ORIGINAL ARTICLE

SHEAR BOND STRENGTH OF CONVENTIONAL GLASS IONOMER

CEMENT TO MECHANICALLY TREATED VERSUS CHEMO-
MECHANICALLY TREATED DENTIN

Ali Shamim Atta Ullah* , BDS, MDSc

Basma Ali**, BDS, MDSc
Asaad Javed Mirza***, BDS, MCPS, MDS
Irfan Ullah Khan****, BDS, FCPS
Faisal Balouch*****, BDS, MSc,

OBJECTIVE: To determine the effect of a chemo mechanical caries removal (CMCR) gel Carisolv™ on shear
bond strength (SBS) of conventional glass ionomer cement bonded to human permanent dentin.
METHODOLOGY: One conventional glass ionomer cement (Fuji IX, GC Co. Tokyo Japan) was used. Sixty four
teeth were sectioned occlusally; exposed coronal dentin was polished with silicon papers. Teeth in the control
groups (C) were directly bonded to respective glass ionomer cements (GIC). For test groups (T) the polished dentin
surface was pre-treated with Carisolv™ (Singlemix Uncoloured Gel, Medi Team, Sweden) prior to bonding.
Bonded specimens were stored for 24 hours and stressed to failure in the shear mode.
RESULT:SBS of Fuji IX, test group (4.97 ± 0.82 MPa) was significantly higher (P = .001) than its control group
(3.98 ± 0.67 MPa).
CONCLUSION: Carisolv™ pre-treatment significantly increased the shear bond strength of conventional glass
ionomer cement to dentin.
KEY WORDS: Shear bond strength; Carisolv™, Chemo-mechanical caries removal, Glass ionomer cements.
J Pak Dent Assoc 2010;19(3): 139 - 143

INTRODUCTION tooth structure 6.

C onventional method of caries removal involves the

use of rotary instruments on a high-speed hand
piece (to gain access to the carious lesions) and a
low-speed hand piece (to remove carious lesion). This is
perceived as unpleasant and painful to many patients and
local anaesthesia is frequently required to control pain 1
.The apprehension is due to fear of injections and drilling
with attendant noise, vibration and smell 2,3. This drilling
can also cause deleterious thermal 4 and pressure effects on
the dental pulp 5 and equally removes both infected and
uninfected dentine, resulting in excessive loss of healthy
* Assistant Professor, College of Dentistry, Qassim University,
Kingdom of Saudi Arabia.
** Assistant Professor, College of Dentistry, Qassim University,
Kingdom of Saudi Arabia.
*** Professor, College of Dentistry, Qassim University, Kingdom of
Saudi Arabia.
**** Associate Professor, College of Dentistry, Qassim University,
Kingdom of Saudi Arabia.
***** Lecturer, Dental Material, College of Dentistry, Qassim
University Kingdom of Saudi Arabia
Correspondence: “Dr.A.S.Atta Ullah ” <dralishamim@gmail.com>,
Over the years various techniques and methods have
been developed for the removal of carious dentine. These
include air-abrasion (using a novel Alumina-
hydroxyapatite powder mix, at a specific pressure), air
polishing (using water soluble particles of sodium
bicarbonate and tricalcium phosphate under pressure),
sono-abrasion (using diamond-coated oscillating tips
operating at a particular frequency and ultrasonication
(using kinetic energy of water molecules and abrasives) 7.
Other techniques include chemo-mechanical caries
removal (CMCR), atraumatic restorative treatment
(ART), enzymes (collagenase and pronase) and lasers 8.
The dentine caries has two layers of high and low
levels of infection 9. The minimal removal of infected
carious dentine, together with the use of a therapeutic
restorative material is a fundamental requirement of
10
modern operative dentistry . The aim is to remove only
the outer layer of dentine with a high level of infection
(infected dentine) and to preserve the inner layer with a
low level of infection (affected dentine), which consists of

