RESEARCH AND EDUCATION

Additive effects of touch-activated polymerization and

extended irradiation time on bonding of light-activated
adhesives to root canal dentin
Wahyuni S. Dwiandhany, DDS, MDS,a Ahmed Abdou, BDS, MSc, PhD,b Antonin Tichy, DDS,c
Kazuhide Yonekura, DDS, PhD,d Masaomi Ikeda, RDT, BSc, PhD,e Keiichi Hosaka, DDS, PhD,f
Junji Tagami, DDS, PhD,g and Masatoshi Nakajima, DDS, PhDh

Dual-activated adhesives are ABSTRACT

widely used for bonding dual-
activated resin core materials
to root canal dentin, as the
chemical polymerization does
not require light.1,2 However,
solely chemically activated
polymerization leads to a
lower degree of conversion
(DC) compared with light-
activated polymerization.3,4
As a consequence, dual-
activated adhesives exhibit
higher bond strengths in the
coronal region of post cavities
than in the apical region where
light energy is attenuated.
Previous studies revealed that
the extension of light-irradiation
time improved bond strength
Statement of problem. The bonding of light-activated adhesives to root canal dentin with an
additional touch-polymerization activator has been insufficiently examined.
Purpose. The purpose of this in vitro study was to investigate the effect of touch-polymerization
activators and extended light-irradiation time on the microtensile bond strength (mTBS) of light-
activated adhesives.
Material and methods. Post cavities were prepared in 50 extracted mandibular premolars and
bonded using Prime&Bond Universal (PBU); PBU+Self Cure Activator (SCA); Clearfil SE Bond 2
(SEB); SEB+Clearfil DC Activator (DCA); or Clearfil Universal Bond Quick ER (UBQ). After light-
irradiation for 10 or 20 seconds, the post cavities were filled with dual-activated resin core
materials. Eight beams were prepared per specimen and subjected to the mTBS test. The mTBS
data were analyzed by using 3-way ANOVAs with the Bonferroni correction (a=.05).
Results. The 3-way ANOVAs indicated that the use of touch-polymerization activators (SCA and
DCA) significantly increased the mTBS of PBU and SEB in both the coronal (P=.015) and apical
(P=.001) regions. The extension of light-irradiation time to 20 seconds significantly improved
their mTBS in the apical region (P<.001), but not in the coronal region (P=.09). Light-irradiation
for 20 seconds increased the mTBS of UBQ significantly in the coronal region (P=.014).
Conclusions. Touch-polymerization activators improved the bond strength of light-activated
adhesives to root canal dentin, especially when combined with an extended light-irradiation
time. (J Prosthet Dent 2020;-:---)

Supported by the Ministry of Education, Culture, Sports, Science and Technology of Japan (Grant Numbers 17K17125, 18K09571 and 19K10106) and by the Cooperation
Program between TMDU and Sony IP&S, Inc scholarship to W.S.D.
a
Graduate student, Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;
and Lecturer, Department of Conservative Dentistry, Faculty of Dentistry, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
b
Graduate student, Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;
and Lecturer, Biomaterials Department, Faculty of Oral and Dental Medicine, Modern University for Technology and Information, Mokatam, Cairo, Egypt.
c
Graduate student, Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;
and Graduate student, Institute of Dental Medicine, First Faculty of Medicine of the Charles University and General University Hospital in Prague, Prague, Czech Republic.
d
Clinical Fellow, Operative Dentistry Clinic, Tokyo Medical and Dental University Dental Hospital, Tokyo, Japan.
e
Senior Lecturer, Department of Oral Prosthetic Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
f
Assistant Professor, Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
g
Professor, Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
h
Junior Associate Professor, Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo,
Japan.

