-way ANOVA revealed that there
were no interactions between adhesives and types of
enamel (p = 0.4136). Bond strength to sound vs HPAIaffected enamel was found to differ highly significantly
(p < 0.0001). The split-plot model and box plot of the
microtensile bond strength results are shown in Table 3
and Fig 2.
Mean +TBS results and standard deviations for study
groups are listed in Table 4 and Fig 3. Although the
mean bond strength value (MPa) of the HPAI-affected
enamel was higher with ER (19.63 8.16) than with
SE (18.21 5.72), there was no statistically significant
difference (p > 0.05). However, significant differences
were found between HPAI-affected enamel and control
group results (p < 0.05). The highest +TBS was obtained for group 1 (31.59 7.78), followed by group 3
(29.24 7.17). The lowest bond strength was observed
in group 4 (18.21 5.72). The failure mode distribution
(%) is shown in Table 2. The majorities of the fracture patterns were adhesive failure at the resin/enamel interface
and cohesive failure within the enamel for HPAI groups;
also in control groups, the most common fracture patterns
were adhesive failure at the resin/enamel interface and
mixed failure modes.
The Journal of Adhesive Dentistry
Yaman et al
35
30
25
MPa
20
15
10
5
0
SEM Findings
The morphological changes in the enamel surfaces
treated with the phosphoric acid etchant or self-etching
primer are shown in Figs 4 and 5.
The orthophosphoric acid applied to HPAI-affected
enamel surfaces created shallow parallel grooves demarcating the incremental growth of enamel and a very few
pits with diameters similar to the diameter of the prism
core (Fig 4a). On the other hand, phosphoric acid produced well-defined etching patterns on the sound enamel.
Different dissolutions of either the prism cores or boundaries could be seen across the entire enamel surface of
the teeth (Fig 4b).
Vol 16, No 1, 2014
Group 4 (SE-HPAI)
11
Yaman et al
DISCUSSION
There are several alternatives for the rehabilitation of
defective enamel in amelogenesis imperfecta (AI) patients. The ultimate treatment plan relates to the age
and socioeconomic status of the patient, type and severity of the disorder, and the intraoral situation at the
time of treatment planning.27
The mineral content of dental hard tissues is related
to their potential micromechanical interlocking with
bonding agents. The higher mineral content of enamel
is expected to generate a better mechanical interlocking
with the adhesive resin than is the case with dentin substrate.35 However, enamel affected by AI presents loss
of the normal architecture. Enamel prisms are incompletely formed, sometimes with the presence of abnormal amorphous material obscuring the rods. Genetic mutations may result in hypocalcification of enamel, as the
altered tissue shows incomplete biomineralization and
thus lower bond strength.2,6,30 El-Sayed et al6 reported
an approximately 40% mineral reduction in enamel affected by HPAI. However, hypoplastic defects result in
deficiencies in the amount of enamel usually characterized as thin enamel.6 One would expect that the differences in mineral content and structure of HPAI-affected
enamel may provide challenges to the bond of adhesive
resin system.
Bond strength studies on AI-affected human teeth are
rare due to the difficulty of collecting respective samples. Sixteen teeth with HPAI were obtained for bond
12
Yaman et al
CONCLUSIONS
Within the limitations of this study, the following conclusions were drawn:
1. The micromorphological changes and irregularities
detected on the HPAI-affected enamel surface influenced bond strength values of both SE and ER adhesive systems.
2. SE and ER adhesive systems provided similar bond
strengths to HPAI-affected enamel surfaces.
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Yaman et al
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