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ORIGINAL ARTICLE
Year : 2018  |  Volume : 21  |  Issue : 3  |  Page : 280-286

The effect of endodontic irrigants on the microtensile bond strength of different dentin adhesives


1 Department of Restorative Dentistry, Istanbul Medipol University Faculty of Dentistry, Istanbul, Turkey
2 Department of Restorative Dentistry, Istanbul University Faculty of Dentistry, Istanbul, Turkey

Date of Acceptance29-Nov-2017
Date of Web Publication09-Mar-2018

Correspondence Address:
Dr. B Dikmen
Medipol Mega University Hospital, TEM Avrupa Otoyolu Goztepe Cikisi, Number: 1, 34214 Bagcilar-Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_282_17

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   Abstract 


Objectives: The aim of this study was to determine the influence of irrigants on bond strength of adhesive systems. Materials and Methods: Superficial dentin surfaces of 60 extracted molars were divided into 15 groups, according to irrigants and adhesives. In the control groups, surfaces were irrigated with distilled water. In experimental groups, sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA) + NaOCl, chlorhexidine (CHX), and NaOCl + sodium ascorbate were used as irrigants. Resin composites were then built up using Single Bond, Clearfil SE Bond, and Xeno 3 as adhesives. The microtensile bond strength of groups was determined. Data were statistically analyzed by two-way analysis of variance (ANOVA), one-way ANOVA, and the Bonferroni test. Results: NaOCl reduced bond strength of Single Bond and Clearfil SE Bond (P < 0.01). For all adhesive systems, EDTA + NaOCl-treated groups exhibited lower bond strength than control groups (P < 0.01). CHX decreased bond strength of Single Bond (P < 0.01). Application of sodium ascorbate improved compromised bond strength to NaOCl-treated dentin (P < 0.01). Conclusion: Different irrigants had several effects on bonding of different adhesives. Sodium ascorbate after NaOCl could restore compromised bond strengths.

Keywords: Adhesive, antioxidant, composite, irrigation, microtensile bond strength


How to cite this article:
Dikmen B, Tarim B. The effect of endodontic irrigants on the microtensile bond strength of different dentin adhesives. Niger J Clin Pract 2018;21:280-6

How to cite this URL:
Dikmen B, Tarim B. The effect of endodontic irrigants on the microtensile bond strength of different dentin adhesives. Niger J Clin Pract [serial online] 2018 [cited 2022 Nov 29];21:280-6. Available from: https://www.njcponline.com/text.asp?2018/21/3/280/226961




   Introduction Top


Coronal restoration of endodontically treated teeth can significantly affect their longevity.[1],[2] The main purposes of restoring root-filled teeth are to avoid marginal leakage, increase the resistance of the remaining tooth structure, and reestablish functionality and esthetics.[3] When the remaining tooth structure is sufficient, root-filled teeth should preferably be restored with resin composites because the composites have the capacity to bond with dentin, increase resistance of the remaining tooth structure, and reduce marginal leakage.[4]

Effective cleaning and shaping of the root canal can significantly affect the success of endodontic treatment, and irrigation is the best method to remove tissue remnants.[5] Sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), and chlorhexidine (CHX) have been widely used as irrigants during instrumentation. NaOCl causes lubrication, disinfection, tissue dissolution, dentin dehydration, and organic component removal.[6] Gomes et al.[7] found that Enterococcus faecalis, the most resistant microorganism in the root canal, can be eliminated following a 30 s irrigation with 5.25% NaOCl. EDTA results in demineralization and provides excellent cleaning of the canal walls. The combination of EDTA and NaOCl is generally used during instrumentation because the organic and inorganic portions of dentin can be removed at the same time.[3] Many studies confirm that irrigation with 17% EDTA for 1 min was effective in the removal of smear layer.[8],[9] CHX has antimicrobial activity and no toxic effects. Five to ten minutes treatment with 2% CHX aqueous solution has been suggested as an irrigant.[7],[10],[11] The chemical composition of the dentin surface can be altered by these endodontic irrigants. Thus, the interaction of dentin with materials that are used for restoration can also be affected.[12],[13] Since coronal dentin is also infected after the endodontic irrigation of the root dentin, bonding of adhesive systems to coronal dentin can be compromised too.