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2 Volume
Clinical Implications
The addition of a touch-polymerization activator
and the extension of light-irradiation time improved
the bond strength of light-activated adhesives.
Therefore, their use may ensure optimal adhesion of
the composite resin to the root canal dentin and
thereby increase the longevity of prosthetic
restorations in endodontically treated teeth.
to root canal dentin, particularly in the apical region.5,6 Total
light-irradiation time and DC have also shown a significant
correlation with bond strength.7-10 The bonding perfor-
mance of light-activated adhesives is also strongly influ-
enced by the light-irradiation strategy,5,11 type of
photoinitiator,12 and its concentration13 in the adhesives.
Recently, light-activated 1-bottle self-etch adhesives
(1-SEA) have started to gain popularity. Some of the
currently available 1-SEAs can also bond to root canal
dentin and may be used to build a resin core without
light-irradiation of the adhesive. The chemical poly-
merization is initiated by contact of the adhesive with a
corresponding dual-activated resin core material, which
is referred to as touch-polymerization.14 The touch-
polymerization system contains an accelerator, which
can promote rapid chemical polymerization with a
specific chemical initiator in the dual-activated resin
core material.15 Touch-polymerization of nonspecific
dual-activated or chemically activated composite resins
with light-activated adhesives can also be achieved by
mixing the adhesive with a touch-polymerization
activator. Generally, touch-polymerization activators
can be classified into 2 types according to their key
ingredients16: aryl sulfinic acid sodium salt-based or
aryl borate salt-based activators. The sodium salt of
aryl sulfinic acid rapidly reacts with the acidic mono-
mer to form aryl sulfinic acid and sodium salt of the
acidic monomer, followed by the subsequent formation
of a charge transfer complex that produces a phenyl or
benzenesulfonyl free radical.17-19 Similarly, aryl borate
salts can form a binary system between the salts and
the organic acids, which effectively initiates free radical
polymerization.20 However, the bonding of light-
activated adhesives with an additional touch-
polymerization activator to root canal dentin has
been insufficiently examined.
Therefore, this study aimed to investigate the
bonding performance of light-activated adhesives
with an added touch-polymerization activator, in
conjunction with different light-irradiation times. The
null hypotheses were that the addition of a touch-
polymerization activator would not affect the micro-
tensile bond strength (mTBS) of light-activated
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
adhesives to the root canal dentin and that the
extension of light-irradiation time would not affect the
mTBS of light-activated adhesives to the root canal
dentin.
MATERIAL AND METHODS
The study protocol was approved by the dental
research ethics committee of Tokyo Medical and
Dental University (No. D2013-022-03). Fifty single-
rooted human mandibular premolars (length <21
mm), extracted for orthodontic purposes, were
collected and stored in a 0.1% thymol solution at 4

C. After the crowns were removed 2 mm coronal to
the cementoenamel junction, the root canals were
enlarged with K-files up to size 40, with the working
length determined 1 mm from the apical foramen.
Thereafter, post cavities of 10-mm depth were pre-
pared by using Gates-Glidden drills up to size 6
(Ø1.5-mm) and a parallel Ø1.5-mm post drill (Fi-
breKor; Pentron Corp) in a low-speed handpiece
under water cooling. Before bonding, the external
surfaces of the roots were covered with a 2-mm layer
of composite resin (Clearfil Universal Bond and
Clearfil Majesty ES-2; Kuraray Noritake Dental Inc) to
create grips for mTBS testing and to prevent external
light penetration through the dentinal walls during
light-irradiation.21
Two 1-SEAs (Clearfil Universal Bond Quick ER
[UBQ]; Kuraray Noritake Dental Inc, and Prime&Bond
Universal [PBU]; Dentsply Sirona) and a 2-SEA (Clearfil
SE Bond 2 [SEB]; Kuraray Noritake Dental Inc) were
evaluated. For the activation of touch-polymerization,
Clearfil DC Activator (DCA; Kuraray Noritake Dental
Inc) was mixed with SEB, and Self Cure Activator (SCA;
Dentsply Sirona) with PBU. No separate activator was
necessary for UBQ, as it is incorporated in the product.
The materials used in this study are presented in
Table 1.
The post cavities were stratified into 5 groups ac-
cording to the bonding system used: PBU, PBU+SCA,
SEB, SEB+DCA, and UBQ. After the post cavity walls
had been dried with paper points, the adhesives were
applied according to the manufacturer’s instructions.
Excess material was removed by using paper points,
and the adhesives were air-dried for 10 seconds at an
air-pressure of approximately 0.35 MPa at 1-cm above
the post cavity orifice. Each group was divided into 2
subgroups according to light-irradiation time (10
seconds or 20 seconds). Light-irradiation was per-
formed at a distance of 5 mm from the post cavity
orifice (1400 mW/cm2, Valo; Ultradent Products, Inc).
Thereafter, the post cavities were filled with a dual-
activated resin core material corresponding with the
adhesives: Core-X Flow (Dentsply Sirona) for PBU
Dwiandhany et al
- 2020 3

