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Original article
Operative Dentistry Department, Dental Faculty, Shiraz University of Medical Sciences, Shiraz, Iran
Pediatric Dentistry Department, Dental Faculty, Shiraz University of Medical Sciences, Shiraz, Iran
Received 20 October 2009; received in revised form 24 December 2009; accepted 28 January 2010
Available online 11 March 2010
Abstract
Purpose: The purpose of this study was to investigate the effect of chlorhexidine [CH] on dentin bond strength of three resin cements after 1 year
of water storage.
Methods: A flat middle dentin surface was prepared on 120 extracted premolars. The teeth were randomly divided into 6 groups of 20 specimens each
according to the resin cement used: Panavia F2.0, Variolink II, and RelyX Unicem, with or without CH application. After cementation of an indirect
composite rod [Z250], one subgroup [n = 10] was tested after 24 h in water at 37 8C and the other subgroup [n = 10] was tested after 1 year storage in
water plus thermocycling. A shear bond strength [SBS] test was performed. The data [in MPa] were analyzed with ANOVA and Tukey tests [P < 0.05].
Results: Three-way ANOVA [resin cement, CH and time] indicated that Variolink II had the highest strength [16.65 3.60] and RelyX Unicem
had the lowest strength [9.30 4.07]. Chlorhexidine application increased SBS [13.31 4.61] compared to samples without CH [12.16 5.04]
[P = 0.04]. Initial SBS [15.63 4.37] was significantly higher than after 1 year of storage [9.85 3.36] [P < 0.001]. Separate two-way ANOVA
for 24-h and 1-year data showed that cement had a significant effect but CH and its interaction had no significant effect at 24 h, whereas at 1 year the
two factors and their interaction differed significantly [P 0.001].
Conclusions: Chlorhexidine 2% can diminish the loss of bonding effectiveness over time associated to etch-and-rinse and self-etch cements,
although it appears not have any effect on self-adhesive cement.
# 2010 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
Keywords: Shear bond strength; Chlorhexidine; Resin cements
1. Introduction
Despite some advantages of indirect composite restorations
compared to direct composite [1], durable bonding of these
restorations to dentin is still a problem. Resin cements together
with adhesive systems are used to bond indirect restorations to
the tooth structure. These adhesives include both etch and rinse
or self-etch materials [2,3]. To reduce technique sensitivity and
simplify handling, self-adhesive cements were introduced in
2002, eliminating the need for pretreatment for both the tooth
and the restoration [4]. RelyX Unicem1 self-adhesive resin
cement is based on newly developed multifunctional phosphoric acid methacrylates that can react with the basic fillers in
the resin cement and the hydroxyapatite of the tooth [3]. During
* Corresponding author. Tel.: +98 711 6263193 4; fax: +98 711 6270325.
E-mail address: memarpour@sums.ac.ir (M. Memarpour).
1883-1958/$ see front matter # 2010 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
doi:10.1016/j.jpor.2010.01.005
154
Table 1
Resin cement systems used and their application procedures.
Resin cement/
manufacturer
Adhesive system/
category
Component/bath#
Dentin pretreatment
Composite pretreatment
Panavia F2.0
ED primer II
one-step
self-etch
ED primer A 00252
ED primer B 00129
No pretreatment
No pretreatment
Kuraray Inc.,
Tokyo, Japan
Variolink II
155
Table 2
Shear bond strength [Mean SD], to dentin of three resin cements after 24 h
and 1 year.
Resin cement
Mean SD (MPa)
24 h
One year
15.30 1.94
15.00 2.16
19.40 2.22
18.40 3.06
13.00 2.40
12.70 1.94
7.20 1.61
11.60 1.71
12.40 2.01
16.40 2.45
5.70 1.49
5.80 1.98
Fig. 1. Box plot of dentin shear bond strength of different resin cements in the
12 experimental groups after 24 h and 1 year.
156
[3050%] and two other hydrophilic monomers [MDP,5NMSA] in its composition. Water would react with HEMA to
form a hydrogel in the hybrid layer [42]. The presence of
HEMA can compromise the mechanical properties of the
polymers [43].
Water sorption caused a remarkable reduction in the elastic
modulus of the resins. This plasticizing of the resin may
contribute to the decrease in bond strength independently of
resin hydrolysis [40]. Earlier studies reported degradation of the
resindentin bond with ED Primer II after 1 year of storage [44]
and high permeability of the adhesive layer with Excite DSC
[45].
In the current study, RelyX Unicem was used without any
adhesive system. This cement contains a high concentration of
hydrophilic acidic monomers. This hydrophilicity can lead to
water uptake which can in turn result in swelling and
plasticizing of the resin cement [46]. The extent and rate of
water uptake depend on the formulation and density of the
polymer network and the potential for hydrogen bonding and
polar interactions [47,48]. During the storage period, the
storage water was changed daily to prevent bacterial growth as
was also done in the study by Kitasako at al. [24]. Daily changes
of the water might weaken the resindentin interface and might
be a way to accelerate the testing of long-term bond strength
[24].
In attempt to prevent hydrolytic degradation of collagen
matrices in aged dentinresin bonds, application of CH as an
MMP inhibitor during bonding procedures was suggested
[15,16]. Mild acids such as those found in simplified etch-andrinse and self-etch adhesives may activate MMPs [41,49,50].
These MMPs can reach the exposed collagen fibers at the base
of the hybrid layer in etch-and-rinse adhesive following
incomplete resin penetration within demineralized dentin
[36,38]. Incomplete resin impregnation was also observed
for self-etch adhesives, with the result that naked collagen in the
hybrid layer was affected by activated MMPs [51]. With
Panavia F 2.0 a self-etching primer (ED Primer II) is used
without any bonding resin; the relatively high-viscosity cement
acts as a bonding resin. Therefore, the presence of unprotected
collagen fibers is possible.
Because of these considerations, in the current study the
application of CH could diminish but not completely prevent
the loss of bond strength of etch-and-rinse cement (Variolink II)
and self-etch cement [Panavia F2.0] after 1 year. The decreased
bond strength in groups with CH was related to resin
hydrolysis.
The beneficial effect of CH on the bonding integrity of etchand-rinse adhesives such as Single Bond was reported
previously [5254]. In a study by Campos and others [55],
the preservative effect of CH 2% on bond strength of etch-andrinse and self-etch adhesives was reported during a 6-month
aging period. In the current study, CH had no effect on bonding
durability of RelyX Unicem. This cement was used on the
smear layer-covered dentin directly without any adhesive, and
its interaction with the dentin surface was very superficial.
Therefore, exposure of collagen and MMP activation in the
dentin may be not possible. Thus, the second part of the null
157
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