Hikita K, Van Meerbeek B, De Munck J, Ikeda T, Van Landuyt K, Maida T, Lambrechts P, Peumans M
Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium.
Dent Mater. 2007 Jan;23(1):71-80. doi: 10.1016/j.dental.2005.12.002. Epub 2006 Jan 19.
The bonding effectiveness of five adhesive luting agents to enamel and dentin using different application procedures was determined using a micro-tensile bond strength protocol (microTBS).
Enamel/dentin surfaces of human third molars were flattened using a high-speed diamond bur. Composite resin blocks (Paradigm, 3M ESPE) were luted using either Linkmax (LM; GC), Nexus 2 (NX; Kerr), Panavia F (PN; Kuraray), RelyX Unicem (UN; 3M ESPE) or Variolink II (VL; Ivoclar-Vivadent), strictly following manufacturers' instructions. For some luting agents, modified application procedures were also tested, resulting in four other experimental groups: Prompt L-Pop+RelyX Unicem (PLP+UN; 3M ESPE), Scotchbond Etchant+RelyX Unicem (SE+UN; 3M ESPE), Optibond Solo Plus Activator+Nexus 2 (ACT+NX; Kerr) and K-Etchant gel+Panavia-F (KE+P; Kuraray). The experimental groups were classified according to the adhesive approach in self-adhesive (UN), etch-and-rinse (ACT+NX, NX, KE+P, SE+UN and VL when bonded to enamel) and self-etch adhesive luting agents (LM, PLP+UN, PN and VL when bonded to dentin). The specimens were stored for 24h in distilled water at 37 degrees C prior to microTBS testing. The Kruskal-Wallis test was used to determine pairwise statistical differences (p<0.05) in microTBS between the experimental groups.
When bonded to enamel, ACT+NX (15 MPa) and UN (19.6 MPa) scored significantly lower than VL (49.3 MPa), LM (49.2 MPa), PN (35.4 MPa) and SE+UN (35.2 MPa), while PLP+UN (23.5 MPa) showed a significantly lower microTBS than VL (49.3 MPa) and LM (49.2 MPa). No significant differences were noticed between VL (49.3 MPa), LM (49.2 MPa), NX (37.9 MPa), KE+PN (38.8 MPa), PN (35.4 MPa) and SE+UN (35.2 MPa). Regarding the bonding effectiveness to dentin, all luting agents bonded equally effectively (UN: 15.9 MPa; LM: 15.4 MPa; PN: 17.5 MPa; NX: 22.3 MPa), except VL (1.1 MPa), SE+UN (5.9 MPa) and ACT+NX (13.2 MPa). VL revealed an exceptionally high number of pre-testing failures, most likely due to a combined effect of not having cured the adhesive separately and an insufficiently light-cured luting agent.
Following a correct application procedure, the etch-and-rinse, self-etch and self-adhesive luting agents are equally effective in bonding to enamel and dentin. Several factors negatively influenced bond strength such as bonding RelyX Unicem to enamel without prior phosphoric acid etching; no separate light-curing of a light-polymerizable adhesive prior to cementation, use of a light-polymerizing adhesive converted into a dual-polymerizing adhesive, and use of a dual-cure luting agent with a low auto-polymerizable potential.
采用微拉伸粘结强度试验方法（microTBS），测定五种粘结性粘固剂在不同应用程序下对釉质和牙本质的粘结效果。
使用高速金刚石车针将人第三磨牙的釉质/牙本质表面磨平。按照制造商的说明，分别使用Linkmax（LM；GC公司）、Nexus 2（NX；登士柏公司）、Panavia F（PN；可乐丽公司）、RelyX Unicem（UN；3M ESPE公司）或Variolink II（VL；义获嘉伟瓦登特公司）将复合树脂块（Paradigm，3M ESPE公司）粘结起来。对于一些粘固剂，还测试了改良的应用程序，从而形成了另外四个实验组：Prompt L-Pop+RelyX Unicem（PLP+UN；3M ESPE公司）、Scotchbond蚀刻剂+RelyX Unicem（SE+UN；3M ESPE公司）、Optibond Solo Plus活化剂+Nexus 2（ACT+NX；登士柏公司）和K-蚀刻凝胶+Panavia-F（KE+P；可乐丽公司）。根据粘结方式，将实验组分为自粘结（UN）、酸蚀冲洗粘结（ACT+NX、NX、KE+P、SE+UN以及粘结到釉质时的VL）和自酸蚀粘结性粘固剂（LM、PLP+UN、PN以及粘结到牙本质时的VL）。在进行microTBS测试之前，将标本在37℃的蒸馏水中储存24小时。使用Kruskal-Wallis检验来确定实验组之间microTBS的两两统计差异（p<0.05）。
当粘结到釉质时，ACT+NX（15MPa）和UN（19.6MPa）的得分显著低于VL（49.3MPa）、LM（49.2MPa）、PN（35.4MPa）和SE+UN（35.2MPa），而PLP+UN（23.5MPa）的微拉伸粘结强度显著低于VL（49.3MPa）和LM（49.2MPa）。在VL（49.3MPa）、LM（49.2MPa）、NX（37.9MPa）、KE+PN（38.8MPa）、PN（35.4MPa）和SE+UN（35.2MPa）之间未发现显著差异。关于对牙本质的粘结效果，除了VL（1.1MPa）、SE+UN（5.9MPa）和ACT+NX（13.2MPa）外，所有粘固剂的粘结效果相同（UN：15.9MPa；LM：15.4MPa；PN：17.5MPa；NX：22.3MPa）。VL在预测试中出现了异常高的失败率，最可能的原因是未单独固化粘结剂以及光固化粘固剂的光固化不足共同作用的结果。
按照正确的应用程序，酸蚀冲洗粘结、自酸蚀和自粘结性粘固剂在粘结到釉质和牙本质方面同样有效。有几个因素对粘结强度产生了负面影响，例如在没有预先磷酸蚀刻的情况下将RelyX Unicem粘结到釉质上；在粘结前未对光固化粘结剂进行单独光固化、使用转化为双重聚合粘结剂的光聚合粘结剂以及使用自动聚合潜力低的双重固化粘固剂。