Table 1. Materials used

Materials Manufacturer Composition (Batch Number) Application Polymerization Mode pH
PBU Dentsply Sirona Phosphoric acid-modified acrylate resin Apply for 20 s, air-dry with Light-polymerization 2.5
(PENTA and 10-MDP), multifunctional moderate air-pressure, light-
acrylate, bifunctional acrylate, acidic irradiation for 10 s.
acrylate, isopropanol, water, phosphine
oxide photoinitiator, stabilizer
(1806000806)
SCA Dentsply Sirona UDMA, HEMA, tetraphenyl borate salt, Mix liquids in 1:1 ratio for at least Dual-polymerization 6-8
phosphine oxide initiator, stabilizer, 1-2 s, air-dry gently, light-
acetone, water (00019692) irradiation according to the
bonding agent used.
Core-X Flow Dentsply Sirona Base: Silane-treated barium Inject into the post cavity; light- Dual-polymerization d
fluoroaluminoborosilicate glass, UDMA, irradiation for 20 s.
EBPADMA, urethane resin,
trimethylolpropane trimethacrylate,
TEGDMA, photopolymerization initiator,
BHT (00021999).
Catalyst: Silane-treated barium
fluoroaluminoborosilicate glass, Bis-GMA,
EBPADMA, TEGDMA, chemical
polymerization initiator, BHT (00021999)
SEB Kuraray Noritake, Dental Primer: 10-MDP, HEMA, hydrophilic Primer: Apply for 20 s, air-dry Light-polymerization 2.1
Inc aliphatic dimethacrylate, dl- with mild air-pressure.
camphorquinone, water (8V0099) Adhesive: Apply and air-dry with
Adhesive: 10-MDP, HEMA, Bis-GMA, mild air-pressure, light-
hydrophobic aliphatic dimethacrylate, dl- irradiation for 10 s.
camphorquinone, initiators, accelerators,
silanized colloidal silica (8P0152)
DCA Kuraray Noritake, Dental Arysulfinate salt, accelerators, ethanol Mix liquids in 1:1 ratio for at least Dual-polymerization 3.2
Inc (6N0007) 1-2 s, air-dry gently, light-
irradiation according to the
bonding agent used.
UBQ Kuraray Noritake, Dental 10-MDP, Bis-GMA, HEMA, hydrophilic Apply bond with no waiting Light-polymerization 2.3
Inc amide monomers, colloidal silica, silane time, air-dry with mild pressure
coupling agent, sodium fluoride, CQ, air blow, light- irradiation for 10 s.
ethanol, water (8A0018)
Clearfil DC Core Kuraray Noritake, Dental Base: TEGDMA, surface-treated glass Inject into the post cavity and Dual-polymerization d
Automic ONE Inc powder, surface-treated silica type light-irradiation for 20 s.
microfiller, aluminum-type microfiller,
chemical polymerization accelerators
(2G0231, 8U0308)
Catalyst: Bis-GMA, CQ, silanized barium
glass filler, silanized silica, chemical
photopolymerization catalyst, chemical
polymerization catalysts, colorant
(2G0231, 8U0308)

