Gunaydin Z, Yazici A R, Cehreli Z C
Oper Dent. 2016 May-Jun;41(3):258-67. doi: 10.2341/14-231-C. Epub 2016 Feb 26.
This study evaluated the effect of 2% chlorhexidine (CHX) pretreatment of dentin on the immediate and aged microtensile bond strength (μTBS) of different adhesives to dentin in vivo and in vitro. Class I cavities were prepared in 80 caries-free human third molars of 40 patients in a split-mouth fashion. In each tooth pair, one tooth received 2% CHX pretreatment after which both teeth were randomly assigned to one of the following groups with respect to the type of adhesive system applied: Adper Single Bond 2 (etch-and-rinse), Clearfil SE Bond (two-step self-etch), Clearfil S(3) Bond (one-step self-etch), and Adper Prompt-L-Pop (all-in-one self-etch). The teeth were restored with resin composite and extracted for μTBS testing either immediately or after six months in function. In vitro specimen pairs were prepared as with the clinical protocol in intact, freshly extracted human molars, and thereafter, subjected to testing immediately or after 5000× thermocycling. Data were analyzed with four-way analysis of variance (ANOVA). Bonferroni test was utilized for pair-wise comparisons. The immediate bond strength values were significantly higher than "aged" ones for all tested adhesives (p=0.00). The in vitro immediate bond strength values were statistically higher than in vivo bond strength values (p<0.05). While the bond strength of in vitro aged, CHX-treated samples were higher than their in vivo counterparts (p<0.05), no difference was observed in non-CHX treated groups (p>0.05). In the absence of CHX pretreatment, all adhesives showed significantly higher immediate bond strength values than CHX-treated groups, while all "aged", non-pretreated adhesives exhibited significantly lower bond strength values (both p<0.05). By contrast, chlorhexidine pretreatment resulted in significantly higher aged bond strengths, regardless of the adhesive system and testing condition. Aging-associated decline in dentin bond strength of etch-and rinse and self-etch adhesives can be counteracted by chlorhexidine application.
本研究评估了2%氯己定（CHX）预处理牙本质对不同黏结剂在体内和体外与牙本质的即时和老化微拉伸黏结强度（μTBS）的影响。采用双盲法在40例患者的80颗无龋人类第三磨牙上制备I类洞。在每对牙齿中，一颗牙齿接受2% CHX预处理，之后根据所应用的黏结剂系统类型，将两颗牙齿随机分配到以下组中：Adper Single Bond 2（酸蚀冲洗型）、Clearfil SE Bond（两步自酸蚀型）、Clearfil S(3) Bond（一步自酸蚀型）和Adper Prompt-L-Pop（通用自酸蚀型）。用树脂复合材料修复牙齿，并在功能状态下立即或6个月后拔除进行μTBS测试。体外样本对按照临床方案在完整的新鲜拔除的人类磨牙上制备，然后立即或在5000次热循环后进行测试。数据采用四因素方差分析（ANOVA）进行分析。采用Bonferroni检验进行两两比较。所有测试黏结剂的即时黏结强度值均显著高于“老化”后的数值（p = 0.00）。体外即时黏结强度值在统计学上高于体内黏结强度值（p < 0.05）。虽然体外老化的CHX处理样本的黏结强度高于其体内对应样本（p < 0.05），但在未用CHX处理的组中未观察到差异（p > 0.05）。在没有CHX预处理的情况下，所有黏结剂的即时黏结强度值均显著高于CHX处理组，而所有“老化”的未预处理黏结剂的黏结强度值均显著较低（p均< 0.05）。相比之下，无论黏结剂系统和测试条件如何，氯己定预处理均导致显著更高的老化黏结强度。应用氯己定可抵消酸蚀冲洗型和自酸蚀型黏结剂与牙本质黏结强度的老化相关下降。
