Shirani Farzaneh, Malekipour Mohammad Reza, Azary Maryam, Manesh Vahid Sakhaei, Gilani Amirali, Mazdak Ali
Department of Operative Dentistry, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Operative Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
Dent Res J (Isfahan). 2025 Jan 24;22:1. doi: 10.4103/drj.drj_118_23. eCollection 2025.
During tooth preparation, the clinician may face a hard remineralized enamel surrounding the cavity with unknown effects on the enamel bond strength. This study aims to assess the effect of remineralizing pretreatments with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or CPP-amorphous calcium fluoride phosphate (CPP-ACFP) on the bond strength of composite resin and sound or demineralized enamel.
This study employed an experimental factorial design. A total of 144 enamel surfaces were prepared and randomly divided into 12 groups (G1-G12). The surfaces of G7-12 were demineralized to create a lesion (L), while G1-6 were assigned to the sound (S) enamel group. The three pretreatment protocols were CPP-ACFP, CPP-ACP, or no pretreatment for a 10-day pH-cycling period. A composite rod was bonded to the surfaces using a self-etch or total-etch bonding system. Shear force was applied, and the bond strengths of the specimens were measured. The data were analyzed using the Kruskal-Wallis test, followed by pairwise comparisons using Dunn's test. The significance level for all tests was set at 0.05.
The sound (S) groups (33.81 ± 8.48) showed a significantly higher bond strength than the lesion (L) groups (25.77 ± 6.69). Among the pretreatments, CPP-ACFP-pretreated groups had the highest bond strength (33.86 ± 8.87). Pairwise comparisons showed significant differences between CPP-ACFP-treated demineralized enamel and control demineralized enamel in both bonding systems ( = 0.019 and = 0.025 for Clearfil SE and Optibond FL, respectively).
Pretreatment of demineralized enamel with CPP-ACFP before using total-etch and self-etch systems results in a bond strength comparable to that of sound enamel, making it clinically acceptable.
在牙体预备过程中，临床医生可能会遇到龋洞周围有坚硬的再矿化牙釉质，其对牙釉质粘结强度的影响尚不清楚。本研究旨在评估用酪蛋白磷酸肽 - 无定形磷酸钙（CPP - ACP）或酪蛋白磷酸肽 - 无定形氟化磷酸钙（CPP - ACFP）进行再矿化预处理对复合树脂与完好或脱矿牙釉质粘结强度的影响。
本研究采用实验析因设计。共制备144个牙釉质表面，并随机分为12组（G1 - G12）。G7 - 12组的表面进行脱矿以形成病变（L），而G1 - 6组被分配到完好（S）牙釉质组。三种预处理方案为CPP - ACFP、CPP - ACP或不进行预处理，为期10天的pH循环周期。使用自酸蚀或全酸蚀粘结系统将复合树脂棒粘结到表面。施加剪切力，并测量样本的粘结强度。数据采用Kruskal - Wallis检验进行分析，随后使用Dunn检验进行两两比较。所有检验的显著性水平设定为0.05。
完好（S）组（33.81±8.48）的粘结强度显著高于病变（L）组（25.77±6.69）。在预处理中，CPP - ACFP预处理组的粘结强度最高（33.86±8.87）。两两比较显示，在两种粘结系统中，CPP - ACFP处理的脱矿牙釉质与对照脱矿牙釉质之间存在显著差异（Clearfil SE和Optibond FL分别为 = 0.019和 = 0.025）。
在使用全酸蚀和自酸蚀系统之前，用CPP - ACFP对脱矿牙釉质进行预处理可使粘结强度与完好牙釉质相当，使其在临床上可以接受。