10-MDP, 10-Methacryloyloxydecyl dihydrogen phosphate; BHT, Butylated hydroxytoluene; Bis-GMA, Bisphenol A-glycidyl methacrylate; CQ, Camphorquinone; DCA, Clearfil DC Activator;
EBPADMA, Ethoxylated bisphenol A dimethacrylate; HEMA, Hydroxyethylmethacrylate; PBU, Prime&Bond Universal; PENTA, Dipentaerythritol penta-acrylate phosphate; s, seconds; SCA, Self
Cure Activator; SEB, Clearfil SE Bond 2; TEGDMA, Triethylene glycol dimethacrylate; UBQ, Universal Bond Quick ER; UDMA, Urethane dimethacrylate.

and PBU+SCA; and Clearfil DC Core Automix ONE
(Kuraray Noritake Dental Inc) for SEB, SEB+DCA,
and UBQ, followed by light-irradiation for 60 seconds.
The bonding procedures are illustrated in Figure 1.
After being stored in water at 37  C for 24 hours, each
bonded specimen was sectioned mesiodistally at the
center of the post cavity with a low-speed precision cutter
(Isomet; Buehler) to create a 0.6-mm-thick slab. The slab
was sectioned perpendicular to the bonded interface to
produce eight 0.6×0.6-mm-thick beams.22 Four coronal
beams represented the coronal region of the post cavity,
corresponding to the coronal third of the root canal, and
4 apical beams represented the apical region of the post
cavity, corresponding to the middle third of the root ca-
nal. The interface to be tested was selected, and the
beams were carefully glued to a testing jig with cyano-
acrylate resin (Model Repair II Blue; Dentsply Sirona).
Each beam was then subjected to a tensile force at a
crosshead speed of 1 mm/min until fracture on a table-
top testing machine (EZ-SX; Shimadzu Co), and the
force at bond failure was converted to mTBS value in
MPa. The mTBS testing procedure is summarized in
Figure 1.
The resin and dentin fragments were mounted on
brass holders and sputter-coated with gold (Quick Auto
Coater SC-701AT; ELIONIX Inc). Using a scanning
electron microscope (JSM IT-100; JEOL Ltd), failure
modes were classified into 1 of 4 categories: adhesive
failure (A: >70% of the failure area was at the interface
between the resin and the dentin), cohesive failure
within dentin (CD: >70% of the failure area was within
the dentin), cohesive failure within resin core (CR: >70%
of the failure area was within the resin), or mixed failure
(M: combination of both cohesive and adhesive failure).21

Dwiandhany et al THE JOURNAL OF PROSTHETIC DENTISTRY

4 Volume - Issue -

Figure 1. Schematic illustration of bonding procedures and microtensile bond strength testing. DCA, Clearfil DC Activator; PBU, Prime&Bond Universal;
s, seconds; SCA, Self Cure Activator; SEB, Clearfil SE Bond 2; UBQ, Universal Bond Quick ER.

The Kolmogorov-Smirnov test indicated that mTBS Table 2. Results of repeated measures ANOVA showing effects of
data were normally distributed. A repeated measures bonding systems, dentin region, and light-irradiation time on
analysis of variance (ANOVA) was performed to evaluate microtensile bond strength
the effect of 2 between-subject variables (bonding systems Source SS df MS F P