JPDA Vol. 19 No. 3 July - Sept 2010 139

 Atta Ullah A.S / Ali B / Mirza AJ/ Khan IU SHEAR BOND STRENGTH OF CONVENTIONAL GLASS IONOMER CEMENT TO
MECHANICALLY TREATED VERSUS CHEMO-MECHANICALLY TREATED DENTIN
3
tissues that are able to remineralize .
Recently a new minimally invasive chemo-
mechanical caries removal system “Carisolv Gel” by Medi
Team Co. Sweden has been introduced to the market. The
manufacturer claims that this new gel based caries removal
system removes only the infected dentine. Various clinical
studies have confirmed the efficacy and biocompatibility
11, 12
of Carisolv™ gel . The manufacturer also claims that
the dentine surface treated with Carisolv™ gel is suitable
for bonding of current adhesive restorative materials. The
search for a dental restorative material which adheres
directly to enamel and dentine has engaged the interests of
material scientists for many decades. Since, the
development of glass ionomer cements in the late 1960s,
these materials have found mounting applications in the
13
field of clinical dentistry . The chief advantages of these
materials in addition to their tooth colour characteristic are
biocompatibility, adhesion to tooth structure and
14
prolonged fluoride release .
Bond strength is an important criterion for selection of
adhesive restoratives. The bond strength is defined as the
load required for fracturing the bond divided by the cross-
sectional area of the bond 15. Bond strengths are measured
either in shear or tension. Many factors, including the
dentine substrate, the storage conditions and the test
method, affect the bond strength values 15. Bond strength
of conventional GIC with mechanically-cut dentin has
16,17,18.
been extensively investigated The bond strength of
12
conventional GIC to dentin ranges from 1.1 to 4.5 MPA .
Findings of another study suggest that the bonding of GIC
to dentin is not weak 19. One study evaluated the effect of
dentin surface treatment on shear bond strengths of two
visible light activated glass ionomers to dentin. It was
found pre-treated dentin surfaces had significantly higher
bond strength 12. However, little data is available regarding
the performance of the conventional glass ionomer
cements to chemo-mechanically prepared dentine.
Therefore, this study was designed to explore the adhesive
potential of restorative conventional glass ionomer
cements to chemo-mechanically prepared dentine
following Carisolv gel pre treatment.To evaluate the shear
bond strength of restorative conventional glass ionomer
cements to Carisolv treated dentin.
METHODOLOGY:
Conventional glass ionomer restorative cement (Fuji
IX, GC Co. Tokyo Japan) and a chemo-mechanical caries
removal system (Carisolv, Singlemix Uncoloured, Medi
Team, Sweden) were used in this study.
140
Teeth Selection and Storage: Thirty sound human
permanent molars extracted (due to compromised
periodontal status) within a period of 6 months were used
in the study 15, 20. Teeth with caries, signs of extraction
damage, fillings and endodontic treatment were
excluded. All teeth were first disinfected keeping them in
0.5% chloramine solution 15, 20.They were thoroughly
cleaned by ultrasonic scaler (Peizon® Master 400, EMS,
Switzerland) under copious amount of water to remove
any soft and hard tissue deposits. They were lightly
polished by bristle brush and pumice slurry and stored in
distilled water at 4 °C 15, 20 until required to use. The
distilled water was changed once a week .
15, 20
Mounting of Teeth: Teeth were mounted in a clear self
cure epoxy resin (Miracon®, Malaysia) using mounting
cups (Buehler® Ltd, USA). The teeth were mounted with
their crowns facing downward. A strip of modeling wax
(Metrodent Ltd, UK) was adapted at the base of the
mounting cup to allow central positioning of the teeth and
helping them in vertical alignment.
The internal surface of the cup was coated with
Vaseline (Kofa Chemicals, China) and epoxy resin was
carefully poured. Following overnight curing of the
resin, mounted teeth were removed and thoroughly
washed under running water and stored in distilled water
15, 20
at 21-25°C .
Sectioning and Polishing of Teeth: All mounted teeth
were secured to a jig of a sectioning machine (Isomet™
2000 Precision-saw, Buehler® Ltd, USA). Occlusaly 0.5
mm of enamel was removed by a diamond disc under
lubrication. Superficial coronal dentine was exposed by
rubbing p-180 grit silicon carbide abrasive paper
(Carbimet®, Buehler® Ltd, USA) under running water
using a grinder (Metaserve® 2000, Buehler® Ltd, USA) .
Grinding and polishing was done from the deepest fissure
of the teeth until a 3 mm diameter of dentine was exposed
for bonding 15. Final polishing was done by p-600 grit
silicon carbide paper (Carbimet®, Buehler® Ltd, USA)
to achieve a standardized smooth surface with smear
layer 20).
A new pair of silicon carbide abrasive papers was
used for every five specimens. The dentin was examined
under a stereo microscope (Kyowa SD-2PL, Kyowa
Optical CO., Tokyo Japan) at 10 x magnification to
ensure that the prepared dentine surface was free from
residual resin. Prepared mounted specimen is shown in
figure number 1. The teeth were randomly divided into 2
groups; a Test group and a Control group. Each group had
JPDA Vol. 19 No. 3 July - Sept 2010
 Atta Ullah A.S / Ali B / Mirza AJ/ Khan IU SHEAR BOND STRENGTH OF CONVENTIONAL GLASS IONOMER CEMENT TO
MECHANICALLY TREATED VERSUS CHEMO-MECHANICALLY TREATED DENTIN

