Juliana Carvalho Jacomine, DDS, MS, Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
Marina Ciccone Giacomini, DDS, MS, PhD, Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil, and University Centre Integrated Faculties of Ourinhos, Ourinhos, SP, Brazil.
Oper Dent. 2023 Mar 1;48(2):196-206. doi: 10.2341/21-142-L.
Since the use of dentin antiproteolytic agents with universal adhesives (UAs) can potentially degrade the bonding interface, this study evaluated bond strengths with and without chlorhexidine (CHX) on variously altered dentin surfaces for up to 20 months.
Human molar specimens (n=20) were categorized by substrates as S=sound, E=eroded, and C=carious, and by pretreatment as W=water or CHX. These specimens were subjected to micro-tensile bond strength (μTBS) testing at 24 hours, 6 months, and 20 months, after 30 seconds of pretreatment with CHX or W, followed by self-etching and bonding (Adper Single Bond Universal, 3M ESPE). Modes of failure were assessed using optical microscopy (40×) and scanning electron microscopy (SEM), and the results were analyzed by 3-way ANOVA and Tukey's statistical tests (α=0.05).
Substrate (p<0.001), pre-treatment (p=0.0413), and time (p<0.0001) were statistically significant. The sound-dentin group in initial time (W=39.27/CHX=40.55) yielded the higher μTBS values (MPa) in comparison with altered substrates pre-treated with CHX (E-CHX=19.84; C-CHX=18.24) after 20 months, which showed the lowest values. Under SEM analysis, heterogeneous patterns appeared in the hybrid layer of the CHX-treated group, particularly in the altered substrates.
Bond strength to dentin decreased over a period of 20 months using UA with 10-methacryloyloxydecyl-dihydrogen phosphate (MDP) in self-etching mode. Substrates altered by erosion or caries have impaired adhesion and associated clinical use of UA with MDP and CHX should be avoided.
由于通用粘结剂（UAs）中使用牙本质抗蛋白水解剂可能会降解粘结界面，因此本研究评估了在不同处理的牙本质表面上使用和不使用洗必泰（CHX）的粘结强度，最长可达 20 个月。
将人类磨牙标本（n=20）根据基底分为 S=正常、E=酸蚀、C=龋坏，并根据预处理分为 W=水或 CHX。这些标本在预处理 30 秒后，用 CHX 或 W 处理 24 小时、6 个月和 20 个月，然后进行微拉伸粘结强度（μTBS）测试，采用自酸蚀和粘结（Adper Single Bond Universal，3M ESPE）。使用光学显微镜（40×）和扫描电子显微镜（SEM）评估失效模式，并通过 3 因素方差分析和 Tukey 统计检验（α=0.05）分析结果。
基底（p<0.001）、预处理（p=0.0413）和时间（p<0.0001）具有统计学意义。与用 CHX 预处理的改变基底（E-CHX=19.84；C-CHX=18.24）相比，初始时间（W=39.27/CHX=40.55）的正常牙本质组产生更高的 μTBS 值（MPa），20 个月后，改变基底的组显示出最低值。在 SEM 分析中，CHX 处理组的混合层出现不均匀模式，特别是在改变的基底中。
在自酸蚀模式下，使用含 10-甲基丙烯酰氧癸基二氢磷酸（MDP）的 UAs 20 个月后，牙本质粘结强度下降。被酸蚀或龋坏改变的基底的粘结性能受损，因此应避免使用含 MDP 和 CHX 的 UAs。