and light-irradiation time) and 1 within-subject variable Regiona 19070.165 1 19070.165 963.098 <.001
Region×Bonding systema 2834.236 4 708.559 35.784 <.001
(dentin region). To analyze the effect of touch-
Region×Light-irradiation timea 52.541 1 52.541 2.653 .111
polymerization activators, a 3-way ANOVA was per-
Region×Bonding system×Light- 113.007 4 28.252 1.427 .243
formed for each region with the following factors: adhe- irradiation timea
sives (PBU and SEB), touch-polymerization activator (with Bonding systemb 5549.767 4 1387.442 9.624 <.001
or without), and light-irradiation time (10 seconds or 20 Light-irradiation timeb 2071.330 1 2071.330 14.368 <.001
seconds). The Bonferroni correction was performed for Bonding system×light-irradiation timeb 863.046 4 215.762 1.497 .221
multiple comparisons of all analyses. The failure modes DCA, Clearfil DC Activator; PBU, Prime&Bond Universal; SCA, Self Cure Activator; SEB,
were analyzed with the Kruskal-Wallis test to compare the Clearfil SE Bond 2; UBQ, Universal Bond Quick ER. Bonding systems (PBU, PBU+SCA,
SEB, SEB+DCA, and UBQ); region (coronal and apical); and light-irradiation time (10 or
bonding systems and light-irradiation times within each 20 seconds). aTest of within-subject effect. bTest of between-subject effect.
region of the root, followed by pairwise comparisons with
the Dunn-Bonferroni correction (a=.05). A statistical
software program (IBM SPSS Statistics for Windows, v23;
the dentin region were also significantly different (P<.001),
IBM Corp) was used for the analyses.
whereas the interaction between light-irradiation time and
both dentin region (P=.111) and bonding system (P=.221)
RESULTS
were not. Moreover, the interaction among the 3 factors was
The repeated measures ANOVA (Table 2) revealed that the also statistically similar (P=.234). The 3-way ANOVAs
effects of dentin region, bonding system, and light- (Tables 3 and 4) revealed that the touch-polymerization
irradiation time were statistically significantly different activator significantly affected mTBS in the coronal (P=.015)
(P<.001). The interactions between the bonding systems and and apical regions (P=.001). The effect of adhesives was

THE JOURNAL OF PROSTHETIC DENTISTRY Dwiandhany et al

- 2020 5

Table 3. Results of 3-way ANOVA showing effects of adhesives, touch- Table 4. Results of 3-way ANOVA showing effects of adhesives, touch-
polymerization activator, and light-irradiation time in coronal region polymerization activator, and light-irradiation time in apical region
Variables SS df MS F P Variables SS df MS F P
Adhesives 4146.014 1 4146.014 35.327 <.001 Adhesives 101.194 1 101.194 2.23 .145
Touch-polymerization activator 774.088 1 774.088 6.596 .015 Touch-polymerization activator 664.251 1 664.251 14.641 .001
Light-irradiation time 358.31 1 358.31 3.053 .090 Light-irradiation time 1163.336 1 1163.336 25.642 <.001
Adhesives×Touch-polymerization activator 27.192 1 27.192 0.232 .634 Adhesives×Touch-polymerization activator 3.136 1 3.136 0.069 .794
Adhesives×Light-irradiation time 4.199 1 4.199 0.036 .851 Adhesives×Light-irradiation time 12.442 1 12.442 0.274 .604
Touch-polymerization activator×Light- 93.25 1 93.25 0.795 .379 Touch-polymerization activator×Light- 33.686 1 33.686 0.743 .395
irradiation time irradiation time
Adhesives×Touch-polymerization 247.415 1 247.415 2.108 .156 Adhesives×Touch-polymerization 443.421 1 443.421 9.774 .004
activator×Light-irradiation time activator×Light-irradiation time

DCA, Clearfil DC Activator; PBU, Prime&Bond Universal; SCA, Self Cure Activator; SEB, DCA, Clearfil DC Activator; PBU, Prime&Bond Universal; SCA, Self Cure Activator; SEB,
Clearfil SE Bond 2; UBQ, Universal Bond Quick ER. Adhesives (PBU and SEB); touch- Clearfil SE Bond 2; UBQ, Universal Bond Quick ER. Adhesives (PBU and SEB); touch-
polymerizeation activator (with or without); and light-irradiation time (10 or 20 seconds). polymerization activator (with or without); and light-irradiation time (10 or 20 seconds).