15 teeth. from the bonded specimen. The specimen was again

coated with a layer of same cavity varnish and allowed to
Test Groups: The polished dentin surface was treated dry. The diameter of the specimen (figure 2) was
with Carisolv gel. It consisted of one colourless gel and a confirmed by using a digital vernier calliper (Mitotoyo,
transparent liquid. Both the components were mixed until Digmatic, Japan). Finally the bonded specimen was stored
homogenized and a small amount was placed in a dappen at 37 °C in a closed jar with 100% relative humidity) for 24
15,18
dish. One drop of homogenized gel was applied to the hours before shear bond testing . Prepared test
dentin of the prepared specimen for 30 seconds. The specimen is shown in figure number 2.
specimen was then placed on the vibrator (Mestra®
Spain) preset at a low speed. A flat instrument was
allowed to make contact with the gel covered dentin and
the vibrator was turned on for 3 minutes. One study
recommended that the dentin be gently agitated for 3
minutes to simulate clinical practice 21. The vibrator
allowed controlled agitation to produce a standard
surface. The gel was gently wiped off using moist cotton
pellets following the manufacturer's instructions.

Before bonding, the dentin was conditioned with one

drop of Fuji IX liquid (40% polyacrylic acid) for 10
seconds with a clean cotton pellet. The surface was then
rinsed with water and dried with a dry cotton pellet
resulting in a glistening surface. Fuji IX powder and liquid Figure 1: Mounted Specimen
was manually mixed on a mixing pad. To ensure proper
powder/liquid ratio (3.6g: 1.0g); one level spoon of Shear Bond Strength Testing: Bonded specimens
powder was mixed with one drop of liquid for 25-30 were attached to a shear bond test assembly by connecting
seconds as per manufacturer's instructions. All procedure them to the lower compression cell of a Universal Testing
for bonding was accomplished within 2 minutes as it is the Machine (Instron® 4302 Corp., USA). A knife-edge rod
working time of the cement. device of 0.5 mm thickness was attached to its crosshead.
The knife-edge rod was placed at approximately 0.5 mm
Control Group: The polished dentin was bonded with above the specimens at their bonded interface.
Fuji IX without any pre-treatment.
Preparation of Test Specimens: To control the area of
bonding to dentin a special bonding apparatus and a brass
split mould with a central hole of 3 mm in diameter was
used. The thickness of the split mould was 2 mm. The split
mould was carefully adapted to the conditioned dentin
surface. The mixed material was applied through this hole
with a plastic instrument. The split mould together with
mounted specimen was then quickly secured on to the
bonding apparatus and tightly screwed. Excess material
from the top of the split mould was carefully removed
using a sharp steel blade.
After, initial setting of the cement, a load of 10 N was
applied on the specimen for 10 seconds 20. After 6 minutes, Figure 2: Diameter of the prepared test specimen
a coat of cavity varnish (GC Corporation, Tokyo, Japan)
was lightly applied to the upper surface of the specimen Following calibration of the testing machine, a crosshead
with a cotton pellet. speed of 1mm/min [15,18] was used and all the specimens
were stressed to failure in the shear mode (ISO/TS 11405,
The bonded assembly was then carefully removed 2003)15,20. The obtained shear load values were converted
from the bonding apparatus. Split mould was removed to stress units, mega Pascal (Mpa).

