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The conventional three-step adhesive system is composed of an etchant, a primer, and a bonding resin. Japanese manufacturers focused on simplifying the etching and priming procedures, resulting in a one-step process referred to as "self-etching". Currently, a universal adhesive system and a universal-shade composite are trending. Morphological changes at the interface of the bonded specimens following an artificial acid-base challenge have been observed under SEM and TEM. A new layer is created beneath the hybrid layer, which is referred to as the "acid-base resistant zone (ABRZ)". With the increasing number of older adults and better teeth retention in the elderly population, the prevention and treatment of root caries are becoming increasingly important. 38% silver diamine fluoride (SDF, Saforide) contains high concentrations of silver and fluoride ions, which is very effective in preventing the progression of root dentin caries. However, the discoloration of the tooth structure is a drawback. It was reported that light exposure and demineralization of dentin accelerated its discoloration. From the evaluation of S. mutans biofilm accumulation on dentin surfaces, application of 38% SDF was the most effective to decrease the amount of biofilm attached to the dentin surface. In addition, 38% SDF has the potential to be used as a root caries indicator. From the clinical assessment, the SDF induced discoloration of the root caries lesions and provided an anti-inflammatory effect on the gingiva around the teeth affected by root caries. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of different etching products used prior to the application of universal self-etching adhesive on dentin bonding. Materials and Methods: The etching products Multi Etchant (ME), Enamel Conditioner (EC), and K-etchant GEL (KE) were used as pre-treatments prior to the application of the one-bottle self-etching adhesive Adhese Universal (AU). Ground human dentin surfaces were randomly divided into four treatment groups: 1. control (CT; AU without conditioner); 2. ME; 3. EC; 4. KE. Microtensile bond strength (μTBS) tests with a thermocycling challenge (0-TC or 10,000-TC) were carried out and the morphological attributes of the adhesive-dentin interface were observed after an acid-base challenge using SEM to observe the acid-base resistant zone (ABRZ). Results: The KE group had a statistically significantly lower μTBS than did the ME and EC groups at 0-TC, and than the CT, ME, and EC groups at 10,000-TC (p < 0.05). An ABRZ was observed in all groups but had partially disappeared in KE. A funnel-shaped area of erosion was also observed at the junction of the dentin and bonding layer in the CT, ME, and EC groups, while the hybrid layer was thicker in the KE group with no evidence of erosion. Conclusion: The application of ME or EC did not reduce the microtensile bond strength and resulted in ABRZ formation, while the ABRZ was partially reduced in the KE group. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the acid-base resistant zone (ABRZ) at the adhesive/enamel interface of self-etching adhesives with or without prior phosphoric acid etching. Materials and Methods: Four adhesives were used in 8 groups: Clearfil SE Bond (SEB), Optibond XTR (XTR), Scotchbond Universal Adhesive (SBU), and Clearfil BOND SE ONE (ONE) without prior phosphoric-acid etching, and each adhesive with phosphoric acid etching for 10 s (P-SEB, P-XTR, P-SBU and P-ONE, respectively). After application of self-etching adhesives on ground enamel surfaces of human teeth, a flowable composite was placed. For observation of the acid-base resistant zone (ABRZ), the bonded interface was exposed to demineralizing solution (pH 4.5) for 4.5 h, followed by 5% NaOCl with ultrasonication for 20 min. After the acid-base challenge, morphological attributes of the interface were observed using SEM. Results: ABRZ formation was confirmed in all groups. The funnel-shaped erosion beneath the interface was present in SBU and ONE, where nearly 10 to 15 μm of enamel was dissolved. With phosphoric acid etching, the ABRZs were obviously thicker compared with no phosphoric acid etching. Conclusion: Enamel beneath the bonding interface was more susceptible to acid dissolution in SBU and ONE. In the case of the one-bottle self-etching adhesives and universal adhesives that intrinsically have higher pH values, enamel etching should be recommended to improve the interfacial quality. [ABSTRACT FROM AUTHOR]