Table 5. Microtensile bond strength to root canal dentin for each 100
bonding system, light-irradiation time, and root region (mean ±standard
deviation) 80
Bonding System Irradiation Time Coronal Apical P

μTBS (MPa)
PBU 10 s 52.8a ±9.1 34.3a ±5.0 .002
60
a b
20 s 66.1 ±4.2 52.5 ±5.8 .020
40
PBU+SCA 10 s 67.9a ±10.4 51.5b ±7.6 .005
20 s 65.2a ±9.9 52.7b ±6.8 .032
20
SEB 10 s 75.8a ±11.9 37.3a ±7.4 <.001
20 s 80.5ab ±10.4 44.3ab ±3.9 <.001 0
PBU
PBU+SCA
SEB
SEB+DCA
UBQ

PBU
PBU+SCA
SEB
SEB+DCA
UBQ

PBU
PBU+SCA
SEB
SEB+DCA
UBQ

ab
SEB+DCA 10 s 84.3 ±16.4
20 s 92.9b ±10.6
UBQ 10 s 54.7a ±12.8
20 s 69.0b ±5.4
DCA, Clearfil DC Activator; PBU, Prime&Bond Universal; s, seconds; SCA, Self Cure
Activator; SEB, Clearfil SE Bond 2; UBQ, Universal Bond Quick ER. For each individual
adhesive (PBU, SEB, UBQ), different letter within each column indicates significant
difference (P<.05). P values refer to difference between coronal and apical regions.
significant only in the coronal region (P<.001), while light-
irradiation time was a significant factor only in the apical
region (P<.001). Interactions between pairs of factors were
not significant in either of the dentin regions (P>.05);
however, the interaction among the 3 factors was significant
in the apical region (P=.004).
The mTBS of the tested groups are presented in Table 5
and Figure 2. The coronal region demonstrated significantly
higher mTBS than the apical region in all tested groups
(P<.05). In the coronal region, there was no significant
difference between groups bonded with PBU and
PBU+SCA. In the apical region, the mTBS of PBU (10 sec-
onds) was significantly lower than that of PBU (20 seconds)
(P=.013), PBU+SCA (10 seconds) (P=.022), and PBU+SCA
(20 seconds) (P=.001). SEB (10 seconds) exhibited a
significantly lower mTBS than SEB+DCA (20 seconds) in the
coronal (P=.023) and apical (P=.007) regions. The addition
of DCA or the extension of light-irradiation time alone did
not significantly increase the mTBS of SEB (P>.05) in either
of the regions except for the mTBS of SEB+DCA (20 sec-
onds), which was significantly higher than that of
SEB+DCA (10 seconds) in the apical region (P<.05). The
PBU
PBU+SCA
SEB
SEB+DCA
UBQ
40.0a ±8.6 <.001
56.7b ±7.6 <.001
27.0a ±5.9 <.001
36.7a ±10.4 <.001
10 s 20 s 10 s 20 s
Apical Coronal
Figure 2. Microtensile bond strengths of dentin region, bonding system,
and light-irradiation time. Horizontal bars between columns indicate
significant difference (P<.05). DCA, Clearfil DC Activator; PBU,
Prime&Bond Universal; s, Seconds; SCA, Self Cure Activator; SEB, Clearfil
SE Bond 2; UBQ, Universal Bond Quick ER.
mTBS of UBQ (10 seconds) was significantly lower than
that of UBQ (20 seconds) in the coronal region (P=.014),
but not in the apical region (P>.05).
Failure mode distributions are presented in Table 6. In
the coronal region, there was no significant difference in
failure mode among the tested groups (P=.099). In
contrast, in the apical region, the PBU (10 seconds) group
exhibited a significantly higher incidence of adhesive
failures (85%, P=.002) than the other groups. Addition-
ally, the adhesive layers in the apical region contained
numerous voids, whereas no such voids were observed in
the coronal region (Fig. 3). No pretesting failures
occurred during specimen preparation.
DISCUSSION
The results of this study revealed that the addition of a
touch-polymerization activator to light-activated adhe-
sives SEB and PBU significantly improved their mTBS to