JPDA Vol. 19 No. 3 July - Sept 2010 141

 Atta Ullah A.S / Ali B / Mirza AJ/ Khan IU SHEAR BOND STRENGTH OF CONVENTIONAL GLASS IONOMER CEMENT TO
MECHANICALLY TREATED VERSUS CHEMO-MECHANICALLY TREATED DENTIN

RESULT: strength of glass ionomer cements, resin composites and

The mean shear bond strength of the specimens for
each test and control groups is presented in Table 1. Figure
3 shows the histogram for both control and test groups.
The shear bond strength of test group (T) ranged from 3.35
to 6.12 MPa, with a mean of 4.97 MPa. For control group
(C) the shear bond strength ranged from 2.89 to 5.19 MPa,
with a mean of 3.98 Mpa.
dentine bonding agents after chemo-mechanical caries
removal 12, 23. However, the test conditions varied from one
24
study to another . Some researchers have used carious
teeth while others have used sound teeth 15. Moreover,
substrate for bond testing also varied from human to
bovine dentin 25. Hence, direct and accurate comparison
among these studies is difficult if not impossible.

Table 1: Mean shear bond strength (Mpa) of all test and control Mclnnes and colleagues evaluated the shear bond
group strength of two glass ionomer base materials (Ketac-Bond
and Shofu) to Caridex treated dentin conditioned with 10
Group N Mean (Mpa) S.D. S.E. Min. Max % polyacrylic acid for 20 seconds, conventionally
prepared dentin conditioned with 10% polyacrylic acid
Fuji IX, T 15 4.97 0.82 0.21 3.35 6.12 26
and only Caridex treated dentin . They found no
Fuji IX, C 15 3.98 0.67 0.17 2.89 5.19 significant difference in the mean shear bond strengths
among the three groups. They also reported that the shear
bond strength using 10% polyacrylic acid showed no
The mean shear bond strength of group T (4.97 ± 0.82 significant bond strength enhancement.
MPa) was higher than its control group (3.98 ± 0.67) and
27
the mean difference is statistically significant at P = .001 Another study reported that chemo-mechanical
as indicated by a student t-test (Table 2). caries removal with Carisolv had no adverse effect on the
Table 2: Student t-test between Fuji IX test and control group bonding of modern adhesive systems to dentin. They also
Independent Sample Test stated that chemo-mechanical excavation did not
negatively affect composite bond strength.
Levene’s test
for Equality T-test for equality of Means 21
Hosoya and co-workers reported the influence of
of variances Carisolv on resin adhesion to sound human primary and
F Sig. T df Sig. Mean Std. Error young permanent dentin. They found that dentin treated
(2 Tailed) Difference Difference with Carisolv before application of adhesive systems and
resin composites significantly increased shear bond
.600 .445 -3.620 28 .001 -.99400 .27462
strength to permanent dentin but not to primary dentin.
They speculated that Carisolv may have dissolved more
dentine collagen in primary dentin than that of permanent
dentin because lower mineral content of primary dentin
Shear Bond Strength (Mpa)

5 offers less protection against the non-specific

4.5 deproteinizing effect of sodium hypochlorite. This might
4 have caused excessive demineralization and could have
3.5 lead to inferior bonding in case of primary dentin.
3
2.5 In this study Carisolv pre-treatment significantly
2 increased the bond strength of Test group as compared to
1.5 Control group. The specimens were conditioned with 40
1
% polyacrylic acid as per manufacturer's
0.5
recommendation. Dentin pre-treatment with polyacrylic
0
Fuji IX, T Fuji IX, C acid removes the smear layer and demineralises the
Figure 3: Histogram of Shear Bond Strength (Mpa) superficial dentin 28. The increased concentration (40 %)
of Test and Control Groups may have removed the underlying smear layer and
produced a more favourable dentin surface for bonding.
The results of this study are in accordance with previous
DISCUSSION:
studies 21,27. The results of these studies show significant
Several studies have evaluated the shear bond increase in the shear bond strengths of Carisolv pre-

142 JPDA Vol. 19 No. 3 July - Sept 2010

 Atta Ullah A.S / Ali B / Mirza AJ/ Khan IU SHEAR BOND STRENGTH OF CONVENTIONAL GLASS IONOMER CEMENT TO
MECHANICALLY TREATED VERSUS CHEMO-MECHANICALLY TREATED DENTIN
treated permanent human dentin.
CONCLUSION
Pretreatment with Carisolv significantly increased the
shear bond strength of conventional glass ionomer cement
to dentin.
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