ABSTRACT
Objective: The aim of this study was to test the null hypothesis that different surface conditioning (etch and rinse and selfetch)
and curing techniques(light cure/dual cure) had no effect on the shear bond strength of direct and indirect composite inlays.
Materials and Methods: Atotal of 112 extracted human molar teeth were horizontally sectioned and randomly divided into
two groups according to restoration technique(direct and indirect restorations). Each group was further subdivided into seven
subgroups(n=8) according to bonding agent(etch and rinse adhesives Scotchbond multipurpose plus, AllBond 3, Adper Single
Bond and Prime Bond NT; and selfetch adhesives Clearfil Liner Bond, Futurabond DC and G bond). Indirect composites were
cemented to dentin surfaces using dualcuring luting cement. Shear bond strength of specimens was tested using a Universal
Testing Machine. Two samples from each subgroup were evaluated under Scanning electron microscopy to see the failing modes.
Data was analyzed using independent sample ttests and Tukeys tests. Results: Surface conditioning and curing of bonding agents
were all found to have significant effects on shear bond strength(P<0.05) of both direct and indirect composite inlays. With
direct restoration, etch and rinse systems and dualcured bonding agents yielded higher bond strengths than indirect restoration,
selfetch systems and lightcured bonding agents. Conclusions: The results of the present study indicated that direct restoration
to be a more reliable method than indirect restoration. Although etch and rinse bonding systems showed higher shear bond
strength to dentin than selfetch systems, both systems can be safely used for the adhesion of direct as well as indirect restorations.
INTRODUCTION
Direct restoration is the most commonly used technique
for both anterior and posterior teeth.[1] However,
with direct restoration, excessive polymerization
shrinkage increases the stress at the compositetooth
interface and can compromise the integrity of the
bond.[2] In large posterior cavities, especially in those
with cervical margins located in dentin, excessive
shrinkage can produce marginal defects and gaps[3]
that promote microleakage and result in marginal
discoloration, postoperative sensitivity, secondary
caries and pulpal irritation.[4] When some mistakes in
How to cite this article: Zorba YO, Ilday NO, Bayindir YZ, Demirbuga S. Comparing the shear bond strength of direct and indirect composite inlays in
relation to different surface conditioning and curing techniques. Eur J Dent 2013;7:436-41.
Copyright 2013 Dental Investigations Society.
436
DOI: 10.4103/1305-7456.120679
Surface conditioning
techniques
Curing
mode
Manufacturer
Code
SBMP
AB 3
Adper SB
PBNT
Clearfil LB 2 V
Lightcure
Dualcure
Lightcure
Dualcure
Dualcure
SBMP
AB
SB
PBNT
LB
Futurabond DC
GB
Selfetch
Selfetch
Dualcure
Lightcured
DC
GB
SBMP: Scotch bond multipurpose plus, AB: Allbond, SB: Single bond, PBNT: Prime bond NT, LB: Liner bond, DC: Dualcure, GB: Gbond
437
a1
a2
b1
b2
c1
c2
RESULTS
Mean shear bond strengths by restoration
technique, surface conditioning and curing of
bonding agents are given in Table 2. According
to ttest, direct restorations were found to have
significantly higher shear bond strengths than
indirect restorations(P<0.05); etch and rinse surface
conditioning resulted in significantly higher shear
bond strengths than selfetching (P < 0.05); and
dualcured bonding agents resulted in significantly
higher shear bond strengths than lightcured
bonding agents(P<0.05).
Mean values of shear bond strength and standard
deviations by restoration technique and bonding
agent are given in Table3. Mean values ranged from
a high of 26.506.05 MPa (direct restoration/PBNT)
to a low of 16.964.09 MPa (direct restoration/GB).
European Journal of Dentistry, Vol 7 / Issue 4 / Oct-Dec 2013
Table2: Shear bond strength values(mean and standard deviation) of composite resin restorations by
restoration technique, surface conditioning and curing of bonding agent
Restoration technique
Shear bond strength(MPa)
Surface conditioning
Direct
Indirect
Selfetch
Lightcure
Dualcure
23.474.80a
21.234.83b
23.354.63a
21.035.04b
21.084.76a
23.304.87b
The superscript letters represent significant differences in values for techniques. MPa: Megapascal
Restoration techniques
Direct
Indirect
26.322.2318a
24.962.55abc
22.904.11abcde
26.506.05a
23.072.40abcde
23.644.70abcde
16.94.09e
22.932.53abcde
19.291.87cde
19.344.85bcde
24.545.58abcd
18.311.75cde
26.155.59ab
18.073.41de
DISCUSSION
According to the findings of this study, the null
hypothesis stating that the shear bond strength
of composite resins is not affected by restoration
preparation technique, surface conditioning or curing
of the bonding agent must be rejected.
Adhesive dentistry involves the physical bonding of
restorative materials to dental substrates in order to
return esthetics and functioning to previously damaged
teeth. Since the introduction of acidetching into the
field of dentistry,[16] various adhesive methods have
been developed to bond composites to tooth structure.
Given the importance of bond strength between the
adhesive system and the dentin surface,[9] this subject
continues to remain a topic of extensive research.
Studies have shown that indirect composite
restorations, introduced in the 1990s, exhibit better
clinical performance than direct restorations in terms
of proximal contact, occlusal anatomy and marginal
adaptation.[17,18] With indirect restorations, except for
a thin layer of highflow composite resin (socalled
resin cement) used to lute the restoration to the tooth
surface, all technical processing of the restoration,
including polymerization, is performed externally.[19]
However, it is still possible for polymerization stress
to occur during the curing of the resin cement, causing
a disruption between the restoration and the cavity
walls that will subsequently lead to marginal leakage,
particularly if the margins are located in dentin.[20,21]
Douglas et al. [20] concluded that the indirect
method of placement of composite restorations
offers considerable improvement in microleakage
performance, particularly on the dentinrestorative
interface. However, our finding that direct restoration
produces higher shear bond strengths than indirect
restoration is in conflict with Douglas etal., given that
microleakage is directly related to the strength of the
bond between the dentin surface and the adhesive
system/resin cement.
In clinical practice, indirect restorations are usually
applied in large cavities. Thus, the clinical life of
439
Table4: Failure modes of bonding agents for direct and indirect restorations
Bonding
agents
SBMP
AB 3
Adper SB
PB NT
Clearfil LB 2 V
Futurabond DC
GB
Direct
Indirect
Adhesive
Cohesive
Mixed
Adhesive
Cohesive
Mixed
6
7
6
7
6
8
7
2
1
2
1
2
5
5
6
5
5
6
7
2
3
2
2
3
1
1
No statistically significant differences were observed among the groups. SBMP: Scotch bond multipurpose plus, AB: Allbond, SB: Single bond, PBNT: Prime bond
NT, LB: Liner bond, DC: Dualcure, GB: Gbond
CONCLUSIONS
REFERENCES
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