Dwiandhany et al THE JOURNAL OF PROSTHETIC DENTISTRY

6 Volume - Issue -

Table 6. Failure mode percentages The mTBS of SEB and PBU were significantly lower
Region Adhesive Irradiation Time A C/D C/R M in the apical region than in the coronal region. In the
Coronal PBU 10 s 30 0 0 70 case of SEB, whose polymerization is initiated by
20 s 30 0 20 50 camphorquinone,24 the apical mTBS was almost half of
PBU+SCA 10 s 15 0 20 65
the coronal mTBS, on which the extension of the light-
20 s 50 0 15 35
irradiation time had no significant effect. In contrast,
SEB 10 s 45 5 5 45
PBU, which uses a phosphine oxide photoinitiator,
20 s 40 5 35 20
exhibited significantly higher mTBS in the apical region
SEB+DCA 10 s 25 10 15 50
20 s 20 25 10 45
if light-irradiation time was extended to 20 seconds
UBQ 10 s 30 25 10 35
and the difference between regions decreased. The
20 s 15 5 20 60 apical mTBS was significantly lower than the coronal
Apical PBU 10 s 85 0 0 15 mTBS even if touch-polymerization activators were
20 s 35 5 0 60 added (SCA to PBU and DCA to SEB). This indicated
PBU+SCA 10 s 25 0 10 65 that light energy delivered to the adhesives affected the
20 s 35 0 20 45 bonding performance of dual-activated adhesives,
SEB 10 s 40 5 0 55 regardless of touch-polymerization.
20 s 50 0 15 35 Extending the light-irradiation time slightly
SEB+DCA 10 s 55 0 20 25 increased the mTBS of SEB in both regions, but its effect
20 s 35 25 5 35 was more pronounced with SEB+DCA, leading to a
UBQ 10 s 65 0 10 25
significant increase in mTBS in the apical region. The
20 s 45 5 5 45
SEB+DCA (20 seconds) group exhibited the highest
A, Adhesive failure; CD, Cohesive failure within dentin; CR, Cohesive failure within resin
core; DCA, Clearfil DC Activator; M, Mixed failure; PBU, Prime&Bond Universal; s,
mTBS among SEB groups in both regions, indicating a
Seconds; SCA, Self Cure Activator; SEB, Clearfil SE Bond 2; UBQ, Universal Bond Quick combined effect of the DCA addition and extended
ER. light-irradiation time on the mTBS of SEB. Presumably,
the addition of DCA promoted the light-activated
root canal dentin. Hence, the first null hypothesis was polymerization of SEB.
rejected. The effect of extended light-irradiation time was In the case of PBU, the apical mTBS was significantly
significant according to the repeated measures ANOVA, increased with SCA. SCA contains tetraphenylborate
but the 3-way ANOVA for SEB and PBU indicated that (TPB) salts, which are derivatives of aryl borate salts. The
the extension significantly affected the bond strengths reaction between the TPB ion and the proton from acidic
only in the apical region. Therefore, the second null hy- monomer produces triphenyl boron, which later de-
pothesis was partially rejected. composes to a phenyl free radical that initiates chemical
UBQ is a type of 1-SEA that contains a touch- polymerization.25 This mechanism is similar to that of
polymerization activator. Consequently, it can poly- DCA, which contains aryl sulfinic acid sodium salt. How-
merize chemically when used in combination with a ever, in contrast with DCA, the combination of SCA with
specific chemical initiator in a dual-polymerizing resin extended light-irradiation time did not further increase the
core material such as in Clearfil DC Core Automix ONE. mTBS of PBU. The phosphine oxide photoinitiator in SCA
The mTBS of UBQ in the apical region was lower than could produce more free radicals, thus enabling optimal
that in the coronal region, irrespective of light-irradiation polymerization even at a shorter light-irradiation time.
time. The lower bond strengths in the apical region may Therefore, touch-polymerization activators may affect the
be attributed to insufficient solvent evaporation from the mTBS of light-activated adhesives not only by using an
1-SEA in the post cavity,21,23 resulting in the increased accelerator of chemical polymerization but also by incor-
incidence of adhesive failure because of the formation of porating an additional photoinitiator.
multiple voids in the adhesive layer in the apical region The 3-way ANOVA revealed no significant inter-
(Fig. 3). The extension of light-irradiation time improved action between adhesives, touch-polymerization ac-
the mTBS of UBQ significantly in the coronal region, tivators, and light-irradiation time in the coronal
indicating that chemical polymerization initiated solely region. Conversely, the interaction was significant in
by the touch-polymerization system may not fully replace the apical region, presumably because light energy
light-activation and that optimal polymerization is ob- was attenuated. Since no significant interaction was
tained if the 2 activation methods are combined, because observed between pairs of the factors, this indicated
additional radicals are formed by photoinitiators upon that the combined effect of touch-polymerization
light-irradiation.14 These results are consistent with those activators and extended light-irradiation time was
of previous reports on touch-polymerization systems15 dependent on the adhesive used: the apical mTBS of
and dual-activated materials.3,4,23 SEB was improved but that of PBU was not.