This article reviews the current concepts for operatively managing carious lesions extending into dentine with minimal removal of tooth structure and restoring with dentine adhesives and direct composite resin. It looks sequentially at the operative steps involved including remineralisation with bioactive cements, bonding to caries-affected dentine including smear-layer modification using HOCl, creation of an acid-base resistance zone,steps to optimise the performance of all-in-one adhesives, and incremental placement of direct composite resin to improve bond strengths to cavity floor dentine. It explores how understanding the phenomenon of colour-shifting at the composite resin-enamel/dentine restoration borders can help in creating near "invisible" restoration margins through a "chameleon" effect. With the increased risks of transmission of Covid-19 when aerosol generating procedures are carried out in Dentistry, following a minimally invasive approach to managing dental caries should be given serious consideration. [ABSTRACT FROM AUTHOR]

Self-etch adhesive (SEA) systems simplify bonding procedures. It is believed that good mechanical retention and chemical bonding are both important factors to obtain reliable bonding to enamel. The enamel acid-base resistant zone (ABRZ) has been confirmed at the adhesive/enamel interface by scanning electron microscopic observation. However, the formation of enamel ABRZ is influenced by the type and components of adhesive systems. Chemical interactions by a functional monomer with hydroxyapatite strongly support the explanation of the mechanism for enamel ABRZ formation. The ABRZ created by MDP-containing SEA systems has shown good potential to resist acid attack from simulated recurrent caries models. In addition, fluoride release may enhance acid resistance. It has been proposed that such a reinforced enamel be termed "Super Enamel". The concept of the formation of super enamel may contribute to protecting enamel, and conserve tooth structure leading to improved restoration longevity. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the tensile bond durability and ability of four MMA-based adhesive resins to prevent demineralization along the hybrid layer when exposed to a demineralizing solution. Materials and Methods: A PMMA rod was bonded to human dentin using one of four MMA-based adhesive systems: Super-Bond C&B (SB), SBP-40TX (SBP, experimental), M-Bond (MB), and M-Bond II (MB II). Bonded specimens were sectioned into 0.9 mm x 0.9 mm beams and subjected to microtensile bond strength (µTBS) testing after water storage at 37°C for 24 h or 10,000 thermal cycles. Data were analyzed with two-way ANOVA and Bonferroni's t-test. Fracture mode analysis of the bonding interface was performed using a scanning electron microscope (SEM) and statistically analysed using the chi-square test. To disclose the demineralization inhibition potential through formation of an acid-base resistant zone (ABRZ), the bonded interface was exposed to a demineralizing solution (pH 4.5) for 90 min, and then 5% NaOCl for 20 min. After argon-ion etching, the interfacial ultrastructure was observed using an SEM. Results: µTBS values without thermocycling were not significantly different (p > 0.05) among 4 adhesive resins. After thermocycling, a significant decrease in µTBS was found in MB and MB II (p < 0.001), whereas SB and SBP showed no significant change (p > 0.05). Failure modes were signiicantly different (p < 0.05). An ABRZ was seen in SBP, MB, and MB II, while this protective zone was absent in SB. Conclusion: Dentin bonding performance after thermocycling was material dependent in MMA-based adhesive resins. The ABRZ formation was only observed in the self-etching systems. [ABSTRACT FROM AUTHOR]

Summary: Dentin bonding systems have been dramatically simplified and improved during the recent decades. Monomer penetration into dentin and its polymerization in situ creates a hybrid layer, which is essential to obtain good bonding to dentin. Moreover, the presence of an acid–base resistant zone below the hybrid layer has been documented with self-etching adhesive systems in an artificial secondary caries attack. When ultrastructure of the acid–base resistant zone is assessed by SEM and TEM observations, formation of the acid–base resistant zone is considered to be due to the monomer penetration potential and fluoride release in the adhesive systems. Natural dentin has a limited potential to resist an acid attack of secondary caries; however, the acid–base resistant zone does not purely consist of dentin in morphology, it is rather a combination of dentin and the adjacent hybrid layer. Therefore, the reinforced dentin has been called “Super Dentin” bearing the ability to prevent primary and secondary caries. Prospectively, the great potential of adhesive technology in creation of the “Super Dentin” would lead to the development of new materials for mechanical, chemical and biological protection of the dental structures. [ABSTRACT FROM AUTHOR]