Many studies show that NaOCl negatively affects the bonding of adhesives because remnants of this solution negatively impact the polymerization of resin monomers.[6],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24] However, the application of an antioxidant agent before bonding can increase the compromised bonding to NaOCl-treated dentin.[14],[19],[25],[26],[27] There are various reports in the literature regarding the effect of CHX solution on the bond strength of adhesives.[6],[12],[22],[24],[28],[29],[30],[31],[32] While some of them reported the negative effect of the solution,[6],[22],[28] others do not.[12],[28],[29],[30],[31],[32] There are consequently some studies in the literature which investigate the results of the adhesive systems after treatment of dentin surface with EDTA and NaOCl.[3],[6],[12],[16],[33],[34],[35],[36] Researchers usually tested in one study the adhesion of composite materials to the dentin of endodontically irrigated teeth using one type of adhesive system.[3],[6],[12],[14],[18],[20],[22],[23],[29],[32],[34],[37],[38] Thus, the comparison between different types of adhesive systems against different irrigants application is not clear.

The purpose of this in vitro study was to determine the influence of endodontic irrigants on the microtensile bond strength (μTBS) of two-step total etch, two-step self-etch, and one-step self-etch adhesive systems to dentin surfaces and evaluate the effect of antioxidants on the bond strength of these adhesive systems on NaOCl-treated dentin. The tested hypotheses were that (1) endodontic irrigants have negative effects on the bond strength of all adhesives used in the study and (2) the use of sodium ascorbate can improve the compromised bond strength of adhesives to NaOCl-treated dentin.


   Materials and Methods Top


Informed consent was approved by an institutional review board in the Istanbul University, The Institute of Medical Sciences. Sixty intact human third molars were used in this study. Teeth are examined under ×20 stereomicroscope magnification (SZ61 microscope; Olympus, Munster, Germany) to exclude those with fracture lines, wear, and decay. The teeth were collected after receiving detailed verbal and written information about the study and stored in 0.5% chloramine solution for 1 week for disinfection. The teeth were then cleaned of debris and stored in distilled water until use.

To expose flat dentin surfaces, all teeth were sectioned 3 mm below the occlusal surface using a low-speed diamond saw (IsoMet – Buehler, Düsseldorf, Germany). The surfaces were ground with #600 grit silicon carbide paper (IsoMet – Buehler, Düsseldorf, Germany) under running water to create a standardized smear layer. The specimens were randomly divided into five main groups. In Group 1 (i.e., the control group), distilled water was applied for 30 s. In Group 2, 5.25% NaOCl (Chloraxid, Cerkamed, Rudnik nad Sanem, Poland) was applied to the dentin surface for 30 s. In Group 3, 5.25% NaOCl was applied as described for Group 2; this was followed by a 10-min rinse with 10% sodium ascorbate. In Group 4, 17% EDTA (SoftPrep, Spident, Incheon, Korea) was applied for 1-min followed by the application of 5.25% NaOCl for 30 s. In Group 5, 2% CHX (Troy Co, Inc., Michigan, USA) was applied for 5 min. After pretreatment with irrigation solutions, all dentin surfaces were rinsed with distilled water for 30 s. Each group was then divided into three subgroups (n = 5): (1) two-step total etch adhesive subgroup (Adper Single Bond 2, 3M ESPE, St. Paul, MN, USA); (2) two-step self-etch adhesive subgroup (Clearfil SE Bond, Kuraray Medical, Tokyo, Japan); and (3) one-step self-etch adhesive subgroup (Xeno 3, Dentsply, DeTrey, Konstanz, Germany). These were applied in accordance with the manufacturer's instructions. In all groups, the composite build up was produced with the Filtek Z250 (3M ESPE, St. Paul, MN, USA) using an incremental technique to a height of 5 mm. [Table 1] lists the adhesive systems that were used in the study.
Table 1: Adhesives used in the study

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After storage in distilled water for 24 h, the teeth were placed in a sectioning machine (IsoMet 1000 precision saw; Buehler, Düsseldorf, Germany) and sectioned occlusogingivally into serial cross-sections approximately 1-mm-thick using a low-speed diamond saw (IsoMet – Buehler, Düsseldorf, Germany). These cross-sections were placed again in the machine to create serial sticks with a 1-mm2 cross-sectional area. A total of 7–11 sticks were obtained from each tooth. Each stick was fixed in a metallic device with a cyanoacrylate adhesive (Zapit; Dental Ventures of America Inc., Anaheim, CA, USA). The metal device was placed in a universal testing machine (BİSCO Inc., Schaumburg, IL, USA). The sticks were subjected to the μTBS test at a crosshead speed of 0.5 mm/min until fracture. At the moment of fracture, the values were recorded in megapascals (MPa).