THE JOURNAL OF PROSTHETIC DENTISTRY Dwiandhany et al

- 2020 7

Figure 3. Representative scanning electron microscope images of adhesive and/or mixed failures in coronal and apical regions of post cavities. Original
magnification ×500. A, PBU coronal region. B, PBU apical region. C, PBU+SCA coronal region. D, PBU+SCA apical region. E, SEB coronal region. F, SEB
apical region.

Presumably, the photoinitiator-containing SCA did CONCLUSIONS

not require the increased light energy provided by
Based on the findings of this in vitro study, the following
the extended light-irradiation time to achieve optimal
conclusions were drawn:
light-activated polymerization of PBU+SCA. Further
research is required to study the effect of the pho- 1. The bond strength of light-activated adhesives to
toinitiator concentration in touch-polymerization ac- root canal dentin may be improved by extending the
tivators on bond strength to root canal dentin, light-irradiation time and adding a touch-
especially in deeper regions of the post cavity. polymerization activator.

Dwiandhany et al THE JOURNAL OF PROSTHETIC DENTISTRY

8 Volume
Figure 3. (Continued) G, SEB+DCA coronal region. H, SEB+DCA apical region. I, UBQ coronal region. J, UBQ apical region. DCA, Clearfil DC Activator;
PBU, Prime&Bond Universal; SCA, Self Cure Activator; SEB, Clearfil SE Bond 2; UBQ, Universal Bond Quick ER.
2. Their effect may be additive, especially in the apical
region, but it depends on whether the touch-
polymerization activator contains an additional
photoinitiator.
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Corresponding author:
Dr Masatoshi Nakajima
Department of Cariology and Operative Dentistry
Graduate School of Medical and Dental Sciences
Tokyo Medical and Dental University
1-5-45 Yushima Bunkyo-Ku, Tokyo 113-8549
JAPAN
Email: nakajima.ope@tmd.ac.jp
CRediT authorship contribution statement
Wahyuni S. Dwiandhany: Conceptualization, Methodology, Investigation,
Writing - original draft. Ahmed Abdou: Methodology, Investigation, Formal
analysis, Writing - review & editing. Antonin Tichy: Methodology, Writing -
review & editing. Kazuhide Yonekura: Methodology, Investigation. Masaomi
Ikeda: Validation, Writing - review & editing. Keiichi Hosaka: Conceptualiza-
tion, Resources. Junji Tagami: Conceptualization, Resources, Supervision.
Masatoshi Nakajima: Conceptualization, Methodology, Resources, Writing -
review & editing, Supervision.
Copyright © 2020 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2020.11.021
THE JOURNAL OF PROSTHETIC DENTISTRY