After the μTBS test, the fractured specimens in each group were examined under a stereomicroscope (SZ61 microscope; Olympus, Munster, Germany) at ×30 magnification to determine the failure modes. Failures were classified into three categories: adhesive/mix, cohesive in resin, and cohesive in dentin. Authors were blinded to the materials while performing the microtensile test. All statistical analyses were performed using SPSS version 15.0 for Windows (SPSS, Inc, Chicago, IL). The Kolmogorov–Smirnov test was used to assess for a normal data distribution. The mean bond strength data were statistically analyzed by two-way analysis of variance (ANOVA) and one-way ANOVA. Multiple comparisons were performed by the Bonferroni test. Any samples that failed during processing were excluded from the statistical analysis. Failure mode distributions were compared using Chi-square test. The level of statistical significance was set at P < 0.05.


   Results Top


According to the Kolmogorov–Smirnov test, the data were normally distributed. [Table 2] presents the mean μTBS values and standard deviations of each group. For the distilled water groups, there was no significant difference between Adper Single Bond 2 (3M ESPE) and Clearfil SE Bond (Kuraray Medical Medical) (P > 0.05), but the bond strength of Xeno 3 (Dentsply) was lower than that of Adper Single Bond 2 (3M ESPE) and Clearfil SE Bond (Kuraray Medical) (P< 0.01). Pretreatment by NaOCl significantly reduced the μTBS of Adper Single Bond 2 and Clearfil SE Bond (P< 0.01). There was no significant effect of NaOCl pretreatment on the μTBS of Xeno 3 (P > 0.05). For all adhesive systems, the EDTA + NaOCl-treated groups exhibited significantly lower bond strength than the control groups (P< 0.01). Irrigation with CHX had no significant effect on the μTBS of the self-etch adhesives (i.e., Clearfil SE Bond and Xeno 3) (P > 0.05) but significantly decreased the bond strength of the total etch adhesive (i.e., Adper Single Bond 2; P < 0.01). Application of sodium ascorbate significantly improved the compromised μTBS of Adper Single Bond 2 and Clearfil SE Bond to NaOCl-treated dentin (P< 0.01). However, the μTBS was significantly lower in the NaOCl + sodium ascorbate group than in the control groups for Adper Single Bond 2 and Clearfil SE Bond (P< 0.01). In the groups that were applied NaOCl and the groups that were applied EDTA + NaOCl, the bond strength values of Clearfil SE Bond were significantly higher than the values of Adper Single Bond 2 and Xeno 3 (P< 0.01); however, there was no significant difference between Adper Single Bond 2 and Xeno 3 (P > 0.05).
Table 2: The mean microtensile bond strength values and standard deviations of each group

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[Figure 1] lists the distribution of the failure modes, based on stereomicroscopic observation. In all groups, the failure modes were primarily adhesive/mix failure. There was no statistical difference between failure modes of different solution groups when Adper Single Bond 2, Clearfil SE Bond, and Xeno 3 were used as adhesive agent (P > 0.05). There was no statistical difference between failure modes of different adhesive groups when distilled water, NaOCl, EDTA + NaOCl, CHX, and NaOCl + sodium ascorbate were used as irrigant solution (P > 0.05).
Figure 1: Percentage of failure modes in each group

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   Discussion Top


Some researchers have reported that a bonding delay of 1 week following the application of the endodontic treatment provides time for adverse effects of irrigant to dissipate.[35],[39] However, this delay is not always possible in clinical settings. Sometimes, we should do the restoration of teeth immediately after endodontic treatment. Therefore, we immediately did adhesive procedures in the experimental protocol.

In the μTBS test, specimens are generally prepared in three geometries; hourglass, stick, and dumbbell.[40] In fact, hourglass-shaped specimen better concentrates stress at the interface. However, trimming microspecimens to hourglass-shaped specimens should be carried out carefully since the interface can fail at a lower bond strength as a result of interfacial defect occurred during trimming.[41] Therefore, for reduced crack origination, an equipment specially designed for notch formation should be utilized instead of manually trimming. Due to lack of this equipment, some laboratories have suggested using “nontrimming” preparation technique.[42],[40] Consequently, we selected using unnotched sticks in the present study. Moreover, as explained in our previous article, to avoid increasing the standard deviations, pretest failures were not included as zero values in the statistical analysis.[43]

According to the various results obtained from different irrigants, the tested hypothesis that all endodontic irrigants have negative effects on the bond strength of all adhesives should be rejected. In the present study, NaOCl pretreatment significantly reduced the μTBS of Adper Single Bond 2 and Clearfil SE Bond. The reason for this situation may be because of NaOCl-induced damage to the organic matrix of dentin and oxidation in the dentin. As a result of oxidation, reactive-free radicals are produced in the NaOCl-treated dentin. These radicals compete with the propagation of vinyl-free radicals that are produced by the polymerization of the adhesives. Thus, the polymerization of the resin adhesives cannot be completed.[6],[12],[14],[21],[23],[37] However, according to the our results, there was no significant effect of NaOCl pretreatment on the μTBS of Xeno 3. This may be because of the specificity of different adhesive systems to the oxidizing effect of NaOCl.[16]

Some studies have found that applying antioxidant agents after NaOCl increases the bonding of the adhesives to dentin.[14],[19],[20],[23],[27],[34],[37] In this study, the application of sodium ascorbate to NaOCl-treated dentin significantly increased the bond strength of Adper Single Bond 2 and Clearfil SE Bond. The tested hypothesis that using sodium ascorbate can improve compromised bond strength of adhesives to NaOCl-treated dentin was accepted. However, for Xeno 3, there was no significant difference between the NaOCl + sodium ascorbate group and the NaOCl group because NaOCl application had no effect on bonding of Xeno 3.

For all adhesive systems in our study, the EDTA + NaOCl-treated groups exhibited significantly lower bond strength, compared to the control groups. This result is in agreement with many previous studies.[6],[12],[35],[36] Wattanawongpitak et al.[35] demonstrated in their study that erosion occurred on the dentin after applying both EDTA and NaOCl. In addition to this erosion, the oxidizing effect of NaOCl could decrease the bond strength of different adhesive systems.

On the other hand, Yurdagüven et al.[36] reported that the bond strength of the adhesives (e.g., Clearfil SE Bond by Kuraray Medical of Tokyo, Japan, and XP Bond by Dentsply, Ballaigues, Switzerland) after the application of NaOCl + EDTA (47.2 ± 19.2 MPa and 35.7 ± 20.6 MPa, respectively) was not significantly lower than that of the control groups (55.5 ± 15.4 MPa and 43.5 ± 14.8 MPa, respectively). However, based on the numerical values in the study by Yurdagüven et al., the bond strength of the NaOCl + EDTA groups was lower than that of the control groups.[36]

Some studies claim that CHX does not affect the interaction of the resin systems to dentin because it is a nonoxidizing agent.[12],[29],[30],[38],[44] The present results that were obtained with self-etch adhesives also confirm these findings. However, in the present study, irrigation with CHX significantly decreased the bond strength of the total etch adhesive (i.e., Adper Single Bond 2 [3M ESPE]). When dentin surfaces are irrigated with a solution, the products of the irrigants diffuse into the dentinal tubules. After etching dentin with phosphoric acid, dentinal fluid flows out because of increased permeability. Therefore, chemical irrigants that remain in the fluid arrive to the dentin surface, and the penetration of adhesives into dentin can be affected negatively.[15] This situation may cause the lower bond strength of the CHX-treated teeth in the Single Bond groups. However, some previous studies demonstrated that CHX does not adversely affect the bond strength values to dentin.[24],[30],[32] The common point of these studies is the short application time of the solution. In our study, the solution was applied for 5 min, which is much longer than in these previous studies, in which CHX is used as cavity disinfectant.

For all irrigation solutions, the Clearfil SE Bond groups exhibited higher bond strength than the other adhesive groups. The chemical interaction caused by MDP monomer (10-methacryloyloxydecyl dihydrogen phosphate) can explain this higher bonding efficacy. Thus, Clearfil SE Bond was least affected by endodontic irrigation solutions.

Adhesive/mix failures comprised the majority of failures modes in all groups. Microtensile tests lead to better stress dispersion over small surfaces than conventional bond strength tests. Thus, failures mainly occur in the adhesive.[45] Actually, cohesive failures do not not reveal the real bond strength value; they reflect material properties.[42] These failures can form with microtensile test due to faults in the arrangement of the specimen along the long axis of the equipment.[45]

The limitation of this in vitro study is that the relationship between μTBS and the clinical success of the adhesives is dubious.[46],[47] However; microtensile tests are ideal tests in evaluating the effect of experimental variables.[42] Armstrong et al.[48] reported that the microtensile test is promising due to its versatility and significant potential for in vivo applicability.


   Conclusion Top


Within the limitations of this study, irrigation with NaOCl significantly reduced the μTBS of Single Bond (3M ESPE) and Clearfil SE Bond (Kuraray Medical) adhesives, compared to the control groups. The use of 10% sodium ascorbate after treating dentin with NaOCl significantly improved the bond strength of these adhesives. The application of CHX has no significant effect on the μTBS of self-etch adhesives (Clearfil SE Bond [Kuraray Medical]) and Xeno 3 [Dentsply]) but significantly decreased the bond strength of the total etch adhesive (Single Bond). For all adhesive systems, the EDTA + NaOCl-treated groups exhibited a significantly lower bond strength than the control groups. Therefore, while clinically restoring endodontically treated teeth, these impacts should be considered and appropriate restoration materials should be chosen.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2]



 

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